Elizabeth Gram v. HHS - MMR, afebrile seizure disorder and epilepsy (2022)

On May 19, 2015, Elizabeth Gram filed a petition on behalf of her minor daughter, A.L.M., alleging that A.L.M. received DTaP, Hib, MMR, Pneumococcal conjugate (Prevnar 13), and Varicella vaccinations on October 25, 2012, and subsequently developed afebrile seizure disorder and epilepsy. The petition alleged that the vaccines caused A.L.M.'s condition.

The respondent, the Secretary of Health and Human Services, denied that the vaccines caused the alleged injury. An entitlement hearing was held on November 23, 2020.

Special Master Mindy Michaels Roth issued a decision on November 16, 2022, finding that the petitioner failed to prove by a preponderance of the evidence that the vaccinations caused A.L.M.'s condition. The Special Master concluded that the petitioner was not entitled to compensation.

Petitioner's experts, Dr. Marcel Kinsbourne and Dr.

Alan Levin, proposed a "two-hit" theory, suggesting that a pre-existing brain abnormality or trauma, combined with the vaccines, led to the seizures. They argued that cytokines released by the vaccines could cause seizures independently of fever.

Dr. Kinsbourne specifically focused on the MMR vaccine and proposed that it triggered a hyperexcitable neural network in the left temporal lobe through the release of IL-1 beta, leading to afebrile seizures.

Dr. Levin suggested that multiple traumas, including birth trauma and head trauma from falls, along with the 21 antigens in the vaccines, caused neuronal damage leading to seizures.

Respondent's experts, Dr. Gregory Holmes and Dr.

Christine McCusker, opined that there was no evidence that vaccines can cause afebrile seizures or epilepsy. They stated that A.L.M.'s condition was idiopathic epilepsy, meaning its cause was unknown, and that the seizures were likely coincidental or due to other factors unrelated to the vaccines.

Dr. Holmes specifically argued that vaccines can cause fever, which can provoke seizures, but that vaccines themselves do not cause afebrile seizures or epilepsy.

Dr. McCusker explained that while cytokines are involved in immune responses, the levels produced by vaccines are too low to affect the brain and cause seizures, and that fever, not the cytokines themselves, is the trigger for seizures in susceptible individuals.

The Special Master found the respondent's experts' opinions more persuasive. The Special Master noted inconsistencies in the petitioner's and her witnesses' accounts of the seizure onset timeline.

The Special Master concluded that the petitioner failed to satisfy the first prong of the Althen test, which requires a sound and reliable medical theory connecting the vaccine to the injury, as well as the second and third prongs related to a logical sequence of cause and effect and a proximate temporal relationship. Therefore, the petition was denied.