EPILEPSY IN CEREBRAL MALARIA
Pietrangeli A., Morrone A.
Dermatological care for all “A basic human right”
Addis Abeba, November 1-4, 2006
Malaria is the most important of the parasitic diseases of humans. Plasmodium falciparum causes nearly all the deaths and neurological complications. Cerebral malaria (CM), is one of the most common non-traumatic encephalopathies in the world, with a mortality of 10 to 40%. In tropical areas it is the most frequent cause of seizures with fever. The histopathological finding of cerebral malaria is engorgement of cerebral capillaries and venules with parasitised red blood cells and
disruption of the blood-brain barrier. In acute malaria, multiple seizures precede acute encephalopathy in 50% of children. In central Africa the incidence rate was 17.0 per 1000 personyears in the CM group and 1.8 per 1000 person-year in the NCM group. During malaria, single seizures may simply result from fever and therefore consist of febrile seizures, but convulsions could also occur without fever in malaria. In addition status epilepticus may complicate CM and is often associated with severe neurological sequelae (prolonged and deep coma, spastic tetraparesis, vegetative states, cognitive difficulties, language and behavioural problems). Long-lasting focal seizures with fever could cause mesial temporal damage with hippocampal sclerosis and later epilepsy that usually begins in the second decade of life. Partial motor seizures may also occur.
Compared with adults, african children have a higher incidence of seizures (50%). Neurological sequelae are associated with protracted seizures, Management: complications of cerebral malaria, such as convulsions, hypoglycaemia, and hyperpyrexia, should be prevented or detected and treated early.
Phenobarbital is the most common drug but in high doses is associated with an increase in mortality. EEG may detect subclinical seizures. The pathogenesis of epilepsy is complex and multifactorial and hypoxia may be a precipitating factor.