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Electroencephalographic and clinical features of cerebral malaria
J Crawley1, S Smith, P Muthinji
1KEMRI Centre for Geographic Medicine Research (Coast), Kilifi, Kenya. jane.crawley@ndm.ox.ac.uk
Insights
Seizures are common in childhood cerebral malaria, impacting coma and outcomes. Electroencephalography (EEG) revealed seizure origins and their link to adverse results, highlighting the need for better seizure management.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Clinical Electrophysiology
Background:
- Seizures are a significant complication of childhood cerebral malaria.
- These seizures increase the risk of mortality and long-term neurological deficits.
- This study details electroencephalographic (EEG) findings in affected children.
Purpose of the Study:
- To characterize the electroencephalographic (EEG) patterns of seizures in children with cerebral malaria.
- To correlate EEG findings with clinical presentation, intracranial pressure, and patient outcomes.
- To understand the role of seizures in the pathogenesis of coma in cerebral malaria.
Main Methods:
- Electroencephalography (EEG) was performed on children with cerebral malaria within six hours of admission and monitored periodically.
- Intracranial pressure was monitored in deeply comatous children.
- Clinical and EEG data were correlated due to the absence of mechanical ventilation.
Main Results:
- 40 out of 65 children experienced seizures, with 18 having status epilepticus.
- Seizure activity predominantly originated from the posterior temporo-parietal region.
- Subtle or electrographic seizures occurred in 15 children and were linked to increased intracranial pressure.
- Adverse outcomes were associated with initial EEGs showing very slow frequencies, background asymmetry, burst suppression, or interictal discharges.
Conclusions:
- Serial EEG recordings identified diverse seizure types (clinical, subtle, electrographic) in childhood cerebral malaria.
- These seizures are crucial in the development of coma.
- Further research is needed to optimize seizure prophylaxis and treatment to improve patient outcomes.
Background:
Seizures are a prominent feature of childhood cerebral malaria, and are associated with an increased risk of death and neurological sequelae. We present the electroencephalographic (EEG) findings from a detailed clinical and electrophysiological study.
Methods:
Children with cerebral malaria had EEGs recorded within six hours of admission, and at 12 hourly intervals until recovery of consciousness. Ten deeply comatose children underwent intracranial pressure monitoring. Children were not mechanically ventilated, which made it possible to directly correlate the clinical and EEG findings.
Results:
Of 65 children aged 9 months and above, 40 had one or more seizures, and 18 had an episode of status epilepticus. Most seizures were partial motor, and spike wave activity consistently arose from the posterior temporo-parietal region, a border zone area lying between territories supplied by the carotid and vertebrobasilar circulations. Fifteen children had seizures that were clinically subtle or electrographic. Clinical seizures were associated with an abrupt rise in intracranial pressure. Fifty children recovered fully, seven died, and eight had persistent neurological sequelae. Initial EEG recordings of very slow frequency, or with background asymmetry, burst suppression, or interictal discharges, were associated with an adverse outcome.
Conclusions:
Serial EEG recording has uncovered a range of clinical, subtle, and electrographic seizures complicating childhood cerebral malaria, and has emphasised their importance in the pathogenesis of coma. Further work is required to determine the most appropriate regimen for the prophylaxis and treatment of seizures in cerebral malaria, in order to improve outcome.