Article
Electroencephalographic and clinical features of cerebral malaria
J Crawleya, S Smithb, P Muthinjic, K Marsha, F Kirkhamd
a KEMRI Centre for
Geographic Medicine Research (Coast), Kilifi, Kenya, b Institute of Neurology, London,
UK, c EEG Department, Kenyatta
National Hospital, Nairobi, Kenya, d Institute
of Child Health, London, UK
Correspondence to: Dr J Crawley, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Level 7, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK jane.crawley{at}ndm.ox.ac.uk
Accepted 9 October
2000
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.
METHODSChildren 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.
RESULTSOf 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.
CONCLUSIONSSerial 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.
Keywords: cerebral malaria; coma; seizures; electroencephalogram
© 2001 by Archives of Disease in Childhood
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Arch. Dis. Child. 2001 84: 0.[Extract] [Full Text] [PDF]
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