Seizure activity and neurological sequelae in Ugandan children who have survived an episode of cerebral malaria.
BACKGROUND
Seizures are a common presenting feature in children with cerebral malaria (CM) and neurologic deficits have been described in survivors of CM. However few prospective studies have described the frequency of seizure activity and neurologic deficits in survivors of CM over time.


METHODS
Eighty-two children aged 3 to 12 years who survived an episode of CM were followed up and monitored for seizure activity and neurologic deficits at discharge, 3, 6 and 24 months. Seventy six children with uncomplicated malaria (UM) and 105 healthy community controls (CC) age 3 to 12 years were recruited as comparison groups and the frequency of seizures in the 6 to 24 month follow-up period was compared in the 3 groups.


RESULTS
Cumulative incidence of seizures increased over time in children with CM, with a total of 2 of 76 children (2.6%) reporting seizures at 3 months, 3 of 74 children (4.1%) at 6 months and 11 of 68 children (16.2%) at 24 months (Chi square for trend = 9.36, P=0.002). In contrast, neurologic deficits almost completely resolved over time, occurring in 19 of 76 children with CM (25%) at discharge, 2 of 74 children (2.7%) at 6 months, and 1 of 68 (1.5%) children at 24 months.


CONCLUSIONS
During the 24 months following a CM episode, neurologic deficits resolve but the cumulative incidence of seizures increases in children with CM. Neurologic impairment after an episode of CM may not be limited to the neurologic deficits seen at discharge.
Opoka
Robert O
RO
Department of Paediatrics and Child Health, Mulago Hospital/Makerere University Medical School, Kampala, Uganda. opokabob@yahoo.com
Bangirana
Paul
P
Boivin
Michael J
MJ
John
Chandy C
CC
Byarugaba
Justus
J
D000704:Analysis of Variance; D016022:Case-Control Studies; D002493:Central Nervous System Diseases / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016779:Malaria, Cerebral / Q000150:complications*; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012640:Seizures / Q000150:complications*; D012959:Socioeconomic Factors; D016896:Treatment Outcome