MALARIA: Cerebral malaria, common cause of epilepsy in children

 Sade Oguntola :  27 December 2010
Cerebral malaria, one of the deadliest forms of malaria, is a medical emergency demanding immediate diagnosis and treatment. Experts warn that malaria is best prevented, especially since its severe form is a potential cause of epilepsy in children, reports Sade Oguntola.
What is your impression of malaria? As a mother, do you see it as a deadly disease or one to be handled with levity? Do you belong to that group of mothers that do not bother to treat malaria in your child when you notice its symptoms?
Well, even if you do not bother that malaria could make your child miss some days at school, experts warn that it should concern you that it might turn out to be cerebral malaria, a severe form of the disease, whose aftermath, when not treated promptly, may be epilepsy.
Cerebral malaria is a severe or complicated form of malaria affecting the brain, occurring predominantly in children, with a mortality rate of 15-25 per cent. It affects about one million children every year, primarily in sub-Saharan Africa. Coma, headaches, seizures, and impaired consciousness are frequent manifestations of this infection.
Children less than five years of age are particularly susceptible because of low levels of immunity. It only takes one bite from an infected mosquito to contract the disease that directly affects the brain, causing fever, vomiting, chills, and coma.
In addition, children with cerebral malaria are at risk of developing several adverse neurological outcomes, including epilepsy, disruptive behavior disorders and disabilities characterised by motor, sensory or language deficits. Since most of the neurological effects did not present themselves immediately, they were not evident at the time of the child’s discharge from the hospital after the initial malaria illness.
A new study on cerebral malaria in African children reported that almost a third of cerebral malaria survivors developed epilepsy or other behavioral disorders.
The research, which appeared in journal, The Lancet Neurology, looked at several hundred children during a nearly five-year period in Blantyre, Malawi. The children were evaluated for cognitive function in three major areas: attention, working memory, and tactile learning. Evaluation was done at hospitalisation, six months after the initial malaria episode, and two years after the episode.
They found that at six months, 21 per cent of children with cerebral malaria had cognitive impairment compared with six per cent of their healthy Ugandan peers. At two years, cognitive impairment was present in 26 per cent of the patients, compared with 8 per cent of the community children.
The researchers involved in this first-ever prospective study of cerebral malaria survivors that included a control group suggested that cognitive impairment may begin to manifest itself months after the initial episode. In fact, cognitive function was most dramatically impaired in the area of attention.
The impact of the findings on African society is no doubt immeasurable. By extrapolation, they stated that about 135,000 African children younger than five years might have developed epilepsy due to cerebral malaria-induced brain injury each year, and cerebral malaria may be one of the more common causes of epilepsy in malaria-endemic regions.
Since these are children that had survived the malaria, but their quality of life and what they contribute to society is severely hampered, the experts declared the need to be more aggressive in treating the two major risk factors: seizures and high fever before better treatment for seizure and fever are identified in hopes of minimising the risk of epilepsy in years to come.
Previous studies had linked epilepsy to disruption of brain development during early childhood - roughly between the ages of one and five -because of the fragility of the brain during this period.
Nonetheless, Dr. Ikeoluwa Lagunju, a consultant paediatric neurologist, University College Hospital (UCH), Ibadan, Oyo State, declaring the importance of preventing malaria, stated that cerebral malaria was a severe form of malaria in which you have malaria parasite invading the brain.
Dr. Lagunju stated:“We see cases of cerebral malaria quite often, particularly during the rainy season. Transmission of malaria parasite is quite high during the rainy season and so you tend to have many cases of malaria and its severe forms during this season.”
According to her, “malaria parasite is usually found circulating in the blood stream and that is why you have fever, vomiting, chills and rigours. But in severe cases, these parasites would go through the blood to the brain and when you have a heavy load of malaria parasite in the brain, it is believed that it could block some blood vessels, cause swelling of the brain and some other abnormalities.
“When this happens, the child becomes unconscious, but afterwards, a number of them recover consciousness. But cerebral malaria is highly fatal and can kill rapidly, with poor management, when it is not recognised or involves someone who has not been in a malaria-endemic area.
However, Dr. Lagunju remarked that in those who survived cerebral malaria, the brain had been affected. “It is a form of injury to the brain. The brain is peculiar in the sense that it does not regenerate. You can injure your finger nail and then it grows back. You can have a wound and then you loss the skin and the skin grows back, but the brain is not like that,” she stated.
According to her, ‘If you have a child who has had cerebral malaria, he may recover from the illness, but then he may have problems with vision and hearing and few of them may later continue to have seizures and have what we call epilepsy.
“So, these are the things that we worry about with cerebral malaria and that is why prevention of malaria remains the best option.”
Certainly, nobody can tell which malaria will be severe enough to involve the brain. According to Dr. Lagunju, the best option is to prevent malaria through the use of insecticide-treated nets, ensure clean surroundings, maintain low lawns and clean drains, prevent stagnant waters and ensure a clean environment.
She reiterated the need for mothers to know how to treat malaria. “Gone are the days of: are you a doctor? Why did you then give anti-malarial medicines? We actually expected that mothers should have a pack of rapidly acting anti-malarial drug that they can readily administer as soon as they notice that the child is unwell. This will help to quickly clear the malaria parasite and reduce the risk of the child going on to develop severe forms of malaria.”
Professor Surajudeen Arigbabu, a consultant neurosurgeon at the Lagos University Teaching Hospital, reiterated that once the brain is injured, it cannot recover. According to him,” for any loss of a part of the brain or an injury, the effect is permanent and for that reason, if a person is diagnosed with cerebral malaria and there is a damage to any part of the brains later in life, that part of the brain that is damaged may become an epileptogenic focus and with resultant convulsions from time to time.”
http://tribune.com.ng/index.php/your-health/15291-cerebral-malaria-common-cause-of-epilepsy-in-children