Chloroquine is not a risk factor for seizures in childhood cerebral malaria

OBJECTIVES There are a number of case reports in the medical literature sug gesting an association between the ingestion of chloroquine and subsequent seizure activity. Our study was designed to investigate the relationship be tween blood levels of chloroquine (CQ), its metabolite desethylchloroquine (DCQ), and seizures in children admitted to hospital with cerebral malaria. METHODS Serial blood levels of CQ and DCQ were measured over the first 24 h of hospital admission in children with cerebral malaria. The number and du ration of all seizures was recorded, and statistical analysis subsequently performed to determine the relationship between seizure activity, and blood concentrations of CQ and DCQ. RESULTS Chloroquine was detected in 92% (100/109) of admission blood sample s. 54% (59/109) of the patients had one or more seizures after admission, w hile 8% (9/109) had an episode of status epilepticus. Median (interquartile range) baseline concentrations of CQ anti DCQ were, respectively, 169.4 mu g/ml (75.1-374.9) and 352.3 mug/ml (81.9-580.1) for those children who had seizures after admission, compared to CQ 227.5 mug/ml (79.4-430.2) and DCQ 364.0 mug/ml (131.3-709.4) for those who did not have seizures (P > 0.5 for all comparisons). Baseline concentrations of CQ and DCQ were nor significa ntly associated with the occurrence of seizures lasting for 5 min or more. The nine children who had run episode of status epilepticus had significant ly lower median admission levels of CQ than those without status epilepticu s: 75.1 mug/l (7.4-116.5) vs. 227.5 mug/l (85.6-441.2), P = 0.02. Multivari ate logistic regression analysis, taking into account factors likely to aff ect the risk of seizures in hospital, failed to change the significance of these results. CONCLUSIONS These findings suggest that chloroquine does not play an import ant role in the aetiology of seizures in childhood cerebral malaria.