Electroencephalographic and clinical features of cerebral malaria

Background-Seizures are a prominent feature of childhood cerebral malaria, and are associated with an increased risk of death and neurological sequela e. We present the electroencephalographic (EEG) findings from a detailed cl inical and electrophysiological study. Methods-Children with cerebral malaria had EEGs recorded within six hours o f admission, and at 12 hourly intervals until recovery of consciousness. Te n deeply comatose children underwent intracranial pressure monitoring. Chil dren were not mechanically ventilated, which made it possible to directly c orrelate 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 m otor, 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 asso ciated with an abrupt rise in intracranial pressure. Fifty children recover ed fully, seven died, and eight had persistent neurological sequelae. Initi al EEG recordings of very slow frequency, or with background asymmetry, bur st suppression, or interictal discharges, were associated with an adverse o utcome. Conclusions-Serial EEG recording has uncovered a range of clinical, subtle, and electrographic seizures complicating childhood cerebral malaria, and h as 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.