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Electroencephalographic and clinical features of cerebral malaria

Electroencephalographic and clinical features of cerebral malaria
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 sequelae. We present the electroencephalographic (EEG) findings from a detailed clinical and electrophysiological study.
Methods—Children 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.
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 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.
Conclusions—Serial 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.
Cerebral malaria, Coma, Electroencephalogram, Seizures
0003-9888
247-253
Crawley, J.
59f9c041-b3a3-43ae-9010-1af4c9b3fe02
Smith, S.
5f1e1446-bd4e-4593-858a-299963de4404
Muthinji, P.
dc592d1b-3d24-45da-aedd-ccc033558d2b
Marsh, K.
b2950be1-6a47-4677-ad56-bcfa8849f860
Kirkham, F.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Crawley, J.
59f9c041-b3a3-43ae-9010-1af4c9b3fe02
Smith, S.
5f1e1446-bd4e-4593-858a-299963de4404
Muthinji, P.
dc592d1b-3d24-45da-aedd-ccc033558d2b
Marsh, K.
b2950be1-6a47-4677-ad56-bcfa8849f860
Kirkham, F.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58

Crawley, J., Smith, S., Muthinji, P., Marsh, K. and Kirkham, F. (2001) Electroencephalographic and clinical features of cerebral malaria. Archives of Disease in Childhood, 84 (3), 247-253. (doi:10.1136/adc.84.3.247).

Record type: Article

Abstract

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.
Methods—Children 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.
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 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.
Conclusions—Serial 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.

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More information

Published date: March 2001
Keywords: Cerebral malaria, Coma, Electroencephalogram, Seizures

Identifiers

Local EPrints ID: 429827
URI: https://eprints.soton.ac.uk/id/eprint/429827
ISSN: 0003-9888
PURE UUID: ca12d402-f849-4a18-a2ed-c1ab3ab74d77
ORCID for F. Kirkham: ORCID iD orcid.org/0000-0002-2443-7958

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Date deposited: 05 Apr 2019 16:30
Last modified: 17 Jul 2019 01:00

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Contributors

Author: J. Crawley
Author: S. Smith
Author: P. Muthinji
Author: K. Marsh
Author: F. Kirkham ORCID iD

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