Epileptic seizures and malaria in Kenyan children

Abstract

Between October 1990 and November 1991 data were collected on the frequency, causes, and nature of epileptic seizures in children admitted to the paediatric ward at Kilifi District Hospital, Kenya, from a defined study area. During this period, 1324 children were studied, of whom 15.8% had seizures as part of their illness. Malaria was by far the commonest cause of seizures, accounting for 69.0%; no other single condition caused more than 4.4%. The proportion of respiratory infections complicated by seizures was 4.0% compared to 31.3% for malaria. Only 25% of malaria-related epileptic seizures were associated with cerebral malaria; the remainder were associated with otherwise uncomplicated malaria and, in this group, 84% had complex seizures, with 47% being partial and over 70% repetitive. There was no relationship with fever, with 54% of observed seizures occurring at rectal temperatures below 38 degrees C. The minimum community incidence of complex seizures in association with non-cerebral malaria was 5.8 per 1000 per year. Complex epileptic seizures in association with otherwise uncomplicated malaria are common and may be a significant cause of longer term morbidity in malaria endemic areas.

Indicators of Acute Bacterial Meningitis in Children at a Rural Kenyan District Hospital

“…4,15 In a study of Nigerian infants who were Ͻ6 months, old, 41% of meningitis cases were reported to have a coexisting lower respiratory tract infection. 17 We therefore think that signs of lower respiratory tract infection should not bias clinicians against investigating and/or treating for meningitis when other indicators exist.…”

“…Importantly, at our center, this age range also encompasses almost all of the admissions with malaria, the most common cause of seizures. 17 The optimum management of "seizures with fever" has been the subject of considerable debate in resource-rich countries for many years. Establishing the prevalence of meningitis in children with uncomplicated febrile convulsions, without signs of more serious disease, has been an essential step in defining current practice.…”

Impact of Plasmodium falciparum malaria on performance and learning: review of the evidence

“…Seizures are a common feature of malarial disease, regardless of its severity. 25 They occur in up to 85% of admissions with a diagnosis of cerebral malaria, with about half of these having an episode of status epilepticus. 26 The probable origin of seizures associated with malaria fall into 3 basic categories: those that are febrile; those that are associated with the excitotoxic process related to the presence of parasites; and those that are related to hypoxia (Crawley J, unpublished data).…”

“…26 The probable origin of seizures associated with malaria fall into 3 basic categories: those that are febrile; those that are associated with the excitotoxic process related to the presence of parasites; and those that are related to hypoxia (Crawley J, unpublished data). 25,26 Uncomplicated febrile seizures will have a good prognosis. 27,28 However, as Ͼ 50% of seizures begin with low or normal temperatures, malaria appears to be specifically epileptogenic.…”

Risk of convulsive epilepsy following acute seizures in Kenyan children

“…The proportion of complex acute seizures is higher than that in developed countries (60% vs. 30%) and may have a role in development of epilepsy 14, 15. We conducted a study to determine the risk of epilepsy after acute seizures and the associated factors in children admitted to a rural Kenyan hospital.…”