Asymptomatic malaria parasitaemia and seizure control in children with nodding syndrome; a cross-sectional study. BMJ Open 2018 Oct 18;8(10):e023624
Date
10/21/2018Pubmed ID
30341136Pubmed Central ID
PMC6196862DOI
10.1136/bmjopen-2018-023624Scopus ID
2-s2.0-85055081278 (requires institutional sign-in at Scopus site) 9 CitationsAbstract
OBJECTIVE: Plasmodium falciparum is epileptogenic and in malaria endemic areas, is a leading cause of acute seizures. In these areas, asymptomatic infections are common but considered benign and so, are not treated. The effects of such infections on seizures in patients with epilepsy is unknown. This study examined the relationship between P. falciparum infection and seizure control in children with a unique epilepsy type, the nodding syndrome.
DESIGN: This cross-sectional study was nested in an ongoing trial 'Doxycycline for the treatment of nodding syndrome (NCT02850913)'. We hypothesised that, in patients with epilepsy, infection by P. falciparum, including asymptomatic infections, increases the risk of seizures and impairs seizure control.
SETTING AND PARTICIPANTS: Participants were Ugandan children with nodding syndrome, age ≥8 years, receiving sodium valproate. All had standardised testing including documentation of the number of seizures in the past month, a rapid malaria test and if positive, the peripheral blood parasite density.
OUTCOMES: The primary outcome was the number of seizures in the past month (30 days).
RESULTS: A total of 164/240 (68%) had malaria. Asymptomatic infections (without fever) were seen in 160/240 (67%) and symptomatic infections in 4/240 (2.7%). In participants without malaria, the median (IQR) number of seizures in the past month was 2.0 (1.0-4.0) and it was 4.0 (2.0-7.5) in participants with malaria, p=0.017. The number of seizures in asymptomatic persons was 3.0 (IQR 2.0-7.3) and 6.0 (IQR 4.0-10.0) in symptomatic individuals, p=0.024. Additionally, in asymptomatic patients, a positive correlation was observed between the parasite density and number of seizures, r=0.33, p=0.002.
CONCLUSION: In patients with nodding syndrome, both asymptomatic and symptomatic malaria are associated with an increased risk of seizures and poorer seizure control. Similar effects should be examined in other epilepsy disorders. Malaria prevention should be strengthened for these patients and chemotreatment and prevention studies considered to improve seizure control.
Author List
Ogwang R, Anguzu R, Akun P, Ningwa A, Kayongo E, Marsh K, Newton CRJC, Idro RAuthor
Ronald Anguzu MD, PhD Assistant Professor in the Institute for Health and Equity department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAnticonvulsants
Antiparasitic Agents
Child
Cross-Sectional Studies
Doxycycline
Female
Humans
Malaria, Falciparum
Male
Nodding Syndrome
Seizures
Uganda
Valproic Acid
