Seizures in Severe Malaria: Is there Direct Brain Involvement?

ABSTRACT

Seizures are a frequent manifestation of severe malaria in children especially those less than 5 years of age. Although simple febrile seizures occur in young children of the same age group, for a long time it has not been established whether seizures following severe malaria in children of this age group are a consequence of febrile illness or due to cerebral involvement.

The possibility of determining whether these seizures are simply febrile or due to cerebral involvement is important for accuracy of diagnosis and case management; it forms the basis for making prognostic assessments and predicting future neurologic outcome as part of the burden of the disease in sub-Saharan Africa. The purpose of this review is not to produce any new findings. Instead, we aim to present existing evidence for and against the possible involvement of the central nervous system in seizures accompanying cerebral malaria. This review reveals that controversy still exists and the weight of evidence seems to be on the side of a direct neurologic involvement in patients with seizures from cerebral malaria. We conclude with a call for a heightened sense of awareness and the establishment of stringent treatment regimens in patients who present with malaria complicated by seizures.