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. Al- though 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 cere- bral 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 pro- duce any new findings. Instead, we aim to present existing evidence for and against the possible involvement of the cen- tral 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 ma- laria. 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.