Epilepsy – a long term consequence of severe malaria

When calculating the burden of malaria, we often forget the longer term disabilities that persist after an acute episode. Specifically, Kariuki and co-researchers highlight that, “Falciparum malaria is an important cause of acute symptomatic seizures in children admitted to hospitals in sub-Saharan Africa, and these seizures are associated with neurological disabilities and epilepsy.”
In a new review in Neurology, Ngugi and colleagues report that …

“Our estimates suggest that the incidence of epilepsy in LMIC (low and middle income countries) is approximately twice that of HIC (high income countries) … The cause of the higher incidence in resource-poor compared to industrialized countries is likely to be multifactorial. The higher incidence of head trauma and of infections and infestations of the CNS (central nervous system) such as malaria, neurocysticercosis, and invasive bacterial infections may be important causes.”

dscn9102sm.jpgPreventing malaria or treating malaria in a very timely manner is a crucial step in reducing the long term burden of disease in individuals and countries. Kariuki et al. note a challenge: “… it is difficult to determine the proportion of seizures attributable to malaria in endemic areas since a significant proportion of asymptomatic children have malaria parasitaemia.”

Kenya has been experiencing some intense malaria intervention over recent years.  This provides a setting where researchers have gotten a handle on the potential reduction in the burden of long term CNS disease because of malaria control activities. Among the findings Kariuki et al. report are that, “From 2002 to 2008, the incidence of all acute symptomatic seizures decreased by … 69.2% with 93.1% of this decrease in malaria-associated seizures.”

Malaria itself imposes major immediate costs on a community from direct service payments and indirect loss of work and of course from loss of life. We should not forget the lingering costs of severe malaria may degrade the educational and occupational capacity and opportunities of community members, leaving such endemic communities mired in poverty. Clearly malaria elimination is an essential contribution to national development.

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