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Year : 2000  |  Volume : 48  |  Issue : 1  |  Page : 90

Malaria in epileptics--an additional hazard.






How to cite this article:
Roy M, Gangopadhyay P K, Guha D, Roy T, Maiti B. Malaria in epileptics--an additional hazard. Neurol India 2000;48:90


How to cite this URL:
Roy M, Gangopadhyay P K, Guha D, Roy T, Maiti B. Malaria in epileptics--an additional hazard. Neurol India [serial online] 2000 [cited 2020 Dec 3];48:90. Available from: https://www.neurologyindia.com/text.asp?2000/48/1/90/1463



We would like to draw your kind attention to a new problem caused by malaria. It is well known that the entire population of India is under risk of malaria. Almost all deaths of malaria are caused by Plasmodium falciparum and an increase in falciparum affection has occurred in the past decade. Neurological manifestation is a well known complication of falciparum malaria. While cerebral form of severe falciparum malaria is the most common and important manifestation, presentations include coma, diffuse systemic encephalopathy, various focal neurological deficits, extra pyramidal disorders and psychiatric manifestations.[1] The cerebellar syndrome has been described as a late sequalae.[2],[3] Four cases of falciparum malaria with ataxia, but without any other cerebellar signs have also been reported.[4] On the other hand, it is well known that Mefloquin, an important antimalarial, used in chloroquine resistance cases, is relatively contra indicated in patients of seizure disorder for its epileptogenic potential. We would like to point out a new facet of neurological problem caused by falciparum malaria.
A 15 year unmarried, mildly retarded girl was diagnosed about 4 years back to have myoclonic epilepsy with cerebellar symptoms. She was being treated with sodium valproate 200 mgm, three times a day and clonazepam, 0.5 mgm twice a day. Her seizures were fairly controlled. In August 1997, she had an attack of falciparum malaria and was treated with quinine orally. She had an otherwise uneventful recovery without any alteration in biochemical parameters of glucose, urea, creatinine and electrolytes. Within three months she had another attack of fever and was treated with oral chloroquine emperically in her village. Since the first attack of falciparum malaria, the patient developed marked cerebellar symptoms and started having more frequent attacks of seizure, even on antiepileptic drugs in the dosages, which controlled her seizure before malarial attack.
In the pathogenesis of neurological manifestation of malaria, it is considered that the initial event is vasculopathy followed by brain oedema. Perivascular infiltrates, ring haemorrhages, perivascular demyelination and gliosis occur in the late stage. It is possible that an immune reaction may operate or post malarial activation of dormant neurotropic microorganisms may produce cerebellar damage.[8] Hyperpyrexia in itself also been blamed to cause degeneration in cerebellum. In the present case, cerebellar ataxia might have worsened because of metabolic stress due to malaria.
It is our clinical impression that patients with epilepsy often become decontrolled after cerebral malaria. Although there is no concrete data in the available literature, we would like to know from others experience. Whether they also have the experience of post malaria neurological syndrome or delayed cerebellar syndrome, which carries a poor prognosis in respect to seizure control. If this is true, it can be implied that epileptics may require special attention against malaria.
 

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1.Nanda N, Thakral S, Aggarwal HK: Neurology manifestations of malaria. J Assoc Physicians India 1997; 45: 65.   Back to cited text no. 1    
2.Senanayake N: Delayed cerebellar ataxia - A new complication of cerebral malaria. BMJ 1989; 294: 1253-1254.   Back to cited text no. 2    
3.Dhamiza RM, Banerjee AR: Cerebral malaria proceedings medical update, Army Hospital,Delhi Cantt . 1989; 22-24.   Back to cited text no. 3    
4.Mehta SR, Naidu G, Chandra V et al: Falciparum malaria Present day problem - an experience with 425 cases. J Assoc Physicians India 1989; 37(4): 264-267.   Back to cited text no. 4    
5.Mohani R, Agarwal S, Saifee A et al: Opsoclonus - Ataxia as an unusual presentation of Malaria. Neurol India 1991; 39: 39-40.   Back to cited text no. 5    

 

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