Chapter 70 - Malaria

Summary

Plasmodium falciparum is the most severe form of malaria and is responsible for most of the neurological complications. The erythrocyte stages of P. falciparum are responsible for the acute symptoms and probably the development of epilepsy. The manifestations of severe P. falciparum malaria include coma, seizures, severe anemia, metabolic acidosis, and, in nonimmune individuals, renal impairment and pulmonary edema. Complex partial seizures are infrequently reported from the African children, but this may be caused by difficulties in describing the semiology in this patient group. Most patients who develop epilepsy following severe malaria respond to first-line antiepileptic drugs (AEDs), such as phenobarbital, phenytoin, and carbamazepine, used in resource-poor countries. The epilepsy following malaria is often associated with considerable comorbidity, particularly behavioral and neurocognitive impairment in children. The aminoquinolones, such as chloroquine and mefloquine, are contraindicated in patients with epilepsy, based upon a number of case reports.