Fits are dramatic events. They frighten onlookers, particularly parents. Recurrent fits, epilepsy, have profound and broad implications for the sufferer and their family: they not only interfere with everyday activities, but also social functioning, and job prospects. Furthermore in some parts of Africa, epilepsy and convulsions are often thought to be caused by supernatural forces. Seizures are common in malaria endemic areas, particularly in sub-Saharan Africa.

In some areas, over 20% of children admitted to hospital have a history of convulsions and the incidence of epilepsy in Africa is higher than many other parts of the world. But is there any link between these common conditions? Would control of malaria prevent seizures in Africa?

Febrile seizures (characterised by fever) are the most common type of seizure in children and occur in children six months to five years old, most often in association with mild infections. Most are simple and stop spontaneously. Complex febrile seizures (i.e. prolonged or repetitive) occur in 20-30% of cases and are associated with the subsequent development of epilepsy.

In malaria endemic areas, Plasmodium falciparum is the most common cause of fever in children less than five years. Falciparum malaria is the most common cause of admission to hospital, with malaria thought to be the diagnosis in over 65% of children admitted with convulsions.

Whilst P. falciparum may not be the cause of all cases of convulsions in children, there is evidence that it may cause epilepsy: convulsions are more common in falciparum than in vivax malaria despite a similar febrile response; 54% of convulsions occur when the child is without a fever and 86% have complex symptoms; a much higher proportion than in febrile seizures and with a different outcome.

Epilepsy is common in malaria endemic areas. Establishing a link between malaria and epilepsy is difficult, since there are many causes of epilepsy. In Kilifi, on the Kenyan coast, research has demonstrated an association between exposure to severe malaria and the development of epilepsy in children. Children exposed to cerebral malaria or malaria and complex seizures had a greater chance of developing epilepsy than unexposed children in the community.

So what could be the link?  Suggested areas for new and continued research include:

• P. falciparum could cause focal brain damage, resulting in epilepsy but there is little evidence to support this mechanism in most children.
• A genetic component could be responsible. Children who are diagnosed with malaria and have seizures are more likely to have family members who have contracted malaria, although the evidence for a hereditary component is not strong.
• Recent research suggests that malaria antibodies may play a role in affecting brain cell function, but whether these antibodies lead to epilepsy is not yet established.

Source(s):
'Seizure disorders among relatives of Kenyan children with severe falciparum malaria', Tropical Medicine and International Health 8(1): 12-16, by A.C. Versteeg et al, 2003
'Epileptic seizures and malaria in Kenya children', Transactions of the Royal Society of Tropical Medicine and Hygiene 90(2): 152-155, by C.M. Waruiru et al, 1996

id21 Research Highlight: 25 September 2003

Further Information:
Charles Newton
Kenya Medical Research Institute
PO Box 230
Kilifi
Kenya

Contact the contributor: cnewton@kilifi.mimcom.net

Kenya Medical Research Institute

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