Asymptomatic malaria parasitaemia and seizure control in children with nodding syndrome; a cross-sectional study
Objective Plasmodium falciparum is epileptogenic and in malaria endemic areas, is a leading cause of acute seizures. In these areas, asymptomatic infections are common but considered benign and so, are not treated. The effects of such infections on seizures in patients with epilepsy is unknown. This...
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BMJ Publishing Group
2018-10-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/8/10/e023624.full |
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| author | Charles R J C Newton Albert Ningwa Kevin Marsh Richard Idro Rodney Ogwang Ronald Anguzu Pamela Akun Edward Kayongo |
| author_facet | Charles R J C Newton Albert Ningwa Kevin Marsh Richard Idro Rodney Ogwang Ronald Anguzu Pamela Akun Edward Kayongo |
| author_sort | Charles R J C Newton |
| collection | DOAJ |
| description | Objective Plasmodium falciparum is epileptogenic and in malaria endemic areas, is a leading cause of acute seizures. In these areas, asymptomatic infections are common but considered benign and so, are not treated. The effects of such infections on seizures in patients with epilepsy is unknown. This study examined the relationship between P. falciparum infection and seizure control in children with a unique epilepsy type, the nodding syndrome.Design This cross-sectional study was nested in an ongoing trial ‘Doxycycline for the treatment of nodding syndrome (NCT02850913)’. We hypothesised that, in patients with epilepsy, infection by P. falciparum, including asymptomatic infections, increases the risk of seizures and impairs seizure control.Setting and participants Participants were Ugandan children with nodding syndrome, age ≥8 years, receiving sodium valproate. All had standardised testing including documentation of the number of seizures in the past month, a rapid malaria test and if positive, the peripheral blood parasite density.Outcomes The primary outcome was the number of seizures in the past month (30 days).Results A total of 164/240 (68%) had malaria. Asymptomatic infections (without fever) were seen in 160/240 (67%) and symptomatic infections in 4/240 (2.7%). In participants without malaria, the median (IQR) number of seizures in the past month was 2.0 (1.0–4.0) and it was 4.0 (2.0–7.5) in participants with malaria, p=0.017. The number of seizures in asymptomatic persons was 3.0 (IQR 2.0–7.3) and 6.0 (IQR 4.0–10.0) in symptomatic individuals, p=0.024. Additionally, in asymptomatic patients, a positive correlation was observed between the parasite density and number of seizures, r=0.33, p=0.002.Conclusion In patients with nodding syndrome, both asymptomatic and symptomatic malaria are associated with an increased risk of seizures and poorer seizure control. Similar effects should be examined in other epilepsy disorders. Malaria prevention should be strengthened for these patients and chemotreatment and prevention studies considered to improve seizure control. |
| format | Article |
| id | doaj-art-f3fff93966444d478be1694876b596ba |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2018-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-f3fff93966444d478be1694876b596ba2025-02-12T03:15:14ZengBMJ Publishing GroupBMJ Open2044-60552018-10-0181010.1136/bmjopen-2018-023624Asymptomatic malaria parasitaemia and seizure control in children with nodding syndrome; a cross-sectional studyCharles R J C Newton0Albert Ningwa1Kevin Marsh2Richard Idro3Rodney Ogwang4Ronald Anguzu5Pamela Akun6Edward Kayongo7Department of Psychiatry, University of Oxford, Oxford, UK2 Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Kampala, UgandaNuffield Department of Medicine, University of Oxford Centre for Tropical Medicine and Global Health, Oxford, UK1 Makerere University College of Health Sciences, Kampala, Uganda1 Makerere University College of Health Sciences, Kampala, Uganda1 Makerere University College of Health Sciences, Kampala, Uganda1 Makerere University College of Health Sciences, Kampala, UgandaThe Centre for Rapid Evidence Synthesis (ACRES), Makerere University College of Health Sciences, Kampala, UgandaObjective Plasmodium falciparum is epileptogenic and in malaria endemic areas, is a leading cause of acute seizures. In these areas, asymptomatic infections are common but considered benign and so, are not treated. The effects of such infections on seizures in patients with epilepsy is unknown. This study examined the relationship between P. falciparum infection and seizure control in children with a unique epilepsy type, the nodding syndrome.Design This cross-sectional study was nested in an ongoing trial ‘Doxycycline for the treatment of nodding syndrome (NCT02850913)’. We hypothesised that, in patients with epilepsy, infection by P. falciparum, including asymptomatic infections, increases the risk of seizures and impairs seizure control.Setting and participants Participants were Ugandan children with nodding syndrome, age ≥8 years, receiving sodium valproate. All had standardised testing including documentation of the number of seizures in the past month, a rapid malaria test and if positive, the peripheral blood parasite density.Outcomes The primary outcome was the number of seizures in the past month (30 days).Results A total of 164/240 (68%) had malaria. Asymptomatic infections (without fever) were seen in 160/240 (67%) and symptomatic infections in 4/240 (2.7%). In participants without malaria, the median (IQR) number of seizures in the past month was 2.0 (1.0–4.0) and it was 4.0 (2.0–7.5) in participants with malaria, p=0.017. The number of seizures in asymptomatic persons was 3.0 (IQR 2.0–7.3) and 6.0 (IQR 4.0–10.0) in symptomatic individuals, p=0.024. Additionally, in asymptomatic patients, a positive correlation was observed between the parasite density and number of seizures, r=0.33, p=0.002.Conclusion In patients with nodding syndrome, both asymptomatic and symptomatic malaria are associated with an increased risk of seizures and poorer seizure control. Similar effects should be examined in other epilepsy disorders. Malaria prevention should be strengthened for these patients and chemotreatment and prevention studies considered to improve seizure control.https://bmjopen.bmj.com/content/8/10/e023624.full |
| spellingShingle | Charles R J C Newton Albert Ningwa Kevin Marsh Richard Idro Rodney Ogwang Ronald Anguzu Pamela Akun Edward Kayongo Asymptomatic malaria parasitaemia and seizure control in children with nodding syndrome; a cross-sectional study BMJ Open |
| title | Asymptomatic malaria parasitaemia and seizure control in children with nodding syndrome; a cross-sectional study |
| title_full | Asymptomatic malaria parasitaemia and seizure control in children with nodding syndrome; a cross-sectional study |
| title_fullStr | Asymptomatic malaria parasitaemia and seizure control in children with nodding syndrome; a cross-sectional study |
| title_full_unstemmed | Asymptomatic malaria parasitaemia and seizure control in children with nodding syndrome; a cross-sectional study |
| title_short | Asymptomatic malaria parasitaemia and seizure control in children with nodding syndrome; a cross-sectional study |
| title_sort | asymptomatic malaria parasitaemia and seizure control in children with nodding syndrome a cross sectional study |
| url | https://bmjopen.bmj.com/content/8/10/e023624.full |
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