Cognitive sequelae of severe malaria with impaired consciousness

Abstract

Although cerebral malaria is the most common acute encephalopathy arising in children in Africa little is known of its effect upon the longer-term cognitive development of survivors. In Kenya, we compared the performance of 87 survivors of severe malaria with impaired consciousness to matched community controls on a wide range of tasks, not less than 42 months post illness episode. The presence of cognitive impairment was then related to both the pattern of symptoms at the time of the acute illness and the presence of gross neurological impairment on discharge. Significant group differences were found in areas of cognitive functioning suggestive of widespread impairment in the development of the ability to initiate, plan and carry out tasks (the executive functions). On tasks of more discrete cognitive skills (information processing) there were no significant group differences, although impaired performance was found more frequently in the severe malaria group. The odds ratio associated with the development of cognitive impairment following severe malaria with impaired consciousness was found to be 4.48 (95% CI 1.22, 16.47). A combination of 4 signs (coma, hypoglycaemia, seizures, and absence of hyperpyrexia) proved to have greater accuracy than the presence of gross neurological sequelae in predicting cognitive impairment (95% vs 93% specificity, 67% vs 58% sensitivity).

Impact of Plasmodium falciparum malaria on performance and learning: review of the evidence

“…35 Our own investigations have found that not all children who had seizures go on to develop either neurological or cognitive impairments, although all children who had cognitive impairments had also had at least one seizure. 17 Only a small number of our study children (n ϭ 5) were recorded as having had status epilepticus, and not all of these developed sequelae, either cognitive or neurological. Interestingly, neither of the children whose cognitive development was most globally impaired had incurred Ͼ 3 seizures during the course of their illness, nor had they been in status epilepticus.…”

“…There have been 2 published studies that have looked at the cognitive and neuropsychological sequelae of cerebral malaria in children, one in The Gambia and the other in Kenya. 16,17 The Gambia study included 36 children who were assessed only in terms of nonverbal functioning and motor development by use of translations of tests standardized for Western populations. The study excluded children who had a Blantyre Coma Score of Ͼ 2 or who had gross neurological sequelae on discharge.…”

“…17 A total of 87 case patients were matched to controls and were assessed at ages 6-7 years, 3-4 years after discharge. Case patients were selected with a cutoff point of a Blantyre Coma Score of 4 or less (severe malaria with impaired consciousness).…”

Pediatric Cerebral Malaria: A Scourge of Africa

“…Other studies have demonstrated that children with a history of recurring seizures during acute illness are at risk for cognitive and language impairment [51,[105][106][107][108]. Attention, memory, learning and language impairment from CM can place children at a significant disadvantage in such functional domains as academic achievement and day-to-day adaptive behaviors related to executive function at home or in the community [109][110][111][112].…”

Parasitic Central Nervous System Infections in Immunocompromised Hosts: Malaria, Microsporidiosis, Leishmaniasis, and African Trypanosomiasis

“…Children who develop spastic quadriparesis or vegetative state usually die. Residual neurologic sequelae occur in ~10% of immunocompetent people and may include epilepsy and cognitive, behavioral, and language deficits, as well as hemiparesis, blindness, and ataxia [58,60]. The effect of immunosuppression on the incidence of long-term neurologic sequelae is not known.…”