Severe falciparum malaria and acquired childhood language disorder

Abstract

Language disorders have been reported after severe falciparum malaria but the deficits have not been described in detail. We assessed language outcome in three groups of children aged 6 to 9 years (n=487): those previously admitted to Kilifi District Hospital, Kenya, with cerebral malaria (CM; n=152; mean age 7y 4 mo [SD 1y 1mo]; 77 males, 75 females); or those with malaria and complicated seizures (M/S; n=156; mean age 7y 4mo [SD 1y 2mo]; 72 males, 84 females); and those unexposed to either condition (n=179; mean age 7y 6mo [SD 1y 1mo]; 93 males, 86 females). Median age at hospital admission was 28 months (interquartile range [IQR] 19 to 44 mo) among children with a history of CM and 23 months (IQR 12 to 35mo) among children with a history of M/S. A battery of eight assessments covering the major facets of speech and language was used to measure language performance. Cognitive performance, neurological/motor skills, behaviour, hearing, and vision were also measured. Eighteen (11.8%) of the CM group, 14 (9%) of the M/S group, and four (2.2%) of the unexposed group were found to have a language impairment. CM (odds ratio 3.68, 95% confidence interval 1.09 to 12.4, p=0.04) was associated with significantly increased odds of an impairment-level score relative to the unexposed group. The results suggest that falciparum malaria is one of the most common causes of acquired language disorders in the tropics.

Cognitive Impairment After Cerebral Malaria in Children: A Prospective Study

“…Our study findings do complement the findings of retrospective studies that documented a relationship between persisting epilepsy after discharge in children surviving CM and developmental disabilities over a period of years in the areas of attention, word-finding memory, phonology, and language use. 5,6,20 Taken together, the findings from the present study and previous studies suggest that early treatment of CM and aggressive seizure prevention and treatment may provide a way to reduce cognitive sequelae in children with CM. However, seizure management and particularly prevention in CM are complicated; a study in Kenya documented increased mortality rates for children with CM who were given phenobarbital as seizure prophylaxis, in addition to diazepam as needed for seizure control.…”

“…[4][5][6][7][8] However, the enrollment of a control cohort from the same neighborhoods as children with CM or UM permitted assessment of changes over time for this comparison group and helped to ensure that comparison children were not significantly different from children with CM in several important areas that might affect cognitive function. Age, gender, nutrition, home environment, and school level were also adjusted for in our statistical analyses.…”

“…Memory 22 and working memory and language 5,8,20,23,24 have been proposed as the mediators of long-term language deficits observed in children with CM. The developmental lag in attention and working memory performance we observed in our children with CM between the 3-month and 6-month follow-up assessments may help to explain the long-term deficits in higher-order language development identified in these retrospective studies up to 9 years after the CM episode.…”

“…3 However, several retrospective studies suggested that cognitive deficits in children with CM are more frequent (occurring in 11%-28% of children with CM) and persist for a far longer time (3-9 years after the CM episode) than neurologic deficits. [4][5][6][7][8] The data from those studies were strong and generally consistent, but one study found no evidence of increased cognitive deficits. 9 Furthermore, the original clinical and social assessments of those children were performed as part of studies investigating other aspects of CM and not as part of a study designed specifically to address the question of cognitive deficits in children with CM.…”

“…However, seizure management and particularly prevention in CM are complicated; a study in Kenya documented increased mortality rates for children with CM who were given phenobarbital as seizure prophylaxis, in addition to diazepam as needed for seizure control. 21 Efforts at seizure treatment and prevention must balance the potential for prevention of long-term injury with the risk of short-term respiratory depression, and alternatives to phenobarbital for seizure treatment and prevention in CM may be necessary.Memory 22 and working memory and language 5,8,20,23,24 have been proposed as the mediators of long-term language deficits observed in children with CM. The developmental lag in attention and working memory performance we observed in our children with CM between the 3-month and 6-month follow-up assessments may help to explain the long-term deficits in higher-order language development identified in these retrospective studies up to 9 years after the CM episode.…”