CEREBRAL MALARIA IN TROPICAL SUB-SAHARAN AFRICA; A SENTINEL DISEASE FOR EPILEPTIC SEIZURES: "A FOCUSED REVIEW"

Balarabe S. A.*

ABSTRACT

The World Health Organization estimated that more than 83% of Plasmodium falciparum malaria occurs in sub- Saharan Africa. Malaria in its cerebral form known as Cerebral Malaria (CM), may lead to acute or long-term neurological complications. Generally, neurological sequelae are rare in adults recovering from cerebral malaria, accounting for less than 1%, compared with children in whom neurological residual abnormalities are more common, with approximately 12% still having sequelae such as hemiplegia, cortical blindness, aphasia and cerebellar ataxia. These features often resolve in over 50% of the children, but about 25% will be left with major residual neurological deficits. Furthermore, sequelae such as epilepsy have been reported and may only become evident later during the adolescent age. Among all cases of severe malaria caused by plasmodium falciparum, Cerebral Malaria (CM) stands as the most severe neurological presentation of acute plasmodium falciparum infection. It causes diffuse encephalopathy associated with seizures in at least 80%, and status epilepticus, in more than 30% of cases. Although survivors of CM make a full recovery, neurological sequelae such as epilepsy occur in 3-31%. Cerebral malaria is histopathologically characterized by swelling of small blood vessels such as cerebral capillaries and venules with both parasitized and non- parasitized red blood cells. There may be impairment in the structural and physiological dysfunction of the blood-brain barrier. Furthermore, There is histological evidence of cerebral edema, with petechial haemorrhages. Durck's granuloma may also be seen due to accumulation of glial cells surrounding hemorrhagic foci. This review tends to discuss the mechanisms involved in the neuropathology caused by CM, focusing on epilepsy.

Keywords: Cerebral Malaria, epileptic seizures, Sentinel disease, Tropical Sub-Saharan Africa.