Objective

Plasmodium falciparum is epileptogenic and a leading cause of acute seizures in endemic areas. In these countries, asymptomatic infections are common but considered benign and so, not treated. The effect on seizure control in epilepsy is unknown. We examined the relationship between P.falciparum infection and seizure control in a unique epilepsy type.

Methods

This cross-sectional study was nested in an ongoing trial ‘Doxycycline for the treatment of nodding syndrome (NCT02850913)’. We hypothesized that, in patients with epilepsy, infection by P.falciparum, including asymptomatic infections, increases the risk of seizures and impairs seizure-control. Participants were children with nodding syndrome, ages≥8 years, receiving sodium valproate. All had documentation of the number of seizures in the past month, a rapid malaria test and if positive, the peripheral blood parasite density.

Results

A total of 164/240(68%) had malaria. Asymptomatic infections 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 those 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 nodding syndrome, both asymptomatic and symptomatic malaria is associated with poorer seizure control. Similar effects should be examined in other epilepsy disorders. Malaria prevention should be strengthened for these patients and chemo-treatment and prevention studies considered to improve seizure control.