Regarding¹ acute symptomatic seizure associated with tropical conditions such as cerebral malaria² and Japanese encephalitis virus³ as being well-recognized to frequently result in neurologic sequelae including epilepsy, neurodevelopmental abnormalities and behavioral disorders, in the June issue of Seizure, Soni et al¹ working in Chandigarh, India detail neurologic outcomes in a cohort of 604 children with acute symptomatic seizures due to a number of conditions.
The acute mortality rate was 1% and all those who died had seizures as a result of CNS infections. Neurodevelopmental disabilities were seen in 16% and risk factors for this included requiring more than one antiepileptic drug during the index admission, sequelae at discharge, abnormal neuroimaging and an abnormal EEG. Even in the relatively short 6-month follow-up period, almost 6% of survivors developed epilepsy following their acute symptomatic seizure with risk factors for epilepsy development including CNS infection as the etiology for the index seizures, presenting with status epilepticus, abnormal EEG findings and abnormal imaging. Longer term outcomes and behavioral outcomes were not available. Unlike in the US with viral gastroenteritis is the commonest precursor of acute symptomatic seizures in children, in this region of India and many other tropical regions CNS infections predominate. NIH-funded clinical trials aimed at identifying targets for neuroprotection from cerebral malaria sequelae are underway now (NCT01660672; NCT01982812; NIHR01NS102176). Given the similarities in the incidence and type of sequelae seen in this larger India-based cohort, if neuroprotective trials for malaria are successful, expansion to this more heterogenous group might be warranted.
- Soni V, Singhi P, Saini AG, et al. Clinical profile and neurodevelopmental outcome of new-onset acute symptomatic seizures in children. Seizure 2017;50:130-136.
- Birbeck GL, Molyneux ME, Kaplan PW, et al. Blantyre Malaria Project Epilepsy Study (BMPES) of neurological outcomes in retinopathy-positive paediatric cerebral malaria survivors: a prospective cohort study. Lancet Neurol 2010;9:1173-1181.
- Ooi MH, Lewthwaite P, Lai BF, et al. The epidemiology, clinical features, and long-term prognosis of Japanese encephalitis in central sarawak, malaysia, 1997-2005. Clin Infect Dis 2008;47:458-468.