Acute symptomatic seizures in the tropics—The need to improve outcomes

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.

References

  1. 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.
  2. 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.
  3. 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.
Gretchen L. Birbeck, MD, MPH

Gretchen L. Birbeck, MD, MPH

Gretchen Birbeck is a neurologist who divides her time between the US and Africa. Her US academic home is the University of Rochester where she is the Rykenboer Professor of Neurology and Research Director for the Strong Epilepsy Center with adjunct appointments in the Center for Human Experimental Therapeutics and the Department of Public Health. Her additional skills in epidemiology, health services research, and tropical medicine are brought to bear during the 6-months annually she spends in Africa where she serves as Director for the Chikankata Epilepsy Care Team in rural Mazabuka, Zambia, an Honorary Lecturer at the University of Zambia and a consultant for the Paediatric Research Ward at Queen Elizabeth Central Hospital in Blantyre, Malawi. Gretchen’s research programs are aimed at identifying opportunities to prevent or ameliorate the medical and social morbidities of common neurologic conditions in low-income, tropical settings with the ultimate goal of developing successful interventions feasible for scale up and broad implementation. She has been recognized as an Ambassador for Epilepsy by the International League against Epilepsy, a Global Health Research Ambassador by the US Paul Rogers Society, a National Outreach Scholar by the WK Kellogg Foundation and a Leader in Medicine by the American Medical Students Association.

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