Profile of seizures in adult falciparum malaria and the clinical efficacy of phenytoin sodium for control of seizures

Abstract

ObjectiveTo study the profile of convulsion in adult severe falciparum malaria and efficacy of phenytoin sodium for its control. MethodsIt comprised of two sub studies. Study-1 evaluated the pattern and risk factors of seizure in severe malaria and Study-2 investigated the efficacy of phenytoin sodium to control seizure in an open label trial. Patients of severe malaria were diagnosed as per WHO guideline. Clinical type and duration of convulsion were determined. Biochemical and haematological investigations including EEG and CT scan of brain were performed in all cases. All patients were treated with injection artesunate along with other supportive measures and patients with convulsions were treated with injection phenytoin sodium. ResultsOut of 408 patients of severe malaria 118 (28.9%) patients had seizure. Generalized tonic clonic seizure, partial seizure with secondary generalization, and status epilepticus was present in 89(75.4%), 25(21.2%), and 4(3.4%) cases respectively. CT scan was abnormal in 16 (13.6%) cases. EEG was abnormal in 108 (91.5%) cases showing generalized seizure activity. Patients with convulsion (n=118) were treated with phenytoin sodium injection and convulsion was controlled within 12 hours [mean (6.2±2.1) hours] of treatment in 107 (90.6%) patients. Recurrence of seizure occurred in 2 (1.7%) patients and 11 (9.3%) patients did not respond. The mortality and sequelae were more among patients with than without convulsion. ConclusionsSeizure is common in adult falciparum malaria and phenytoin is an effective drug for seizure control.