Response: Pathogenesis of Epilepsy after Exposure to Severe Falciparum Malaria

Abstract

To the Editor: The causes of an increased rate of epilepsy in children who have had severe falciparum malaria are currently a matter of speculation. Our study strongly supports an association between falciparum malaria and epilepsy (1). Two complications of falciparum malaria—cerebral malaria and malaria with complicated seizures—were associated with an increased prevalence of epilepsy compared with that in children unexposed to these conditions. Dr. Aleem's suggestion of granulomas of Durck being a cause of epilepsy in these children is possible. The neuropathology of severe falciparum malaria is discussed in several studies (2, 3), which suggest that several pathogenic processes could be involved. The most likely are vascular/ischemic mechanisms (2), because ischemic lesions have been detected in adults with severe malaria (4, 5); neurotoxic effects (6); and antibodies against voltage-gated channels (7). We would also raise the possibility of genetic mechanisms (8). In addition, complicated seizures occurring during the acute episode have features similar to those of complicated febrile seizures, which are associated with the subsequent development of epilepsy. Elucidating the mechanism of epileptogenesis will require magnetic resonance studies in children and further investigation of the putative mechanisms mentioned earlier.