Introduction Malaria affecting the central nervous system can present with or without coma (cerebral malaria – CM versus ‘CNS malaria’). Differences between them is not well understood, with similar long-term sequelae despite variation in initial illness severity reported. In a prospective cohort of Zambian children, we utilized clinical and EEG data to compare 1-month follow-up in CM versus CNS malaria.

Methods 105 children 6 months - 11 years with CM (P. falciparum infection and coma (GCS≤10 or BCS ≤2)), n=33, or CNS malaria (prolonged seizures or impaired consciousness without coma), n=72, were included. CM vs CNS malaria cases were compared on clinical metrics (including hospitalization length, mortality, Tmax), conventional and quantitative EEG measures, and 1-month neurodevelopmental outcomes (Behavior Rating Inventory of Executive Function, Malawi Developmental Assessment Tool).

Results Aside from coma score, there were no differences in hospitalization clinical metrics or follow-up neurodevelopment. Acute EEGs in CM had increased slowing (conventional review), decreased entropy and increased relative delta power (spectral analyses). CNS malaria had increased power in alpha, beta, and gamma frequency bands. By 1-month, only lower entropy in CM and increased power in higher frequency bands in CNS malaria remained significant.

Conclusion Literature suggests CM is a more severe manifestation of malaria with neurologic involvement, however, we found CNS malaria presented similarly. Like prior studies, we found no significant differences in one-month clinical follow-up. However, quantitative EEG analyses - particularly entropy - suggest CM and CNS malaria differ in severity of cortical injury. Longer term follow-up is in process.

Shaida Nishat
Massachusetts Institute of Technology
United States

Rasesh Joshi
Boston Children's Hospital, Harvard Medical School
United States

Suzanna Mwanza
Chipata Central Hospital
Zambia

Maitreyi Mazumdar
Harvard T.H. Chan School of Public Health
United States

Alexander Rotenberg
Boston Children's Hospital, Harvard Medical School
United States

Gretchen Birbeck
University Teaching Hospitals- Children's Hospital
Zambia

Archana Patel
Boston Children's Hospital, Harvard Medical School
United States