Supplemental Table 1
Severe Neurological and Behavioural Sequelae following Cerebral Malaria in Ugandan children
ID No. Age on Gender Time from Risk factors for Time from Types of sequelae observed Changes on Comments
exposure, exposure to poor outcome discharge to EEG
months attending sequelae
clinic, months 1 24 Male 1 Status Immediate. 1. Quadriparesis with inability N/A Lost to follow up. epilepticus Discharged with to feed self
multiple deficits. 2. Severe cognitive impairment
3. Loss of hearing
4. Loss of speech
5. Blindness 2 30 Male 18 Severe anaemia Immediate. 1. Loss of speech Sleep EEG Recovered vision. Status Discharged with 2. Severe visual impairment – shows epileptic epilepticus multiple deficits. only able to perceive light discharges
3. Quadriparesis from both
4. Severe cognitive impairment temporal lobes.
with loss of toilet control. Left focus has
5. Behaviour problems with tendency to
hyperactivity, aggression generalization
impulsiveness.
6. Focal epilepsy initially had
non convulsive seizures
(startles) 3 72 Male 7 Status Immediate. 1. Blindness EEG testing Vision improved over 7 epilepticus Discharged with 2. Severe hearing impairment not done. months. Deep and prolonged multiple deficits. 3. Loss of speech Refractory seizures coma 4. Chorea despite anticonvulsants. 1 5. Generalized tonic clonic
epilepsy
6. Hyperactivity and short
attention span 4 23 Female 1 Status Immediate. 1. Quadriparesis N/A No improvement epilepticus Discharged with 2. Loss of speech Deep and prolonged multiple deficits. 3. Impaired hearing coma 4. Severe cognitive
impairment, loss of social
skills including independent
feeding and toilet training 5 30 Male 1 Not reported Immediate. 1. Quadriparesis N/A Later, a diagnosis of
Discharged with 2. Severe visual impairment ADHD was made.
multiple deficits. 3. Disordered breathing and
drooling
4. Severe hyperactivity 6 17 Female 0.75 Not reported Immediate. 1. Loss of hearing Low amplitude Seizure activity
Discharged with 2. Blindness activity. No associated with sudden
multiple deficits. 3. Quadriplegia epileptiform onset of limb movements
4. Choreoathetosis discharges. followed by deep guttural
5. Severe cognitive impairment sounds.
6. Epilepsy 7 46 Female 4 Deep and Immediate. 1. Loss of speech N/A Developed severe prolonged Discharged with 2. Loss of hearing choreoathrtoid movement
multiple deficits. 3. Blindness disorder with fluctuating
4. Alternating limb tone and tone 1 month after
choreoathetosis exposure.
5. Severe cognitive impairment 8 11 Female 1 Not reported Immediate. 1. Blindness N/A . Blindness resolved.
Discharged with 2. Loss of hearing
multiple deficits. 3. Movement disorder 9 5 Male 25 Hypoglycaemia Immediate. 1. Loss of speech Diffuse Only minimal 2 Deep coma Discharged with 2. Quadriparesis epileptiform improvement in motor Status multiple deficits. 3. Epilepsy discharges function epilepticus 10 24 Male 4 years 4 years EEG testing On treatment with Status 1. Epilepsy. Doing very well in epilepticus not done. Phenobarbitone. School (most recent position
in class, 1st out of 49). 11 40 Male 1 month Status Immediate. 1. Loss of speech Mild diffuse On treatment with epilepticus Discharged with 2. Severe hearing impairment epileptiform Phenobarbitone and has
multiple deficits 3. Epilepsy activity with no hearing aids.
4. Severe cognitive impairment focus. 12 17 Male 4 months Severe anaemia Immediate. 1. Blindness N/A Regained sight over 6 Hypoglycaemia Discharged with 2. Hearing loss weeks and had partial Refractory status multiple deficits 3. Loss of speech improvement in hearing epilepticus 4. Left sided hemiplegia (worst over 7 weeks. Difficulty in
in upper limbs) chewing.
5. Hyperactive and short
attention span 13 23 Male 5 months 1. Prolonged Some 1. Epilepsy Mild diffuse Seizures controlled with coma immediate 2. Progressively worsening epileptiform carbamazepine.
others 2 months behaviour problems activity Aggressiveness and
(inattentive, hyperactive and hyperactivity are major
aggressive) problems.
3. Un-coordinated speech 14 31 Male 4 Status Immediate. 1. Blindness Diffuse slow Initially on Phenobarbital epilepticus mo Discharged with 2. Loss of hearing background but withdrawn after Deep and prolonged multiple deficits. 3. Loss of speech and spike developing hyperactivity. coma 4. Intractable epilepsy wave Seizures failed to
discharges respond to 5. Behaviour problems similar to EEG carbamazepine and (excessive movements, in Lennox sodium valproate. Both aggression, shouting, Gastaut seizures and removes clothing) epilepsy hyperactivity reduced on 3 clonazepam. 15 30 Male 0.75 (3 weeks) Not reported Immediate. 1. Quadriplegia with N/A Vision improved to
Discharged with Inability to sit unsupported perceiving light in 2
multiple deficits. and had feeding problems months and near normal
2. Blindness in 6months. He was able
3. Loss of speech to walk alone within 5
4. Impaired hearing months.
Incomprehensible
speech 6 months after
exposure. On regular
speech therapy. 16 30 Female 12 Status Immediate. 1. Epilepsy, multiple seizure Diffuse slow Poor seizure response to epilepticus Discharged with types, 10-15 seizures a day. waves and Phenobarbital. Improved
multiple deficits. 2. Quadriparesis focal on sodium valproate.
3. Severe cognitive impairment discharges
and regression in milestones over right
with severe seizures. posterior
temporal
region. 17 13 Female 3 Hypoglycaemia Some 1. Quadriparesis with inability N/A Vision started to improve
immediate to sit in 2 months and motor
others 1 month 2. Choreoathetoid movements deficits within 3 months.
later. 3. Blindness 18 24 Female 48 Prolonged Immediate. 1. Loss of speech EEG testing Epileptic seizures coma Discharged with 2. Severe behaviour problems not done. controlled with
multiple deficits. (destructive, excessive carbamazepine.
anger, injures self when
angry, hyperactive and in
attentive). Has periods when
she eats rubbish and runs
away from home. 4 3. Severe cognitive impairment
and learning disability
4. Epilepsy 19 25 Female 54 Multiple risk Immediate. 1. Incomprehensible speech N/A Regained vision after 1 factors Discharged with 2. Quadriplegia mo and walked 4 yrs
multiple deficits. 3. Severe cognitive impairment later. The behaviour
with loss of toilet control problems progressively
4. Blindness worsened over the 4
years. Given haloperidol 5. Severe behaviour and and methylphenidate. psychiatric problems (biting, Lost only sibling to eats rubbish, chews cerebral malaria. Ten yr clothing, hyperactivity and in old cousin has severe attentiveness) sequelae after cerebral
malaria. 20 31 Male 78 Status Immediate. 1. Loss of speech EEG testing No family history of epilepticus Discharged with 2. Right sided hemiplegia with not done neurological disorders.
Prolonged multiple deficits. cranial nerves VI and VII Seizures frequency coma palsies reduced on
3. Secondarily generalized Phenobarbital but
epilepsy. behaviour problems
4. Self injurious behaviour, worsened. Phenobarbital
(bites himself), shouts and replaced with
makes noises. Carbamazepine.
5. Sleep disorder – poor sleep 21 17 Male 48 Status Immediate. 1. Blindness N/A Regained vision and epilepticus Discharged with 2. Loss of speech hearing 3 and ½ months
Hypoglycemia multiple deficits. 3. Impaired hearing after discharge.
Prolonged 4. Behaviour problems coma (hyperactive and short
5 attention span).
5. Left sided hemiplegia
6. Feeding difficulties. 22 49 Female 0.5 (2 weeks) Repeated focal One week. 1. Excessive anger and EEG testing Multiple family members seizures after episodes of excessive not done reporting febrile seizures. initial improvement happiness/laughter. Lost to follow up.
Probable gelastic seizures.
2. Aggressive behaviour 23 37 Female 12 Refractory Immediate. 1. Left sided hemiplegia and Generalized Seizures controlled and status Discharged with VII palsy. sharp waves patient improved on epilepticus multiple deficits. 2. Slurred speech with diffuse Carbamazepine. Prolonged coma 3. Ataxia epileptiform 4. Epilepsy 1 month after activity. No
discharge focus
5. Hyperactivity
6