Severe Neurological and Behavioural Sequelae Following Cerebral Malaria in Ugandan Children

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