Blantyre Malaria Project Epilepsy Study (BMPES) of neurological outcomes in retinopathy-positive paediatric cerebral malaria survivors: a prospective cohort study
Blantyre Malaria Project Epilepsy Study (BMPES) of neurological outcomes in retinopathy-positive paediatric cerebral malaria survivors: a prospective cohort study
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DOI：
10.1016/s1474-4422(10)70270-2
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发表时间：
2010-12-01
期刊：
影响因子：
48
通讯作者：
Taylor, Terrie E.
中科院分区：
文献类型：
--
作者：
Birbeck, Gretchen L.;Molyneux, Malcolm E.;Taylor, Terrie E.
脑型疟疾是一种以昏迷寄生虫血症为特征的疾病，没有其他明显的昏迷原因，在无症状寄生虫病发病率高和神经诊断设施有限的流行地区，明确诊断具有挑战性。最近描述的疟疾视网膜病变提高了诊断特异性。我们的目的是确定视网膜病变阳性脑型疟疾是否是癫痫或其他神经残疾的危险因素。2007年，我们在马拉维的布兰太尔对患有疟疾视网膜病变的脑型疟疾的幸存者进行了前瞻性队列研究，患有脑型疟疾的儿童在他们的索引入院时被鉴定，并且与同期入院的没有昏迷或神经系统感染的儿童年龄匹配。最初病例与对照的匹配是11，但是在2006年，修订了脑型疟疾幸存者的入选标准，以根据间接检眼镜检查将入选限制为患有脑型疟疾和视网膜病的儿童，然后将配对改为1 2，并对以前入组的儿童回顾性应用修订后的纳入标准，出院时进行临床评估，此后每3个月进行一次标准化护士随访，以确定患有新发癫痫发作或其他神经障碍的儿童对癫痫事件进行了Kaplan Meier生存分析发现132名视网膜病变阳性脑型疟疾儿童和264名年龄匹配的儿童，非昏迷对照组随访中位数为495天（IQR 195-819）132例脑型疟疾幸存者中有12例发生癫痫，而264例对照者中无一例发生癫痫（比值比[OR]未定义，P > 0.05）。
Background Cerebral malaria a disorder characterised by coma parasitaemia and no other evident cause of coma, is challenging to diagnose definitively in endemic regions that have high rates of asymptomatic parasitaemia and limited neurodiagnostic facilities A recently described malaria retinopathy improves diagnostic specificity We aimed to establish whether retinopathy positive cerebral malaria is a risk factor for epilepsy or other neurodisabilitiesMethods Between 2005 and 2007 we did a prospective cohort study of survivors of cerebral malaria with malaria retinopahy in Blantyre, Malawi Children with cerebral malaria were identified at the time of their index admission and age-matched to concurrently admitted children without coma or nervous system infection Initially matching of cases to controls was 1 1 but in 2006, enrolment criteria for cerebral malaria survivors were revised to limit inclusion to children with cerebral malaria and retinopathy on the basis of indirect ophthalmoscopic examination, matching was then changed to 1 2 and the revised inclusion criteria were applied retrospectively for children enrolled previously Clinical assessments at discharge and standardised nurse led follow up every 3 months thereafter were done to identify children with new seizure disorders or other neurodisabilities A Kaplan Meier survival analysis was done for incident epilepsyFindings 132 children with retinopathy positive cerebral malaria and 264 age matched, non comatose controls were followed up for a median of 495 days (IQR 195-819) 12 of 132 cerebral malaria survivors developed epilepsy versus none of 264 controls (odds ratio [OR] undefined p