Journal of Pediatric Neurology 2008; 06(01): 017-024
DOI: 10.1055/s-0035-1557433
Original Article
Georg Thieme Verlag KG Stuttgart – New York

Delayed visual evoked potentials in children with Plasmodium falciparum malaria and reduced consciousness

Caroline L. Southern
a   St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
,
Nicholas A.V. Beare
a   St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
,
Benedetto Falsini
b   Instituto di Oftalmologia, Università Cattolica del Sacro Cuore, Largo A. Gemelli, Roma, Italy
,
Jonathan Lochhead
a   St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
,
Malcolm E. Molyneux
c   Blantyre Malaria Project, Queen Elizabeth Central Hospital, Blantyre, Malawi
d   Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, Blantyre, Malawi
,
Terrie E. Taylor
c   Blantyre Malaria Project, Queen Elizabeth Central Hospital, Blantyre, Malawi
e   College of Osteopathic Medicine, Michigan State University, East Lancing, Michigan, USA
,
Simon P. Harding
a   St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
› Author Affiliations

Subject Editor:
Further Information

Publication History

10 January 2007

16 October 2007

Publication Date:
30 July 2015 (online)

Abstract

We aimed to investigate the visual evoked potential (VEP) in children unconscious with Plasmodium falciparum malaria, a common cause of death in Africa. Flash VEPs were carried out in Malawi during one peak malaria season. Children were included in the study if they had P. falciparum malaria and reduced consciousness – Blantyre Coma Score (BCS) 4 or less out of 5. Initial VEPs were performed after stabilising the patient and commencing treatment. To investigate optimal VEP protocols, varying stimulus parameters were tested. Where possible, VEPs were repeated daily until the child recovered full consciousness (BCS 5). The initial traces of 40 children were included in the study and serial traces were obtained in 30 of these. Mean VEP latency was greater on admission than either on day 1 or at BCS 5 (paired t-test, P < 0.05) for all test protocols. There was a positive correlation between VEP latency on admission and parasite count and a negative correlation with blood glucose on admission (Spearman's rank correlation, P < 0.05 for all test protocols). Children with severe P. falciparum malaria have delayed VEP responses and recovery occurs in parallel with return to normal consciousness. VEP recordings are quick and reproducible and may find a place in assessing levels of coma and cerebral function in severe malaria.