Long-Term Neurological Deficits in Child Survivors of Plasmodium falciparum Cerebral Malaria in Sub-Saharan Africa

Cerebral malaria, characterized by multiple seizures, coma, and other neurological abnormalities, is a particularly devastating complication of Plasmodium falciparum malaria. Children in sub-Saharan Africa comprise the most susceptible group to cerebral malaria worldwide, with more than 575,000 cases each year. Long-term neurological deficits—including motor impairments, language regression, cognitive deficits, behavioural abnormalities, and epilepsy—occur in approximately 25% of child survivors of cerebral malaria, which is now recognized as the leading cause of childhood neurodisability in sub-Saharan Africa. These neurological sequelae generate a significant economic and social burden as child survivors’ impaired intellectual function impacts their prospects for education and future employment. While current understanding of risk factors, disease mechanisms, and treatments for these neurological deficits is lacking, recent studies have shown great promise in revolutionizing the way that cerebral malaria is diagnosed and treated. It is speculated that during an acute attack of cerebral malaria, an inflammatory response to malarial antigens in neural blood vessels triggers a cascade of events that ultimately results in cerebral tissue damage and hemorrhaging into the brain, causing long-term brain damage. Potential risk factors for neurological deficits include the duration of coma, the occurrence of multiple seizures, and high fever. Malaria retinopathy and angiopoietin are being investigated as potential biomarkers to improve the definitive diagnosis of cerebral malaria. New drug therapies to prevent long-term neurological deficits after cerebral malaria include erythropoietin and statins, and cognitive rehabilitation and speech therapy have been shown to be successful in rehabilitating survivors.