Malaria infection and the risk of epilepsy: a meta-analysis

Epilepsy, a chronic disease of the central nervous system, is highly prevalent in malaria-endemic regions. Therefore, several studies have evaluated the associations between malaria infection and epilepsy development. A meta-analysis of observational studies published from inception to 10 May 2022 has been conducted to synthesize and pool the existing data on this topic. The relevant publications were systematically searched in PubMed/Medline, Scopus, Embase and Web of Science database collections. A random-effects meta-analysis model (REM) was utilized to generate the pooled odds ratio (OR) at 95% confidence intervals (CIs). The between-studies heterogeneity was assessed with I2, as well as several subgroups, meta-regression and sensitivity analysis were performed to identify the source of heterogeneity. Overall, 17 eligible studies containing 6285 cases and 13 909 healthy controls were included. The REM showed a significant positive association between malaria infection and epilepsy development (OR 2.36; 95% CI 1.44–3.88). In subgroup analyses, significant positive associations were observed in studies that: epilepsy was the outcome in the follow-up of patients with cerebral malaria (OR 7.10; 95% CI 3.50–14.38); used blood smear to diagnose malaria (OR 4.80; 95% CI 2.36–9.77); included only children (OR 3.92; 95% CI 1.81–8.50); published before 2010 (OR 6.39; 95% CI 4.25–9.62). Our findings indicated that patients with malaria, especially those with cerebral malaria, are at a high risk of epilepsy development; however, further well-designed and controlled studies are needed to verify the strength of the association

Case-Control Study to Assess the Association between Epilepsy and Toxocara Infection/Exposure

Although causes and etiology of epilepsy are mostly obscure, some zoonotic parasites, such as Toxocara species, have been proposed as a risk factor for this disease. Here, we conducted an age-matched case-control study to evaluate whether there is an association between epilepsy and the presence of serum antibodies to Toxocara in incident cases. We included 94 idiopathic epileptic patients as cases, and—from the same geographical region—88 people with no own history of epilepsy or neurological disease as control subjects. Epilepsy was confirmed by a physician using the International League Against Epilepsy (ILAE) definition. All participants were screened for the anti-Toxocara IgG serum antibody by enzyme-linked immunosorbent assay (ELISA). Univariate and mutltivariate statistical analyses were applied to calculate the crude and adjusted odds ratios (OR) and 95% confidence intervals (CIs). Anti-Toxocara serum antibody was detected in 37 epileptic patients and in 23 control subjects, giving respective seroprevalences of 39.3% (95% CI, 29.4–49.9%) and 26.1% (95% CI, 17.3–36.5%), respectively. Adjusted multivariate logistic regression analysis estimated an OR of 2.38 (95% CI, 1.25–4.63), indicating a significant association between epilepsy and Toxocara seropositivity. There was also a significant association between seropositivity to Toxocara and partial (OR, 2.60; 95% CI, 1.14–6.04) or generalized (OR, 2.17; 95% CI, 1.09–4.40%) seizures. Findings from the present study of incident epileptic cases support previous studies proposing that Toxocara infection/exposure is a risk factor for epilepsy. However, further well-designed population-based surveys and mechanistic/experimental studies in animal models are required to better understand the reason(s) for this association

Superinfected COVID‐19 in a young patient with posterior reversible encephalopathy syndrome: A case report

Key Clinical Message Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome with central nervous system (CNS) symptoms usually related to autoregulatory cerebral failure and high blood pressure. Neuroimaging is critical to diagnosis. Neurological presentations of COVID‐19 disease are categorized into CNS symptoms and peripheral nervous system (PNS) symptoms. The patient was a 15‐year‐old female with SARS‐CoV‐2 pneumonia who developed PRES with a typical clinical and radiological appearance. She was treated with dexamethasone, phenytoin, sodium valproate and remdesivir. The patient was discharged after recovery of symptoms and was in good general condition. It is recommended that in patients affected by COVID‐19 with neurological symptoms, the PRES can be considered in the differential diagnosis

Forest plot for the association between maternal infection and ID in four studies having adjusted OR.

Forest plot for the association between maternal infection and ID in four studies having adjusted OR.</p

Fill and Trim sensitivity analysis for publication bias in crude OR.

Fill and Trim sensitivity analysis for publication bias in crude OR.</p

Pooled OR estimates in subgroups according to the diagnostic criteria for maternal infection in studies assessing the association between maternal infection and ID in children.

Pooled OR estimates in subgroups according to the diagnostic criteria for maternal infection in studies assessing the association between maternal infection and ID in children.</p

Pooled OR estimates in subgroups according to the diagnostic criteria for ID in studies assessing the association between maternal infection and ID in children.

Pooled OR estimates in subgroups according to the diagnostic criteria for ID in studies assessing the association between maternal infection and ID in children.</p

Sub-group analysis of the pooled prevalence and odds ratios for the association between maternal infection and intellectual disability.

Sub-group analysis of the pooled prevalence and odds ratios for the association between maternal infection and intellectual disability.</p