Takle, Mrinmayee, Andrews, Alexander, Riggle, Brittany A, Zelleke, Tesfaye, Harrar, Dana, Zhang, Jiahui, Zhang, Bo, Wilson, Kyle J 
ORCID: 0000-0003-0151-7530, Beare, Nicholas AV ORCID: 0000-0001-8086-990X, Taylor, Terrie E et al (show 3 more authors)
(2025)
Using Electroencephalography to Assess Coma Etiology in Children with Retinopathy-Negative Cerebral Malaria
AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE, 113 (4).
pp. 809-816.
ISSN 0002-9637, 1476-1645
|
Text
EEG_MRet_Neg_CM_AJTMH-25-0377.R1_Proof.pdf - Author Accepted Manuscript Available under License Creative Commons Attribution. Download (1MB) | Preview |
Abstract
Autopsy studies of children dying of cerebral malaria (CM) have revealed that those with malarial retinopathy exhibited high levels of sequestration in the cerebral vasculature, whereas children with retinopathy-negative CM exhibited lower sequestration levels and possible nonmalarial causes of death. This suggests that children dying of retinopathy-negative CM have nonmalarial coma etiologies with concomitant incidental parasitemia, which is common in high malaria transmission areas. Subsequent studies have challenged this assertion, positing that retinopathy-negative CM and retinopathy-positive CM are variants of the same disease pathophysiology or host biology, both caused by acute malaria infection. We recently determined that electroencephalography (EEG) can be used to discriminate between a malarial coma (CM) and a nonmalarial coma. To better understand the contribution of acute malaria infection in the pathophysiology of retinopathy-negative CM, we compared qualitative and quantitative EEG findings from 30-minute EEG recordings of Malawian children aged 3 months to 14 years hospitalized at Queen Elizabeth Central Hospital with retinopathy-negative CM, retinopathy-positive CM, and nonmalarial coma. Neither qualitative nor quantitative EEG interpretation methods allow for the discrimination between children with retinopathy-positive CM and those with retinopathy-negative CM. Conversely, quantitative EEG readily differentiated children with retinopathy-negative CM from those with nonmalarial coma (area under the receiving operating characteristic [AUROC] curve of 0.83). When combining qualitative and quantitative EEG interpretation methods, the ability of EEG to distinguish retinopathy-negative CM from nonmalarial EEG increases (AUROC of 0.87). The EEGs of children with retinopathy-negative CM are similar to those of children with retinopathy-positive CM and significantly different from those of children with nonmalarial coma, supporting the hypothesis that acute malarial infection is pathophysiologically important in retinopathy-negative CM.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Humans, Malaria, Cerebral, Coma, Retinal Diseases, Electroencephalography, Adolescent, Child, Child, Preschool, Infant, Malawi, Female, Male |
| Divisions: | Faculty of Health & Life Sciences Faculty of Health & Life Sciences > Inst. Life Courses & Medical Sciences Faculty of Health & Life Sciences > Inst. Life Courses & Medical Sciences > Inst. Life Courses & Medical Sciences (T&R staff) Faculty of Health & Life Sciences > Inst. Life Courses & Medical Sciences > Eye & Vision Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 20 Oct 2025 10:58 |
| Last Modified: | 23 May 2026 10:26 |
| DOI: | 10.4269/ajtmh.25-0377 |
| Related Websites: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3194923 |
| Disclaimer: | The University of Liverpool is not responsible for content contained on other websites from links within repository metadata. Please contact us if you notice anything that appears incorrect or inappropriate. |
Altmetric
Altmetric