Unlocking malaria’s effects on the brain

Malaria is one of humanity’s oldest diseases. Millions of people contract it each year, and children under 5 bear the greatest burden. Over decades of research and practice, scientists and clinicians have made huge strides in preventing and treating the disease. Yet, the parasite that causes it still evades complete understanding.

More than 1 million children develop severe malaria each year. The most dangerous form, cerebral malaria, is defined as coma with malaria infection, and carries a high risk of death. Even survivors can suffer permanent neurologic injury.  Other severe forms of malaria, including severe malarial anemia, can also lead to lasting neurological injury. Scientists still do not fully understand how neurologic injuries occur in children with severe malaria infections.

Malaria treatment in Malawi

Right now, only children with cerebral malaria admitted to Queen Elizabeth Central Hospital in Blantyre, Malawi, receive an electroencephalogram (EEG) test. EEGs measure electrical activity in the brain, which helps clinicians find changes in brain activity in a minimally disruptive way. In the case of cerebral malaria, clinicians use EEGs to monitor for seizures. Children with other types of malarial illness do not routinely receive EEG evaluations.  As a result, clinicians may miss signs of neurological injury in children with other severe forms of malaria.

“Despite all our efforts with MRIs, transcranial dopplers and lumbar punctures, we still don’t know why malaria causes a coma or how it injures the brain,” said Alexander Andrews, MD, a neurologist at Children’s National. “EEG may be a tool to improve our understanding, another piece of the puzzle that we haven’t fully leveraged.”

To find answers, researchers at Children’s National and Queen Elizabeth Central Hospital are using EEGs in a new way, studying brain activity across different stages of malaria infection to look for clues about how malaria injures the brain. A better understanding of how injury occurs may lead to improved treatments that could prevent these neurologic problems.

An international partnership to strengthen neurological care

The project grew naturally from the long-standing partnership between Children’s National and Queen Elizabeth Central Hospital. Together, clinicians and researchers at both institutions bring decades of expertise in pediatric neurology and malaria care, creating a unique opportunity to investigate one of the disease’s lingering mysteries.

Our clinicians regularly work together to treat and study malaria, support clinical care and build educational curricula that improves care for pediatric neurological patients. To bolster the clinical care in Blantyre, Dr. Andrews and others interpret EEGs, partnering with on-the-ground Malawian clinicians to treat patients from afar.

After seven years of reviewing EEGs from children with severe malaria, Dr. Andrews began to wonder whether the technology could reveal signs of brain injury much earlier in the disease process. With a pilot award from the Children’s National Global Health Initiative, both institutions began enrolling patients admitted to the hospital with malaria infection.

Scientists will examine the EEGs to determine whether there’s a detectable signature of malaria infection in the brain during early stages of the disease. If found, clinicians will try to determine how the parasite interacts with the brain. “EEG allows us to study these questions non-invasively and in real time,” says Dr. Andrews.

Strengthening future malaria care

Over the next year, the Children’s National and Queen Elizabeth Central Hospital teams hope to uncover what happens in the brain early during malaria infection. If they can unlock that secret, they can hopefully catch severe malaria before it becomes catastrophic.

Identifying the biological pathways that lead to brain injury could pave the way for new therapies and earlier interventions. Combined with expanded access to EEG monitoring, that knowledge could help clinicians protect more children from the lifelong consequences of severe malaria.