Summary: Researchers report lumbar puncture procedures are safe to treat malaria in children.
Source: Michigan State University.
A Michigan State University researcher is challenging a widely held African belief that a spinal tap, a procedure safely used to treat other diseases, could suck the brain from the base of the skull and cause death in malaria patients.
Douglas Postels, a pediatric neurologist and a lead author of a new study, has shown that the common medical procedure used to diagnose brain infections and also treat nervous system illnesses that lead to increased pressure around the brain, is safe in patients with cerebral malaria.
Increased pressure in the brain can lead to death in many children who fall into coma from cerebral malaria, which is the most severe form of the disease.
“The thought has been not to use the procedure, especially if any increased pressure in the brain or swelling seen in the eye is present in comatose malaria patients,” Postels said. “But based on our evidence, even children with severe brain swelling had no change in the likelihood of dying, whether or not they had a spinal tap.”
The study is now published in the online issue of Neurology.
Postels, an associate professor in the College of Osteopathic Medicine who travels to southeastern Africa to treat patients and to further his research, realized that performing a spinal tap in children with the disease was not a universal practice across the continent. Many local doctors were concerned that the procedure could force the brain out of the hole at the base of the skull because of the potential pressure difference it could cause.
Questioning the validity of this way of thinking, Postels, along with co-author Christopher Moxon from the University of Liverpool, United Kingdom, set out to show that a spinal tap was not dangerous.
The researchers analyzed the outcomes of 1,827 cerebral malaria patients admitted to the hospital in Malawi between 1997 and 2013. They found that children who were sicker upon arrival at the hospital were more likely to die from their illness, not from the spinal tap, which did not change their risk of death.
Based on these findings, Postels said educating the African population and other areas that have similar beliefs is crucial in treating the disease since it’s estimated that malaria kills a child on the continent every minute.
“This actually is an important procedure that may help patients survive,” he said.
He hopes to further test these findings in a future randomized, controlled clinical trial to see if a spinal tap can actually be used as a therapy to lower brain pressure in children with cerebral malaria.
“The important thing to remember is it’s not the spinal tap that causes death, it’s the underlying illness. Rather than being harmful, we believe the procedure could be beneficial for these critically ill children. Anything we can do to help decrease death and disability rates for children with severe malaria is a positive for everyone.”
Other MSU researchers involved in the study include Chenxi Li, assistant professor in epidemiology and biostatistics, Karl Seydel, assistant professor of internal and tropical medicine and Terrie E. Taylor, University Distinguished Professor in tropical medicine.
Source: Sarina Gleason – Michigan State University
Image Source: NeuroscienceNews.com image is adapted from the Michigan State University press release.
Original Research: Abstract for “Safety of lumbar puncture in comatose children with clinical features of cerebral malaria” by Christopher A. Moxon, Lei Zhao, Chenxi Li, Karl B. Seydel, Ian J. MacCormick, Peter J. Diggle, Macpherson Mallewa, Tom Solomon, Nicholas A. Beare, Simon J. Glover, Simon P. Harding, Susan Lewallen, Sam Kampondeni, Michael J. Potchen, Terrie E. Taylor, and Douglas G. Postels in Neurology. Published online October 28 2016 doi:10.1212/WNL.0000000000003372
[cbtabs][cbtab title=”MLA”]Michigan State University. “Procedure Feared to ‘Suck Brain From Skull’ Safe for Malaria Patients.” NeuroscienceNews. NeuroscienceNews, 28 October 2016.
<https://neurosciencenews.com/malaria-neurology-5378/>.[/cbtab][cbtab title=”APA”]Michigan State University. (2016, October 28). Procedure Feared to ‘Suck Brain From Skull’ Safe for Malaria Patients. NeuroscienceNews. Retrieved October 28, 2016 from https://neurosciencenews.com/malaria-neurology-5378/[/cbtab][cbtab title=”Chicago”]Michigan State University. “Procedure Feared to ‘Suck Brain From Skull’ Safe for Malaria Patients.” https://neurosciencenews.com/malaria-neurology-5378/ (accessed October 28, 2016).[/cbtab][/cbtabs]
Safety of lumbar puncture in comatose children with clinical features of cerebral malaria
Objective: We assessed the independent association of lumbar puncture (LP) and death in Malawian children admitted to the hospital with the clinical features of cerebral malaria (CM).
Methods: This was a retrospective cohort study in Malawian children with clinical features of CM. Allocation to LP was nonrandom and was associated with severity of illness. Propensity score–based analyses were used to adjust for this bias and assess the independent association between LP and mortality.
Results: Data were available for 1,075 children: 866 (80.6%) underwent LP and 209 (19.4%) did not. Unadjusted mortality rates were lower in children who underwent LP (15.3% vs 26.7% in the no-LP group) but differences in covariates between the 2 groups suggested bias in LP allocation. After propensity score matching, all covariates were balanced. Propensity score–based analyses showed no change in mortality rate associated with LP: by inverse probability weighting, the average risk reduction was 2.0% at 12 hours (95% confidence interval −1.5% to 5.5%, p = 0.27) and 1.7% during hospital admission (95% confidence interval −4.5% to 7.9%, p = 0.60). Undergoing LP did not change the risk of mortality in subanalyses of children with severe brain swelling on MRI or in those with papilledema.
Conclusion: In comatose children with suspected CM who were clinically stable, we found no evidence that LP increases mortality, even in children with objective signs of raised intracranial pressure.
“Safety of lumbar puncture in comatose children with clinical features of cerebral malaria” by Christopher A. Moxon, Lei Zhao, Chenxi Li, Karl B. Seydel, Ian J. MacCormick, Peter J. Diggle, Macpherson Mallewa, Tom Solomon, Nicholas A. Beare, Simon J. Glover, Simon P. Harding, Susan Lewallen, Sam Kampondeni, Michael J. Potchen, Terrie E. Taylor, and Douglas G. Postels in Neurology. Published online October 28 2016 doi:10.1212/WNL.0000000000003372