Advertisement
Regular Article| Volume 10, ISSUE 8, P554-558, December 2001

Malnutrition and childhood epilepsy in developing countries

      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      A high prevalence of epilepsy in children is frequently found in developing countries. Though high rates of acquired brain injury may contribute, the possibility that malnutrition may lower seizure threshold has rarely been examined. This review suggests potential biochemical mechanisms that could adversely affect seizure threshold, particularly the effect of malnutrition on inhibitory neurotransmitters and electrolytes. Supporting evidence from animal research and epidemiological findings in children are discussed.

      Keywords

      References

      References

        • de Bittencourt P.R.M
        • Adamolekum B
        • Bharucha N
        • et al.
        Epilepsy in the tropics: I. Epidemiology, socioeconomic risk factors and etiology.
        Epilepsia. 1996; 37: 1121-1127
        • Hackett R.J
        • Hackett L
        • Bhakta P
        The prevalence and associated factors of epilepsy in children in Calicut District, Kerala, India.
        Acta Paediatrica. 1997; 86: 1257-1260
        • Rwiza H.T
        • Kilonzo G.P
        • Haule J
        • et al.
        Prevalence and incidence of epilepsy in Ulanga, a rural Tanzanian district: a community based study.
        Epilepsia. 1992; 33: 1051-1056
        • Durkin M.S
        • Davidson L.L
        • Hasan Z.M
        • et al.
        Estimates of the prevalence of childhood seizure disorders in communities where professional resources are scarce: results from Bangladesh, Jamaica and Pakistan.
        Paediatric and Perinatal Epidemiology. 1992; 6: 166-180
        • Matuja W.B.P
        Aetiological factors in Tanzanian epileptics.
        East African Medical Journal. 1989; 66: 343-348
        • Aziz H
        • Ali S.M
        • Frances P
        • et al.
        Epilepsy in Pakistan: A population-based epidemiologic study.
        Epilepsia. 1994; 35: 950-958
        • Waruiru C.M
        • Newton C.R.J.C
        • Forster D
        • et al.
        Epileptic seizures and malaria in Kenyan children.
        Transactions of the Royal Society of Tropical Medicine and Hygiene. 1996; 90: 152-155
        • Poneprasert B
        Japanese encephalitis in children in northern Thailand.
        South-east Asian Journal of Tropical Medicine and Public Health. 1989; 20: 599-603
        • Leary P.M
        • Morris S
        Recurrent seizures in childhood; Western cape profile.
        South African Medical Journal. 1988; 74: 579-581
        • Bern C
        • Garcia H.H
        • Evans C
        • et al.
        Magnitude of the disease burden from neurocysticercosis in a developing country.
        Clinical Infectious Diseases. 1999; 29: 1203-1209
        • Pal D.K
        • Carpio A
        • Sander J.W
        Neurocysticercosis in developing countries.
        Journal of Neurology, Neurosurgery and Psychiatry. 2000; 68: 137-143
        • Joshi V
        • Katiyar B.C
        • Mohan P.K
        • et al.
        Profile of epilepsy in a developing country: A study of 1000 patients based on the international classification.
        Epilepsia. 1977; 18: 549-553
        • Senanayake N
        • Roman G.C
        Epidemiology of epilepsy in developing countries.
        World Health Organisation Bulletin. 1993; 71: 247-258
        • Gracia F
        • Loo de Lao S
        • Castillo L
        • et al.
        Epidemiology of epilepsy in Guaymi Indians from Bocas del Toro province, Republic of Panama.
        Epilepsia. 1990; 31: 718-723
        • Ogunniyi A
        • Osuntokum B.O
        • Bademosi O
        • et al.
        Risk factors for epilepsy: case-control study in Nigerians.
        Epilepsia. 1987; 28: 280-285
        • Nelson K.B
        • Ellenberg J.H
        Predisposing and causative factors in childhood epilepsy.
        Epilepsia. 1987; 28 (Suppl. 1): 16-24
        • Asindi A.A
        • Antia-Obong O.E
        • Ibia E.O
        • et al.
        Neonatal seizures in Nigerian infants.
        African Journal of Medicine and Medical Science. 1995; 24: 243-248
        • Schaumann B.A
        Family history of seizures in post-traumatic and alcohol associated seizure disorders.
        Epilepsia. 1994; 35: 48-52
        • Gajana A
        • Thenmozhi V
        • Samuel P.P
        • et al.
        A community-based study of subclinical flavivirus infections in children in an area of Tamil Nadu, India, where Japanese encephalitis is endemic.
        Bulletin of the World Health Organisation. 1995; 73: 237-244
        • Bale J.F
        Viral encephalitis.
        Medical Clinics of North America. 1993; 77: 25-42
        • Fikree F.F
        • Gray R.H
        Demographic survey of the level and determinants of perinatal mortality in Kararchi, Pakistan.
        Paediatrics and Perinatal Epidemiology. 1996; 10: 86-96
        • Kunzel W
        • Herrero J
        • Onwuhafua P
        • et al.
        Maternal and perinatal health in Mali, Togo and Nigeria.
        European Journal of Obstetrics, Gynaecology and Reproductive Biology. 1996; 69: 11-17
      1. World Bank. World Development Report 1993: Investing in Health, Oxford University Press, New York, USA

        • Erinoso H.O
        • Akinbami F.O
        • Akinyinka O.O
        Prognostic factors in severely malnourished hospitalised Nigerian children.
        Tropical and Geographical Medicine. 1993; 45: 290-293
        • Caddell J.L
        Magnesium in protein-calorie malnutrition.
        Journal of Pediatrics. 1965; 66: 392-411
        • Anonymous
        Magnesium and Malnutrition.
        The Lancet. 1967; 1: 712-713
        • Antener I
        • Verwilghen A.M
        • Van Geert C
        • et al.
        Study of malnutrition III. Biochemical assessment of the dietary treatment and evolution of the illness.
        Helvetica Paediatrica Acta. 1978; 33: 543-562
        • Leaver D.D
        • Parkinson G.B
        • Schneider K.M
        Neurological consequences of magnesium deficiency: correlations with epilepsy.
        Clinical and Experimental Pharmacology and Physiology. 1987; 14: 361-370
        • Wharton B
        Hypoglycaemia in children with kwashiorkor.
        The Lancet. 1970; i: 171-173
        • Bennish M.L
        • Azad A.K
        • Rahman O
        • et al.
        Hypoglycemia during diarrhoea in childhood.
        New England Journal of Medicine. 1990; 322: 1357-1363
        • Kumar S
        • Berl T
        Electrolyte quintet, Sodium.
        The Lancet. 1998; 352: 220-228
        • Bushinsky D.A
        • Monk R.D
        Electrolyte quintet, calcium.
        The Lancet. 1998; 352: 306-311
        • Back E.H
        • Montgomery R.D
        • Ward E.E
        Neurological manifestations of magnesium deficiency in infantile gastro-enteritis and malnutrition.
        Archives of Diseases of Childhood. 1961; 37: 106-109
        • Sperling M.R
        Hypoglycemic activiation of focal abnormalities in the EEG of patients considered for temporal lobectomy.
        Electroencephalography and Clinical Neurophysiology. 1984; 58: 506-512
        • Wood J.H
        • Hare T.A
        • Glaeser B.S
        • et al.
        Low cerebrospinal fluid gamma aminobutyric acid content in seizure patients.
        Neurology. 1979; 29: 1203-1208
        • Van Gelder N.M
        • Sherwin A.L
        • Rasmussen T
        Amino acid content of epileptogenic human brain.
        Brain Research. 1972; 40: 385-393
        • Perry T.L
        • Hansen S
        • Kennedy J
        • et al.
        Amino acids in human epileptogenic foci.
        Archives of Neurology. 1975; 32: 752-754
        • Smith S.R
        • Pozefsky T
        • Chhetri M.K
        Nitrogen and amino acid metabolism in adults with protein-calorie malnutrition.
        Metabolism. 1974; 23: 603-618
        • Agarwal K.N
        • Bhatia B.D
        • Batta R.K
        • et al.
        Erythrocytic enzymes and amino acids related to glutamic acid metabolism in childhood hypoproteinemic states.
        American Journal of Clinical Nutrition. 1981; 34: 924-927
        • Bohlen P
        • Huot S
        • Palfreyman M.G
        The relationship between GABA concentration in the brain and cerebrospinal fluid.
        Brain Research. 1979; 167: 297-305
        • Chapman A.G
        Amino acid abnormalities in plasma, CSF and brain in epilepsy.
        in: Pedley T.A Meldrum B.S Recent Advances in Epilepsy, No. 4. Churchill Livingstone, London1988
        • Davson H
        • Welch K
        • Segal M.B
        The Physiology and Pathophysiology of the Cerebrospinal Fluid. Churchill Livingstone, Edinburgh1987
        • Andrade J.P
        • Paula-Barbosa M.M
        Protein malnutrition alters the cholinergic and GABAergic systems of the hippocampal formation of the adult rat: an immunocytochemical study.
        Neuroscience Letters. 1996; 211: 211-215
        • Lehmann A
        • Hamberger A
        Extracellular levels of amino acids in epilepsy: methods and findings.
        in: Fisher R.S Coyle J.T Neurotransmitters and Epilepsy. Wiley-Liss, New York1991
        • Stern W.C
        • Forbes W.B
        • Resnick O
        • et al.
        Seizure susceptibility and brain amine levels following protein malnutrition during development in the rat.
        Brain Research. 1974; 79: 375-384
        • Forbes W.B
        • Stern W.C
        • Tracy C.A
        • et al.
        Effect of chronic protein malnutrition on experimentally induced seizures in the rat.
        Experimental Neurology. 1978; 62: 475-481
        • Palencia G
        • Calvillo M
        • Sotelo J
        Chronic malnutrition caused by a corn-based diet lowers the threshold for pentylenetetrazol-induced seizures in rats.
        Epilepsia. 1996; 37: 583-586
        • Levav M
        • Cruz M.E
        • Mirsky A.F
        EEG abnormalities, malnutrition, parasitism and goitre: a study of school children in Ecuador.
        Acta Paediatrica. 1995; 84: 197-202
        • Waterlow J.C
        Current issues in nutritional assessment by anthropometry.
        in: Brozek J Schurch B Malnutrition and Behaviour: Critical Assessment of Key Issues. Nestle Foundation, Lausanne1984: 77-90
        • Dike G.L
        Severe malnutrition due to subtle neurologic deficits and epilepsy: report of three cases.
        East African Medical Journal. 1999; 76: 597-598
        • Weber G.F
        • Maertens P
        • Meng X
        • et al.
        Glutathione peroxidase deficiency and childhood seizures.
        The Lancet. 1991; 337: 1443-1444
        • Ramaekers VTh
        • Calomme M
        • Vanden Berghe D
        • et al.
        Selenium deficiency triggering intractible seizures.
        Neuropediatrics. 1994; 25: 217-223
        • Rayman M.P
        The importance of selenium to human health.
        The Lancet. 2000; 356: 233-241
        • Chandra R.K
        Nutrition and the immune system: an introduction.
        The American Journal of Clinical Nutrition. 1997; 66: 460S-463S