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. 2017 Jun 2:2:13.
doi: 10.12688/wellcomeopenres.10658.2. eCollection 2017.

Antimalarial drugs and the prevalence of mental and neurological manifestations: A systematic review and meta-analysis

Mary A Bitta  1 , Symon M Kariuki  1 , Clifford Mwita  2   3 , Samson Gwer  3   4 , Leah Mwai  3 , Charles R J C Newton  1   5
Affiliations

Antimalarial drugs and the prevalence of mental and neurological manifestations: A systematic review and meta-analysis

Mary A Bitta et al. Wellcome Open Res. .

Abstract

Background: Antimalarial drugs affect the central nervous system, but it is difficult to differentiate the effect of these drugs from that of the malaria illness. We conducted a systematic review to determine the association between anti-malarial drugs and mental and neurological impairment in humans. Methods: We systematically searched online databases, including Medline/PubMed, PsychoInfo, and Embase, for articles published up to 14th July 2016. Pooled prevalence, heterogeneity and factors associated with prevalence of mental and neurological manifestations were determined using meta-analytic techniques. Results: Of the 2,349 records identified in the initial search, 51 human studies met the eligibility criteria. The median pooled prevalence range of mental and neurological manifestations associated with antimalarial drugs ranged from 0.7% (dapsone) to 48.3% (minocycline) across all studies, while it ranged from 0.6% (pyrimethamine) to 42.7% (amodiaquine) during treatment of acute malaria, and 0.7% (primaquine/dapsone) to 55.0% (sulfadoxine) during prophylaxis. Pooled prevalence of mental and neurological manifestations across all studies was associated with an increased number of antimalarial drugs (prevalence ratio= 5.51 (95%CI, 1.05-29.04); P=0.045) in a meta-regression analysis. Headaches (15%) and dizziness (14%) were the most common mental and neurological manifestations across all studies. Of individual antimalarial drugs still on the market, mental and neurological manifestations were most common with the use of sulphadoxine (55%) for prophylaxis studies and amodiaquine (42.7%) for acute malaria studies. Mefloquine affected more domains of mental and neurological manifestations than any other antimalarial drug. Conclusions: Antimalarial drugs, particularly those used for prophylaxis, may be associated with mental and neurological manifestations, and the number of antimalarial drugs taken determines the association. Mental and neurological manifestations should be assessed following the use of antimalarial drugs.

Keywords: Antimalarial drugs; Mental and neurological manifestations; Meta-Analysis; Systematic review; Toxicity.

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Conflict of interest statement

Competing interests: The authors declare that they have no competing interests.

Figures

Figure 1.
Figure 1.. Study selection process.
Figure 2.
Figure 2.. Forest plot of the prevalence of mental and neurological manifestations in studies included in the meta-analysis.
Figure 3.
Figure 3.. A funnel plot of bias of the selected studies.
See this image and copyright information in PMC

References

    1. Kariuki SM, Ikumi M, Ojal J, et al. : Acute seizures attributable to falciparum malaria in an endemic area on the Kenyan coast. Brain. 2011;134(Pt 5):1519–28. 10.1093/brain/awr051 - DOI - PMC - PubMed
    1. Carter JA, Ross AJ, Neville BG, et al. : Developmental impairments following severe falciparum malaria in children. Trop Med Int Health. 2005;10(1):3–10. 10.1111/j.1365-3156.2004.01345.x - DOI - PubMed
    1. Birbeck GL, Molyneux ME, Kaplan PW, et al. : Blantyre Malaria Project Epilepsy Study (BMPES) of neurological outcomes in retinopathy-positive paediatric cerebral malaria survivors: a prospective cohort study. Lancet Neurol. 2010;9(12):1173–81. 10.1016/S1474-4422(10)70270-2 - DOI - PMC - PubMed
    1. Newton CR, Hien TT, White N: Cerebral malaria. J Neurol Neurosurg Psychiatry. 2000;69(4):433–41. 10.1136/jnnp.69.4.433 - DOI - PMC - PubMed
    1. Beny A, Paz A, Potasman I: Psychiatric problems in returning travelers: features and associations. J Travel Med. 2001;8(5):243–6. 10.2310/7060.2001.24019 - DOI - PubMed

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