PMC5913365_01
Left side of the picture shows malaria endemic areas in Thailand (adapted from Malaria Atlas Project: http://www.map.ox.ac.uk/browse-resources/transmission-limits/Pf_limits/THA/). Yellow stars represent areas where the present case lived at the time of being infected with malaria. Areas in red have annual case incidence of malaria to likely exceed 1 per 10,000. Right side of the picture shows a timeline of disease development and clinical course of chronic epilepsy after cerebral malaria.
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One month later, he moved to Kanchanaburi Province, another malaria endemic area, as shown in Fig. 1.
Top right pictures are Fluid Attenuation Inversion Recovery (FLAIR) sequence MRIs in coronal views showing definite left hippocampal sclerosis and few tiny areas of increased signal intensity in subcortical white matter of bilateral frontal lobes. Bottom right pictures reveals interictal epileptiform discharges (IEDs) noted at O2, T5-O1, F8-FT10, and F7-FT9. Most pronounced IEDs are noted at O2, followed by T5-O1. Top left picture represents the majority (six out of seven recorded seizures) of the ictal EEG onset (antero-posterior bipolar montage, low-frequency filter 1 Hz, high-frequency filter 70 Hz, paper speed 15 mm/s, sensitivity 15 muV/mm) where they arise from left temporal region in the form of medium-amplitude rhythmic theta activity. Bottom left picture shows contradictory ictal EEG onset over right temporal region during one seizure (seizure # 5).
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Magnetic resonance imaging (MRI) revealed left hippocampal sclerosis and non-specific subcortical white matter changes in bilateral frontal lobes, as shown in Fig. 2. Electrophysiologically, either voltage attenuation or rhythmic theta activity over left temporal region at ictal EEG onset was observed during six seizures, as shown in Fig. 2. Most pronounced interical epileptiform discharges (IEDs) were appreciated at O2 (50%), followed by T5O1 (20%), shown in Fig. 2.