Spectrum of movement disorders in Malaria: a systematic review of case reports, case series, and cohort studies.

backgroundMovement disorders associated with malaria are often underrecognized. This review aimed to systematically assess their types, onset patterns, and clinical outcomes.

methodsWe systematically searched major databases for case reports, case series, and cohort studies describing movement disorders in malaria patients. Data were extracted on demographics, Plasmodium species, clinical presentation, imaging, treatment, and outcomes. PRISMA guidelines were followed throughout.

resultsA total of 86 individual cases were identified from 72 case reports/series, along with 12 cohort studies were also reviewed. Among individual cases, Plasmodium falciparum was implicated in 75%, and P. vivax in 20%. Cerebellar ataxia was the most common movement disorder, reported in 52% of cases, often appearing 7-21 days after fever resolution. Tremor (16%), dystonia (9%), and chorea (7%) were also documented. Extrapyramidal symptoms, including acute dystonia and rigidity, were observed in 43 children and adolescents treated with artesunate-amodiaquine, with a median onset of 2 days post-treatment. Neuroimaging was normal in 68% of cases, while Cerebrospinal fluid findings were nonspecific. Most patients recovered completely within 1-4 months; however, 4 cases required prolonged rehabilitation. Twelve cohort studies linked malaria, especially Plasmodium falciparum, to movement disorders like cerebellar ataxia. Most cases were immune-mediated with full recovery. Extrapyramidal effects and posturing also occurred, highlighting the importance of drug monitoring.

conclusionsMovement disorders in malaria are rare but clinically significant. They may occur during acute illness or weeks later, often linked to Plasmodium falciparum or antimalarial drugs. Early identification and supportive care usually lead to favorable outcomes.