This is a case of epilepsy secondary to cerebral malaria. The causes of epilepsy are multiple but the commonest in the sub-Saharan African setting are infections like malaria and onchocerciasis. This patient got convulsions in early childhood but later developed overt epilepsy as described above. The sequel of cerebral malaria may not be evident immediately after the infection but may occur years later. This patient she suffered the cerebral malaria at 4 years of age but the epilepsy developed at 9 years of age, 5 years later after the cerebral malaria.

When a child develops a chronic condition like epilepsy, their concentration and academic performance is often affected and many quit school as was this case. If they are still at school, many miss class. In this case, this was made worse by the fact that she used to be segregated at school and no one wanted to sit next to her in class, this is because in the African setting epilepsy is considered as a curse and the sufferers are often stigmatized and treated as outcasts in the community, even in their own homes.

There are several myths about epilepsy in the African setting. For example in Uganda there is a myth that the saliva of an epileptic is highly infectious. This translates into being avoided by others in fear of being infected. If an epileptic happens to get a fit even on a busy street, no one comes to his or her rescue due to such myths. In many African settings including Uganda, people have a tendency to seek alternative modes of treatment especially if diagnosed with chronic illnesses with no cure. This was seen in this patient who first sought treatment from traditional healers where she obtained herbs because the illness was attributed to witchcraft from the step mother.

In order to make a diagnosis of epilepsy, a high index of suscipicion is required as there are often no findings on examination or laboratory tests. In this patient the diagnosis was made basing on the history, In most Low and Middle Income Countries (LMIC) as are found in sub-Sahara Africa sophisticated investigations are not usually available, and in centers where they are available the cost is often prohibitive, forcing the clinician to rely on his/her clinical acumen. In epilepsy investigations, the EEG is informative in only 25–50 % of cases. The EEG confirmed the diagnosis in this patient. One also needs to carry out a series of investigations to look for any possible etiological factors responsible for the condition or at least to exclude them, e.g. HIV or Syphilis serology. Classifying the type of seizure is useful in making the choice of drug for the patient. Thus focal seizures tend to do well on Carbamazepine or Sodium valproate. This patient responded well to Carbamazepine. Management is usually by psychiatrists and neurologists and is biological. However involving psychologists, social workers, nurses and mental health counselors is very important for the patient’s and family’s psycho-education and support.