A 50-year-old Nigerian man was admitted for generalized non febrile seizures. Two weeks before his GP prescribed antimalaric prophilaxis with clorochine for a planned trip in his home country. He suffered of a minor stroke 2 years before with no residual disability. He had also history of arterial hypertension treated with ace inhibitors and aspirin. At admission he was treated with lorazepam i.v. for a second generalized crisis at admission, and started carbamazepine 1000 per day. No other critical events were found during in hospital staying. A CT scan demonstrated the known subcortical right hemispheric hypodensity with no sulcal effacement or swelling features. Three months later carbamazepine was gradually intterrupted. After few months a new trip to Lagos was planned and chosen an antimalaric prophilaxis with Proguanil/Atovaquone (Malarone). The drug was well tolerated and no side effects were detected.

Take home message:
while choosing antimalaric prophilaxis a medical history of stroke and TIA may encourage the use of non epileptogenic drugs.