Epilepsy, poverty and early under-nutrition in rural Ethiopia

Six in ten children with epilepsy visiting the University of Gondar comprehensive specialized hospital were undernourished: a cross-sectional study

Background

The burden of undernutrition among children with epilepsy in low- and middle-income countries is not well studied. This study aimed to assess the magnitude of undernutrition and associated factors among children with epilepsy at the University of Gondar Comprehensive and Specialized Hospital, Northwest Ethiopia.

Method

A single-center cross-sectional study was conducted on 239 epileptic children with epilepsy visiting the University of Gondar Comprehensive Specialized Hospital pediatric neurology clinic from June 2021 to September 2021. A pre-tested, researcher-administered questionnaire and medical record review were used for data collection. We included all participants who fulfilled the inclusion criteria. We did anthropometric measurements and defined undernutrition based on the world health organization criteria. Binary and multivariable logistic regressions were employed to determine factors associated with undernutrition. The statistical association between dependent and independent variables was declared at p-value of ≤ 0.05.

Result

The mean(+/-SD) age was 9.38 ± 0.29 years, with a male to female ratio of 1.8: 1, and school-age children account for 35.6%. The overall magnitude of undernutrition was 141(59%) of which 89(63.1%) had moderate to severe stunting, 91(64.5%) moderate to severe wasting, and 39(27.7%) had both. Being male (AOR = 1.96, 95%CI, 1.05–3.69), low paternal level of education (AOR = 1.88, 95%CI, 1.01–3.50), presence of delay in motor development (AOR = 5.91,95%CI, 1.55–22.49), and gum hyperplasia (AOR = 0.32,95%CI, 0.12–0.81), were significantly associated with undernutrition.

Conclusion

The magnitude of undernutrition among children with epilepsy was high. Male sex, low paternal level of education, presence of delay in motor development, and gum hyperplasia were significantly associated with undernutrition. Therefore, nutritional screening and intervention are recommended to be part of routine epileptic care.

Seizure control status and associated factors among pediatric epileptic patients at a neurologic outpatient clinic in Ethiopia

BACKGROUND

Childhood epilepsy is a major public health problem worldwide. Even though anti-seizure medications (ASM) have been demonstrated to control seizures, children with epilepsy continue to have frequent seizures. There is a scarcity of data on seizure control status among pediatric epileptic patients in Ethiopia. The aim of this study was to assess seizure control status and associated factors among pediatric epileptic patients.

METHODS

A hospital based cross-sectional study was done on 261 pediatric epileptic patients being followed up at the University of Gondar Comprehensive and Specialized Hospital, Northwest Ethiopia, from May 11 to August 11, 2019. The data were collected through caregiver interviews and patients' medical records. All independent variables with p value of ≤ 0.2 in univariate analysis were taken to multivariable analysis. Adjusted odds ratio (AOR) with a 95% confidence interval was computed to see the predictors of seizure control status. Level of statistical significance was declared if p-value < 0.05.

RESULT

From a total of 261 patients, 159 (60.9%) were males and had a mean age was 10.16 ± 4.62 years. More than half (57.1%) of participants were urban dwellers. Almost all (98.5%) were diagnosed with generalized tonic-clonic seizures. Majority (75.1%) of the patients were on mono-therapy. Forty-six (17.6%) of the patients reported adverse effects related to ASMs. Two hundred-three (77.8%) of the patients were adherent to their medications. Nearly half (49.0%) of the patients had controlled seizures. Urban residency (AOR: 2.12; 95% CI: 1.15-3.89; P = 0.016), adherence to medication (AOR: 3.92; 95% CI: 1.84-8.36; P < 0.001), use of combined ASM(AOR: 0.29; 95% CI: 0.14-0.59; P = 0. 001), durations of ASM use [2-5 years (AOR: 5.81; 95% CI: 2.89-11.70; P <0.001) and >5years (AOR: 4.80; 95% CI: 1.91-12.09; P = 0.001)]were significantly associated with seizure control status.

CONCLUSION

Inadequate numbers of pediatric epileptic patients' at the Ethiopian neurologic clinic achieved seizure control. Coming from a rural area, non-adherence to ASMs, use of multiple ASMs, and the use of ASMs for <2years were found to have a significant association with poorer seizure control, needing special attention to get control of seizure. Caregivers should closely monitor and address any barriers that contribute to ASM non-adherence and adverse drug events.

An epidemiological survey of epilepsy in tropical rural areas of China

OBJECTIVE

Epilepsy is a chronic neurological disease that is characterized by seizures. Seizure episodes, stigma, and high medical costs associated with this condition caused significant psychological distress. This study aimed to evaluate epidemiological characteristics and treatment status of epilepsy in individuals existing in the tropical rural areas of Hainan Province of China.

METHODS

A household survey on epilepsy was conducted among the rural population of Chengmai County, Danzhou City, Baoting Autonomous County (Li and Miao nationalities), and Dingan County in Hainan Province, China. A screening questionnaire based on the standard screening questionnaires of the World Health Organization (WHO) was designed and a screening instrument of International Community-based Epilepsy Research Group was used. Individuals suspected or previously diagnosed with epilepsy were reexamined by an experienced neurologist. Further clinical data were collected from subjects with confirmed diagnosis of epilepsy.

RESULTS

This study included 16 676 subjects with 8827 men (52.93%) and 7849 women (47.07%). Majority of the study subjects included were of Han Chinese (N = 13 145, 78.83%), and the remaining were of Li minority ethnicity. The incidence of epilepsy was 0.24 per 1000, and the total prevalence of active epilepsy was 2.33 per 1000. The prevalence of epilepsy in the Han and Li nationalities was 3.27 and 2.27 per 1000, respectively, which was shown to be higher in people aged ≥ 60. The initial onset of epilepsy tended to trigger among children aged between 0 and 9 years old. Initial assessment revealed that the treatment gap for active epilepsy was 58.97%, and stroke is shown as the most common cause of symptomatic epilepsy.

SIGNIFICANCE

The prevalence and incidence of epilepsy in tropical rural areas of Hainan Province were close to those of the earlier findings that are reported in other regions of China and lower than those remaining in the tropical areas around the world. There exists a huge treatment gap for active epilepsy, which indicates an urgent need for a rational intervention strategy.

Malnutrition Essentials for Neurologists and Neurosurgeons: A Review of the Literature

Malnutrition still causes deaths in the world today and protein energy malnutrition (PEM) is characterized by increased oxidative stress, immune deficiency, and development of various infections. Even today, however, it is an underrecognized and undertreated entity in neurology and neurosurgery. In this article, we therefore seek to review the available literature regarding various factors affecting surgical outcome of children with malnutrition undergoing some neurosurgical interventions including shunt surgery and traumatic brain injury in intensive care unit, in addition to its effects upon oxidative stress status and immunity. Furthermore, we attempt to provide essential knowledge of malnutrition affecting surgical outcome of patients with PEM. Based on available evidence in the published literature, it is concluded that it is a serious public health problem characterized by increased oxidative stress, immune deficiency, and development of various infections.

Onchocerciasis-associated epilepsy in the Democratic Republic of Congo: Clinical description and relationship with microfilarial density

Background

High epilepsy prevalence and incidence were observed in onchocerciasis-endemic villages in the Democratic Republic of Congo (DRC). We investigated the clinical characteristics of onchocerciasis-associated epilepsy (OAE), and the relationship between seizure severity and microfilarial density.

Methods

In October 2017, ivermectin-naive persons with epilepsy (PWE) were recruited from onchocerciasis-endemic areas in the Logo health zone in the DRC. Additional PWE were enrolled in the Aketi health zone, where ivermectin had been distributed annually for 14 years. Past medical history, clinical characteristics and skin snips for Onchocerca volvulus detection were obtained from participants. Bivariate and multivariable analyses were used to investigate associations with microfilarial density.

Results

Of the 420 PWE in the Logo health zone, 392 were skin snipped (36.5% positive). Generalized motor seizures were most frequent (392 PWE, 93.3%), and nodding seizures were reported in 32 (7.6%) participants. Twelve PWE (3.1%) presented Nakalanga features. Sixty-three (44.1%) skin snip-positive PWE had a family history of epilepsy, compared to only 82 (32.9%) skin snip-negative PWE (p = 0.027). Eighty-one onchocerciasis-infected PWE were recruited in the Aketi health zone. Positive correlations between seizure frequency and microfilarial density were observed in Logo (Spearman-rho = 0.175; p<0.001) and Aketi (Spearman-rho = 0.249; p = 0.029). In the multivariable model adjusted for age, gender, and previous treatment, high seizure frequency was associated with increasing microfilarial density in Aketi (p = 0.025) but not in Logo (p = 0.148).

Conclusion

In onchocerciasis-endemic regions in the DRC, a wide spectrum of seizures was observed. The occurrence of Nodding seizures and Nakalanga features, as well as an association between seizure severity and O. volvulus microfilarial density suggest a high OAE prevalence in the study villages.

Trial registration

ClinicalTrials.gov NCT03052998.

Several epidemiological surveys suggest that onchocerciasis (a disease resulting from an infection with the parasite Onchocerca volvulus) is a cause of epilepsy. We conducted a study to describe the clinical characteristics of persons with epilepsy (PWE) living in onchocerciasis-endemic villages in the Democratic Republic of Congo. In some study sites, the frequency of seizures increased with increasing number of O. volvulus microfilariae detected in the skin snips of participants. A wide spectrum of seizures was observed, including generalized tonic-clonic seizures, absence seizures, and focal seizures. Growth retardation and household clustering of PWE were common. Specific clinical presentations such as nodding seizures and Nakalanga features were encountered. These results suggest a high prevalence of onchocerciasis-associated epilepsy (OAE) in the study villages.

Community perceptions of epilepsy and its treatment in an onchocerciasis endemic region in Ituri, Democratic Republic of Congo

Background

A recent study in the Logo and Rethy health zones in the Ituri Province in the Democratic Republic of Congo (DRC) reported that the majority of the persons with epilepsy (PWE) had not been treated with anti-epileptic medication (AEM) or had stopped treatment. Prior to the implementation of an epilepsy treatment programme in these health zones, this study investigated the perceptions and experiences regarding epilepsy and its treatment amongst community leaders, PWE and/or their families, traditional healers and health professionals.

Methods

A total of 14 focus group discussions (FGD) and 39 semi-structured interviews (SSI) were conducted with PWE and/or their family members, community leaders, traditional healers, and health professionals in the Logo and Rethy health zones during February 2–19, 2017.

Results

In the two health zones, the clinical signs of convulsive epilepsy were recognized by community members. However, a variety of misconceptions about epilepsy were identified including the beliefs that epilepsy is a family-related condition, a contagious disease, is transmitted by insects, saliva or by touching a person of the same sex during seizures, or is caused by evil spirits and witchcraft. The role of traditional healers in spreading these beliefs was revealed. The study also reported sexual abuse on PWE, stigmatisation of PWE and loss of productivity of PWE and their families. Some PWE had been using AEM and traditional treatment but were not convinced about the efficacy of these treatment options. The lack of training of health providers about epilepsy care, financial barriers in obtaining AEM, and the shortage of AEM at primary health facilities were revealed. As remedies, the community requested access to a decentralized center for epilepsy treatment. They also proposed using churches and community health workers as communication channels for information about epilepsy.

Conclusions

Clinical signs of convulsive epilepsy were recognized by the community in the Logo and Rethy health zones but many misconceptions about epilepsy were identified. A comprehensive community-based epilepsy treatment programme with an affordable uninterrupted AEM supply needs to be established. Such a programme should address stigma, misconceptions, sexual abuse and foster the rehabilitation of PWE to alleviate poverty.

Socioeconomic Status and Pediatric Neurologic Disorders: Current Evidence

Socioeconomic status (SES) is an important risk factor for many neurological disorders and a determinant of health outcomes and quality of life, especially for individuals with neurologic disorders and developmental disabilities. This article focuses on the relationship between SES and pediatric epilepsy, cerebral palsy, autism spectrum disorder, and intellectual disability. Disparities in the prevalence and long-term impact of SES on functioning in persons with disabilities are observed worldwide. Clinicians can use the information presented in the article to target early identification and interventions for improving outcomes in populations most at risk for these disorders and for poor health, social, and economic outcomes.

Frequency of seizure attack and associated factors among patients with epilepsy at University of Gondar Referral Hospital: a cross-sectional study, Gondar, North West Ethiopia, 2017

Objective

About three-fourth of adults with new-onset epilepsy become seizure-free with current anti-epileptic drugs, but around one-fourth of the patients continue to experience seizure which increases the risk of accident, disability, death and treatment side effects. Therefore, this study aimed to address the gap in determining the magnitude of the number of seizure attacks and identify the factors that provoke a repeated seizure in a patient with epilepsy.

Results

A total of 166(40.68%) study participants were experienced seizure attacks with a minimum of one and a maximum of seventeen times attacks. Perceived exposure to noise (adjusted incidence risk ratio (AIRR) = 1.91, 95% confidence interval (CI) [1.46, 2.49]), light (AIRR = 1.48, 95% CI [1.09, 2.00]), head injury (AIRR = 1.71, 95% CI [1.14, 2.57]) and sleep deprivations (AIRR = 1.41, 95% CI [1.02, 1.94]) were associated with increased incidence of seizure, while adherence adjusted odds ratio (AOR) = 18.18, 95% CI [3.49, 94.63]), being in middle wealth index (AOR = 3.52, 95% CI [1.14, 11.02]) and being in rich wealth index (AOR = 4.05, 95% CI [1.54, 10.69]) were associated with inflation of zero count.

Psychosocial challenges affecting the quality of life in adults with epilepsy and their carers in Africa: A review of published evidence between 1994 and 2014

BACKGROUND

Little attention has been paid to the psychosocial challenges of adult patients with epilepsy and their carers in Africa in published studies conducted between 1994 and 2014 - yet these psychosocial challenges have been reported to have a major impact on the quality of life (QOL) of people living with the illness and those who care for them.

AIM

This review aimed to examine the literature on published studies conducted in Africa between 1994 and 2014 that examined psychosocial challenges of adult people with epilepsy and their carers. The aim was to examine the kind of psychosocial challenges from published evidence and to identify gaps in current knowledge.

METHODS

MEDLINE, PubMed, ERIC, Web of Science, Scopus, Cochrane Library, Africa Wide, PsycINFO, EMBASE, PASCAL, SABINET and Google Scholar databases and hand searches of Epilepsy & Behavior, Epilepsia, South African Medical Journal, African Journal of Disability, African Journal of Primary Health Care and Family Medicine were reviewed.

RESULTS

Very few studies in Africa have examined psychosocial challenges affecting the adult patients with epilepsy and their carers. This review reported the existence of evidence of such challenges and the insights into the psychosocial and economic factors that underpin them. There is evidence that where these have been addressed, there were valuable insights on the types of psychosocial, socio-cultural and socio-economic challenges. Collaborative empowering interventions are needed to enable the attainment of good QOL for those affected.

CONCLUSION

Research on psychosocial challenges of adult patients with epilepsy and their carers from different sectors of healthcare to inform the design of appropriate models is needed.

Distribution and Potential Indicators of Hospitalized Cases of Neurocysticercosis and Epilepsy in Ecuador from 1996 to 2008

Background

Epilepsy is one of the most common signs of Neurocysticercosis (NCC). In this study, spatial and temporal variations in the incidence of hospitalized cases (IHC) of epilepsy and NCC in Ecuadorian municipalities were analyzed. Additionally, potential socio-economic and landscape indicators were evaluated in order to understand in part the macro-epidemiology of the Taenia solium taeniasis/cysticercosis complex.

Methodology

Data on the number of hospitalized epilepsy and NCC cases by municipality of residence were obtained from morbidity-hospital systems in Ecuador. SatScan software was used to determine whether variations in the IHC of epilepsy and NCC in space and time. In addition, several socio-economic and landscape variables at municipality level were used to study factors intervening in the macro-epidemiology of these diseases. Negative Binomial regression models through stepwise selection and Bayesian Model Averaging (BMA) were used to explain the variations in the IHC of epilepsy and NCC.

Principal findings

Different clusters were identified through space and time. Traditional endemic zones for NCC and epilepsy, recognized in other studies were confirmed in our study. However, for both disorders more recent clusters were identified. Among municipalities, an increasing tendency for IHC of epilepsy, and a decreasing tendency for the IHC of NCC were observed over time. In contrast, within municipalities a positive linear relationship between both disorders was found. An increase in the implementation of systems for eliminating excrements would help to reduce the IHC of epilepsy by 1.00% (IC_95%; 0.2%–1.8%) and by 5.12% (IC_95%; 3.63%-6.59%) for the IHC of NCC. The presence of pig production was related to IHC of NCC.

Conclusion/Significance

Both disorders were related to the lack of an efficient system for eliminating excrements. Given the appearance of recent epilepsy clusters, these locations should be studied in depth to discriminate epilepsies due to NCC from epilepsies due to other causes. Field studies are needed to evaluate the true prevalence of cysticercosis in humans and pigs in different zones of the country in order to better implement and manage prevention and/or control campaigns.

T. solium neurocysticercosis is considered the most important parasitic disease of the central nervous system in humans; it is estimated to be responsible for at least one third of acquired epilepsies in developing countries. In Ecuador, the relationship between acquired epilepsy and neurocysticercosis remains unclear due to different factors such as, the lack of specialized health care personnel, appropriate diagnostic techniques and the fact that acquired epilepsy is characteristic of many other infectious and non-infectious diseases in the endemic zones of the country. In this study, spatio-temporal information and potential socio-economic indicators were studied for the number of hospitalized neurocysticercosis and epileptic cases in the country in order to locate and characterize important clusters in space and time. This study identified traditional endemic clusters in the highlands for both conditions as well as new clusters appearing in recent years in other zones not considered endemic. Also the incidence of hospitalized cases of epilepsy and neurocysticercosis were significantly higher in urban zones, probably due to a better access to health facilities. The presence of systems for excrement disposal was significantly associated with a reduction in the incident cases for both epilepsy and neurocysticercosis. More studies are needed to evaluate the true prevalence of neurocysticercosis associated epilepsy in humans and cysticercosis in pigs around the country in order to better implement and manage control campaigns.

Evaluation of malnutrition in patients with nervous system disease

Nutritional deficiencies are independent risk factors for adverse outcomes in patients with nervous system disease. Patients with nervous system disease can often become malnourished due to swallowing difficulties or unconsciousness. This malnourishment increases hospitalization duration; average total hospital cost; occurrence of infection, pressure ulcers, and other complications. These problems need to be addressed in the clinic. In this paper, we review the relevant literature, including studies on influencing factors, evaluations, indexes, and methods: Our aim is to understand the current status of malnutrition in patients with nervous system disease and reasons associated with nutritional deficiencies by using malnutrition evaluation methods to assess the risk of nutritional deficiencies in the early stages.