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Anaje OD, Nwani PO, Nwosu MC, Asomugha LA, Anaje CC, Amaechi IA, Ebeogu OG, Oriji SO, Ndukwe CC, Eze LI, Morah NJ, Omaga IC, Ogunniyi A. Prevalence and Patterns of Seizure-related Injuries: A Study of People Living with Epilepsy Found in a Community-based Door-to-door Survey in Southeast Nigeria. Ann Afr Med 2024; 23:628-634. [PMID: 39138960 DOI: 10.4103/aam.aam_39_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/11/2024] [Indexed: 08/15/2024] Open
Abstract
CONTEXT Epileptic seizures and the unpredictable falls resulting from epileptic seizures predispose the people living with epilepsy (PLWE) to various physical injuries as well as postictal cognitive and behavioral changes. AIMS The aim of the study was to determine the frequency and patterns of seizure-related physical injuries, postictal cognitive impairments, and behavioral changes. SETTINGS AND DESIGN This was a cross-sectional descriptive study in a Southeast Nigeria local government area. SUBJECTS AND METHODS PLWE identified during a two-phase door-to-door survey and their caregivers were interviewed using a semi-structured questionnaire. STATISTICAL ANALYSIS USED The Statistical Package for the Social Sciences version 22.0 was used. RESULTS There were 56 cases of active convulsive seizures comprising 33 (58.9%) males and 23 (41.1%) females, with a mean age of 32.9 ± 14.2. The lifetime prevalence of seizure-related physical injuries, postictal behavioral changes, and postictal cognitive impairments was 9.8 per 1000 (95% confidence interval [CI]: 9.1-10.0), 8.4 per 1000 (95% CI: 7.2-9.2), and 6.3 per 1000 (95% CI: 4.9-7.5), respectively. Skin/soft-tissue injuries and tongue laceration were the most frequent physical injuries found in 66.1% ( n = 37/56) and 60.7% ( n = 34/56) of cases, respectively. The frequency of soft-tissue injuries was significantly higher (χ 2 = 5.038; P = 0.0248) in the females 78.3% ( n = 18/23) than the males 48.5% ( n = 16/33). About a third of the females 39.1% had burn injuries compared to 18.1% of the males. CONCLUSIONS Seizure-related injuries are common and have the tendency to increase the burden of epilepsy and epilepsy-related stigma from deformities and the chronic disfiguring scars resulting from such injuries.
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Affiliation(s)
- Obiora Daniel Anaje
- Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Paul Osemeke Nwani
- Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
- Department of Internal Medicine, Department of Mental Health, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Maduaburochukwu Cosmas Nwosu
- Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
- Department of Internal Medicine, Department of Mental Health, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Lasbrey Azuoma Asomugha
- Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
- Department of Internal Medicine, Department of Mental Health, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Chetanna Chioma Anaje
- Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Ifeoma Adaigwe Amaechi
- Department of Medical Rehabilitation, Department of Mental Health, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | | | - Sunday Onyemaechi Oriji
- Department of Psychiatry, Department of Mental Health, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Chinwe Chioma Ndukwe
- Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Linda Ifunanya Eze
- Department of Internal Medicine, Neurology Unit, Enugu State University of Science and Technology Teaching Hospital Parklane, Enugu, Nigeria
| | | | - Imelda Chinenye Omaga
- Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Adesola Ogunniyi
- Department of Internal Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
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Diallo SM, Diallo M, Barry I, Touré M, Barry M, Diallo M, Barry S, Aminou S, Othon GC, Diallo B, Camara N, Diallo M, Zoumanigui M, Lamah E, Hinima M, Mukesh S, Barry A, Sacko A, Singla R, Cissé F, Cissé A. Epileptic seizures revealing tuberous sclerosis in a tropical environment: A study of 12 case series. eNeurologicalSci 2024; 36:100516. [PMID: 39206163 PMCID: PMC11357778 DOI: 10.1016/j.ensci.2024.100516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 07/10/2024] [Accepted: 07/19/2024] [Indexed: 09/04/2024] Open
Abstract
Background Epilepsy remains a significant public health concern in Sub-Saharan Africa (SSA) where diverse etiological factors contribute to its prevalence. Among these factors are conditions originating from the neuroectoderm, such as tuberous sclerosis. Insufficient medical attention and a lack of comprehensive multidisciplinary care contribute to its under-recognition. Materials and methods We conducted a retrospective descriptive study, involving 12 patients admitted to the neurology and pediatric departments of the University Hospital Ignace Deen between 2010 and 2022 due to recurring epileptic seizures. Subsequently, these patients were diagnosed with Tuberous sclerosis using the Schwartz 2007 criteria. The aim of this study is to reassess this condition from a clinical and paraclinical point of view in a tropical environment. Results Tuberous sclerosis, also known as Bourneville disease, was diagnosed in 12 patients exhibiting focal motor seizures and complex focal seizures likely associated with cortical and subcortical tubers detectable by EEG and neuroimaging, including CT and MRI. Delayed treatment resulted in varying degrees of mental decline. Additionally, some patients displayed cardiac hamartomas and intracranial posterior and anterior aneurysms as minor diagnostic indicators. Conclusion The study reveals a consistent clinical presentation accompanied by deteriorating neurological and psychological symptoms attributed to delayed multidisciplinary management. These findings are utilized to assess therapeutic strategies and prognostic outcomes.
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Affiliation(s)
| | - Mamadou Diallo
- Neurology Department, Carle Foundation Hospital, Urbana, IL 61801, USA
| | - I.S. Barry
- Cardiology Department, Conakry University Hospital, Conakry, Guinea
| | - M.L. Touré
- Department of Neurology, Conakry University Hospital, Conakry, Guinea
| | - M.C. Barry
- Pediatric Department, Conakry University Hospital, Conakry, Guinea
| | - M.T. Diallo
- Department of Neurology, Conakry University Hospital, Conakry, Guinea
| | - S.D. Barry
- Department of Neurology, Conakry University Hospital, Conakry, Guinea
| | - S.Y. Aminou
- Department of Functional Rehabilitation and Acupuncture, Conakry University Hospital, Conakry, Guinea
| | - G. Carlos Othon
- Department of Neurology, Conakry University Hospital, Conakry, Guinea
| | - B. Diallo
- Medical Biology Department, Conakry University Hospital, Conakry, Guinea
| | - N. Camara
- Department of Neurology, Conakry University Hospital, Conakry, Guinea
| | - M.B. Diallo
- Department of Neurology, Conakry University Hospital, Conakry, Guinea
| | - M. Zoumanigui
- Department of Neurology, Conakry University Hospital, Conakry, Guinea
| | - E. Lamah
- Department of Neurology, Conakry University Hospital, Conakry, Guinea
| | - M. Hinima
- Department of Neurology, Conakry University Hospital, Conakry, Guinea
| | - Sindu Mukesh
- Liaquat University of Medical and Health Sciences, Jamshoro, Sindh 76090, Pakistan
| | - A.K.T. Barry
- Department of Neurology, Conakry University Hospital, Conakry, Guinea
| | - A. Sacko
- Radiology Department, Conakry University Hospital, Conakry, Guinea
| | - Ramit Singla
- Medical University of South Carolina, Columbia Downtown, SC 29204, USA
| | - F.A. Cissé
- Department of Neurology, Conakry University Hospital, Conakry, Guinea
| | - A. Cissé
- Department of Neurology, Conakry University Hospital, Conakry, Guinea
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Rezaei SJ, Cissé FA, Touré ML, Duan R, Rice DR, Ham AS, de Walque D, Mateen FJ. E = mc 2 : Education (E), medication (m), and conditional cash (c 2 ) to improve uptake of antiseizure medications in a low-resource population: Protocol for randomized trial. Epilepsia Open 2024; 9:445-454. [PMID: 38131270 PMCID: PMC10839367 DOI: 10.1002/epi4.12889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE Most people with epilepsy (PWE) could live seizure-free if treated with one or more antiseizure medications (ASMs). The World Health Organization (WHO) estimates that 75% of PWE in low-resource settings lack adequate antiseizure treatment. Limited education surrounding epilepsy and the out-of-pocket costs of ASMs in particular pose barriers to managing epilepsy in resource-poor, low-income settings. The aim of this study is to implement and test a novel strategy to improve outcomes across the epilepsy care cascade marked by (1) retention in epilepsy care, (2) adherence to ASMs, and (3) seizure reduction, with the measured goal of seizure freedom. METHODS A randomized, double-blinded clinical trial will be performed, centered at the Ignace Deen Hospital in Conakry, Republic of Guinea, in Western Sub-Saharan Africa. Two hundred people with clinically diagnosed epilepsy, ages 18 years and above, will receive education on epilepsy and then be randomized to (i) free ASMs versus (ii) conditional cash, conditioned upon return to the epilepsy clinic. Participants will be followed for 360 days with study visits every 90 days following enrollment. SIGNIFICANCE We design a randomized trial for PWE in Guinea, a low-resource setting with a high proportion of untreated PWE and a nearly completely privatized healthcare system. The trial includes a conditional cash transfer intervention, which has yet to be tested as a targeted means to improve outcomes for people with a chronic neurological disorder. The trial aims to provide an evidence base for the treatment of epilepsy in such settings. PLAIN LANGUAGE SUMMARY We present a clinical trial protocol for a randomized, blinded study of 200 people with epilepsy in the low-resource African Republic of Guinea, providing an educational intervention (E), and then randomizing in a 1:1 allocation to either free antiseizure medication (m) or conditional cash (c2 ) for 360 days. Measured outcomes include (1) returning to outpatient epilepsy care, (2) adherence to antiseizure medications (ASMs), and (3) reducing the number of seizures. This study is an initial look at giving small amounts of cash for desired results (or "nudges") for improving epilepsy outcomes in the sub-Saharan African and brain disorder contexts.
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Affiliation(s)
- Shawheen J. Rezaei
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Fodé Abass Cissé
- Department of NeurologyIgnace Deen Teaching HospitalConakryGuinea
| | | | - Rui Duan
- Department of BiostatisticsHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Dylan R. Rice
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Andrew Siyoon Ham
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | | | - Farrah J. Mateen
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
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Rice DR, Guelngar CO, Traoré M, Condé ML, Diallo D, Lee NJ, Ham AS, Cissé FA, Mateen FJ. Impact of a free medication intervention on seizure recurrence and anxious and depressive symptoms in people living with epilepsy in the Republic of Guinea. Trop Med Int Health 2024; 29:33-41. [PMID: 38031206 DOI: 10.1111/tmi.13950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
BACKGROUND AND OBJECTIVE Of ~5 million people living with epilepsy (PLWE) in Sub-Saharan Africa, roughly one-third experience depression and over one third experience anxiety. In Guinea, these issues may be compounded by fewer available resources, such as appropriate anti-seizure medications (ASMs). We aim to quantify seizure frequency, anxiety and depression in PLWE in Guinea, before and after a free ASM intervention and neurologist's consultation. METHODS Guinean participants >12 years old with ≥2 unprovoked seizure were prospectively recruited. As part of a broader interview, participants reported prior 30-day seizure frequency and screened for depression (PHQ-9) (range 0-27 points) and anxiety (GAD-7) (range 0-21 points) with re-evaluation at 90 days. RESULTS Of 148 participants enrolled (mean age = 27.3 years, range 12-72; 45% female), 62% were currently taking ASMs. For the 30 days pre-enrolment, average seizure frequency was 3.2 (95%CI 2.3, 4.2); 28% of participants were seizure-free. ASM regimens were modified for 95% of participants, mostly initiating levetiracetam (n = 115, 80% of modifications). 90-day study retention was 76% (n = 113) among whom 87% reported full adherence to the ASM. After 90 days, the average seizure frequency over the prior 30 days was 1.5 (95%CI 0.5, 2.6), significantly lower than at baseline (p = 0.002). 66% were seizure-free. At baseline, average PHQ-9 score was 21.2 (95%CI [20.2, 22.2]), indicating severe depressive symptoms. Average GAD-7 score was 16.5 [15.6, 17.4], indicating severe anxious symptoms. At 90-days, average PHQ-9 score was 17.5[16.4, 18.5] and significantly lower than baseline (p < 0.001). Average GAD-7 score was 14.4 [13.6, 15.3] and significantly lower than baseline (p = 0.002). Seizure frequency was not correlated with PHQ-9 nor GAD-7 scores at baseline but was at 90 days for both PHQ-9 (r = 0.24, p = 0.01) and GAD-7 (r = 0.22, p = 0.02) scores. The prevalence of suicidal ideation dropped from 67% to 47% of participants (p = 0.004). DISCUSSION ASM management has dual importance for PLWE in resource-limited settings, improving both seizure control and mental health.
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Affiliation(s)
- Dylan R Rice
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Mohamed Traoré
- Department of Neurology, Ignace Deen Teaching Hospital, Conakry, Republic of Guinea
| | - Mohamed Laminé Condé
- Department of Neurology, Ignace Deen Teaching Hospital, Conakry, Republic of Guinea
| | - Djenabou Diallo
- Department of Neurology, Ignace Deen Teaching Hospital, Conakry, Republic of Guinea
| | - Nathanael J Lee
- Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrew Siyoon Ham
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fodé Abass Cissé
- Department of Neurology, Ignace Deen Teaching Hospital, Conakry, Republic of Guinea
| | - Farrah J Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Namusisi J, Kyoyagala S, Nantongo J, Kyewalyanga M, Sabiiti S, Murorunkwere A, Najjuma JN, Nakibuuka J, Kaddumukasa M, Sajatovic M, Kalubi P. Poor Seizure Control Among Children Attending a Tertiary Hospital in South Western Uganda - A Retrospective Study. Int J Gen Med 2023; 16:895-904. [PMID: 36915422 PMCID: PMC10007866 DOI: 10.2147/ijgm.s398318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/01/2023] [Indexed: 03/09/2023] Open
Abstract
Background Seizure control among children with epilepsy (CWE) receiving anti-seizure medications (ASMs) remains a challenge in low-resource settings. Uncontrolled seizures are significantly associated with increased morbidity and mortality among CWE. This negatively impacts their quality of life and increases stigma. Aim This study determined seizure control status and described the factors associated among CWE receiving ASMs at Mbarara Regional Referral Hospital (MRRH). Methods In a retrospective chart review study, socio-demographic and clinical data were obtained from 112 medical records. CWE receiving ASMs for at least six months and regularly attending the clinic were included in the study. Physical or telephone interviews were conducted with the immediate caregivers of the CWE to establish the current seizure control status of the participants. Results A total of 112 participants were enrolled. Of these, three-quarters had generalized onset seizures, 23% had focal onset seizures, while 2% had unknown onset motor seizures. About 60.4% of the study participants had poor seizure control. Having a comorbidity (p-value 0.048, AOR 3.2 (95% CI 1.0-9.9)), history suggestive of birth asphyxia (p-value 0.014, AOR 17.8 (95% CI 1.8-176.8)), and being an adolescent (p-value 0.006, AOR 6.8 (95% CI 1.8-26.6)) were significantly associated with poor seizure control. Conclusion Seizure control among CWE receiving ASMs at MRRH remains poor. Efforts geared to addressing seizure control and optimizing drugs are needed, especially among children with comorbidities, those with history of birth asphyxia, and adolescents.
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Affiliation(s)
- Jane Namusisi
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology (MUST), Mbarara, Uganda.,Department of Pediatrics and Child Health, Mbarara Regional Referral Hospital (MRRH), Mbarara, Uganda
| | - Stella Kyoyagala
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Josephine Nantongo
- Department of Pediatrics and Child Health, Mbarara Regional Referral Hospital (MRRH), Mbarara, Uganda
| | - Mike Kyewalyanga
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology (MUST), Mbarara, Uganda.,Department of Pediatrics and Child Health, Holy Innocents Children's Hospital, Mbarara, Uganda
| | - Stephen Sabiiti
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Angelique Murorunkwere
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Josephine Nambi Najjuma
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Jane Nakibuuka
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mark Kaddumukasa
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospital Case Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Peter Kalubi
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
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Dwivedi R, Tiwari P, Pahuja M, Dada R, Tripathi M. Anti-seizure medications and quality of life in person with epilepsy. Heliyon 2022; 8:e11073. [PMID: 36281370 PMCID: PMC9586904 DOI: 10.1016/j.heliyon.2022.e11073] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/14/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Objective The goal of this study was to determine the effects of mono-, bi-, and polytherapy anti-seizure medications (ASMs) in terms of seizure reduction and quality of life (QOL) in persons with epilepsy (PWE). Methods A cross-sectional observational study was conducted. All PWE with age <75 years were recruited and further classified into two groups: responders and non-responders, based on the response of the ASMs to the treatments for reduced seizure frequency since the last one year. Other demographic and clinical data such as seizure frequency, type of seizures, age at onset of seizures, and information about ASMs with their daily doses were assessed for the descriptive analysis. The quality of life was assessed in randomly selected PWE (n = 100) using the quality of life in epilepsy inventory-31 (QOLIE-31) in adults. Results With a total of 486 PWE, the median age (years) was comparable in both groups. Out of these the non-responders group was found to be significantly higher (77.8%) than the responders group (22.2%). In the responders group, the percentage of PWE who were on monotherapy was significantly higher (51.85 %) than those who were on polytherapy (17.59%), whereas in the non-responders group, 21.16% of PWE were on monotherapy and 44.86% were on polytherapy. The duration of epilepsy was similar in both groups, but the average seizure frequency was significantly higher in the non-responders. In QOL assessments, 43% of PWE were observed in the responders group, whereas 57% of PWE were found in the non-responders group. The overall comparative QOL scores were also significantly higher (p < 0.0001) in the responders group as compared to the non-responders group. Conclusion Our findings revealed that those PWE who were on monotherapy showed better reduction in seizure frequency and improved QOL in responder groups as compared to non-responder groups.
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Affiliation(s)
- Rekha Dwivedi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Prabhakar Tiwari
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, 110029, India,Corresponding authors.
| | - Monika Pahuja
- Division of Biomedical Sciences, Indian Council of Medical Research
| | - Rima Dada
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, 110029, India,Corresponding authors.
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Deegbe DA, Tshabalala AM, Aziato L, Casteleijn D. Meanings of quality of life among people living with epilepsy in Ghana; a qualitative exploratory study. Epilepsy Behav 2022; 129:108527. [PMID: 35168123 DOI: 10.1016/j.yebeh.2021.108527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to explore the meanings of quality of life among people living with epilepsy (PLWE) in Ghana. METHODS An exploratory-qualitative study design was adopted. Face-to-face in-depth interviews, using a semi-structured interview guide, were conducted on 15 PLWE who were purposively selected for the study. The interviews were audio recorded and transcribed verbatim. The content analysis approach was then used to analyze the data. RESULTS Four themes - "acceptance", "support", "seizure control", and "self-reliance" emerged from the study as meanings of Quality of life (QoL). Quality of life meant unconditional acceptance from family, friends, acquaintances at home, school, and work, and by the public despite epilepsy. Receiving support in the form of protection from injury during a seizure, financial assistance to meet individual and family demands, emotional warmth, and spiritual support through prayers and encouragement, was QoL for PLWE. Achievement of control over seizures and being self-reliant in terms of selfcare and daily activities in addition to having some form of financial independence meant QoL. CONCLUSION Meanings of quality of life among PLWE is associated with being accepted and supported by family and friends as well as being in control of seizures and attaining a status of independence.
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Affiliation(s)
- David Atsu Deegbe
- Department of Mental Health Nursing, School of Nursing and Midwifery, University of Ghana, P.O. Box LG 43, Legon, Accra, Ghana.
| | - Amme Mardulate Tshabalala
- Department of Nursing Education, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, 2193 Johannesburg, South Africa.
| | - Lydia Aziato
- Department of Adult Health, School of Nursing and Midwifery, University of Ghana, P.O. Box LG 43, Legon, Accra, Ghana.
| | - Daleen Casteleijn
- Department of Occupational Therapy, School of Therapeutic Sciences, University of the Witwatersrand, 7 York Road, Parktown, 2193 Johannesburg, South Africa.
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Guelngar CO, Mohamed Lamine T, Mamadou Ciré B, Mamady D, Mahadi K, Bachir Abdoul DH, Foksouna S, Fatimata DH, Naby C, Dago François K, Fatimatou Korka B, Doussou C, Victorine M, Salematou C, Aminata S, Mohamed Tafsir D, Souleymane Djigué B, Mamadou Saliou D, Fodé Mohamed S, Aminou SY, Daouya DG, Said Abdallah R, Mamady K, Souleymane Mbara D, Fodé Abass C, Amara C. Rasmussen syndrome in a tropical environment: a study of six (6) observations. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00409-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In sub-Saharan Africa, encephalitis of various etiologies is a major public health problem and Rasmussen syndrome is rarely diagnosed due to under-medicalization. The objective of this study is to describe the clinical and neuroradiological forms, especially since this affection is little known in sub-Saharan Africa as evidenced by the scarcity of publications.
Results
A retrospective, descriptive and analytical study of six (6) cases of Rasmussen syndrome, shows that it is an unrecognized disease in Africa. Men were more represented with a frequency of 67% with a young age. The clinical picture dominated by 100% seizures, mental deterioration and hemiparesis. The etiology is still questionable, probably autoimmune in our study.
Conclusion
Rasmussen syndrome accounts for 3% in 219 patients hospitalized for epileptic conditions. This study shows a clinical profile dominated by recurrent epileptic seizures refractory to the drugs Phenobarbital, Valproic Acid and Carbamazepine, the only antiepileptics available in the country. These results are valid for therapeutic and prognostic discussion.
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Rice DR, Cisse FA, Djibo Hamani AB, Tassiou NR, Sakadi F, Bah AK, Othon GC, Conde ML, Diawara K, Traoré M, Doumbouya I, Koudaye C, Mateen FJ. Epilepsy stigma in the Republic of Guinea and its socioeconomic and clinical associations: A cross-sectional analysis. Epilepsy Res 2021; 177:106770. [PMID: 34619642 DOI: 10.1016/j.eplepsyres.2021.106770] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/13/2021] [Accepted: 09/19/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We aim to quantify the degree of epilepsy stigma perceived by people living with epilepsy (PLWE) in the Republic of Guinea (2019 gross national income per capita, 930 USD) and analyze the demographic, social, and clinical factors associated with epilepsy stigma in this setting. METHODS A prospective convenience cohort of PLWE was recruited at the Ignace Deen Hospital in Conakry and evaluated by U.S. and Guinean neurology-trained physicians. A survey instrument exploring demographic, social, and clinical variables was designed and administered. The primary outcome measure was the Stigma Scale of Epilepsy (SSE), a 24-item scale with scores ranging from 0 (least stigma)-100 (most). Regression models were fit to assess associations between SSE score and pre-selected demographic, social, and clinical variables of interest. RESULTS 249 PLWE (112 female; mean age 20.0 years; 22 % from rural locales; 14 % of participants >16 years old with no formal schooling; 11 % seizure-free for >=6 months) had an average SSE score of 46.1 (standard deviation = 14.5) points. Children had an average SSE score of 45.2, and adults had an average score of 47.0. There were no significant differences between self- and guardian-reported SSE scores (means = 45.8 and 46.5, respectively), p = .86. In univariate analyses, higher stigma scores were associated with more seizures (p = .005), more depressive symptoms (p = .01), and lower household wealth (p = .03). In a multivariable model including sex, educational level, household wealth, generalized tonic-clonic seizures, seizure frequency, and seizure-related burns, only higher seizure frequency (β = -2.34, p = .03) and lower household wealth (β = 4.05, p = .03) were significantly associated with higher SSE scores. CONCLUSION In this Guinean cohort of people living with poorly-controlled epilepsy, there was a moderate degree of perceived stigma on average. Stigma was associated with higher seizure frequency and lower household wealth-both potentially modifiable factors.
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Affiliation(s)
- Dylan R Rice
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | - Foksouna Sakadi
- Department of Neurology, Ignace Deen Hospital, Conakry, Guinea
| | | | | | - Mohamed L Conde
- Department of Neurology, Ignace Deen Hospital, Conakry, Guinea
| | - Karinka Diawara
- Department of Neurology, Ignace Deen Hospital, Conakry, Guinea
| | - Mohamed Traoré
- Department of Neurology, Ignace Deen Hospital, Conakry, Guinea
| | | | - Camara Koudaye
- Department of Neurology, Ignace Deen Hospital, Conakry, Guinea
| | - Farrah J Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
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10
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Rezaei SJ, Mateen FJ. Encephalitis and meningitis in Western Africa: a scoping review of pathogens. Trop Med Int Health 2021; 26:388-396. [PMID: 33340211 DOI: 10.1111/tmi.13539] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To give an overview of the recently reported literature on the aetiologies of meningitis and encephalitis in western sub-Saharan Africa. METHODS We conducted a scoping review following PRISMA guidance on published meningitis and encephalitis cases in the 16 countries of the United Nations-defined western sub-Saharan African region as identified in cohort studies, case series, and case reports, published 01/01/2000-08/01/2020, and available in four databases in August 2020 with an abstract in English, French or Italian. RESULTS There were 38 distinct pathogens identified from 91 cohort studies' data and 48 case reports or case series' data. In cohort-level data, the majority of cases were caused by Neisseria meningitidis (71.5%), Streptococcus pneumoniae (17.6%) and Haemophilus influenzae (7.3%). In case report- and case series-level data, 40.5% of patients were <18 years old, 28.6% were female, and 28.6% were known to be immunocompromised. The case fatality rate was 39.3%. The most commonly reported pathogens among immunocompetent patients were Salmonella species (13 cases) and Ebola virus (9 cases), and the most commonly reported pathogen among immunocompromised patients was Cryptococcus neoformans (18 cases). Most cohort cases (52.3%) derived from Niger followed by Burkina Faso (28.6%). Most cases from single reports or series were reported from Nigeria (21.4%), Mali (20.2%) and Burkina Faso (19.0%). CONCLUSIONS Given the small number of pathogens reported, our findings underscore the need to better screen, diagnose and monitor populations in western sub-Saharan Africa for additional CNS pathogens, including those posing significant outbreak risks.
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Affiliation(s)
- Shawheen J Rezaei
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Farrah J Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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11
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Sylla M, Vogel AC, Bah AK, Tassiou NR, Barry SD, Djibo BA, Toure ML, Foksona S, Konate M, Cisse FA, Mateen FJ. Prevalence, severity, and associations of depression in people with epilepsy in Guinea: A single-center study. Epilepsy Behav 2020; 113:107475. [PMID: 33189054 PMCID: PMC7736546 DOI: 10.1016/j.yebeh.2020.107475] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/10/2020] [Accepted: 09/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Depression has long been recognized as a comorbidity of epilepsy in high-income countries, ranging from 17 to 49% of people with epilepsy (PWE). Of the limited studies from sub-Saharan Africa (SSA), where most people have uncontrolled seizures, an even higher prevalence of depression is reported among PWE at times exceeding 80%. We sought to assess the prevalence and severity of depression and its associated factors among PWE in Guinea, a sub-Saharan West African country where most PWE have poorly controlled seizures. METHODS People with epilepsy from the community, age 16 years old and above, were consecutively recruited into a convenience cohort at the Ignace Deen Hospital in the capital city, Conakry, in summer 2018 as part of a larger study characterizing PWE in Guinea. Each participant was evaluated by a team of Guinean physicians and a U.S.-based neurologist to confirm the diagnosis of epilepsy. Inperson interviews were performed to measure demographic, clinical, socioeconomic, and related variables. Depression was measured via the Patient Health Questionniare-9 in the language of the participant's preference with a cutoff of 5 or more points being categorized as depressed. Regression analyses were performed to measure the associations between explanatory variables with the outcome of depression. RESULT Of 140 PWE (age range: 16-66 years old; 64 female; 64% taking an antiseizure medication including 28% carbamazepine, 16% phenobarbital, and 14% valproic acid; duration of epilepsy: 11 years; 71% with one or more seizures in the past month; 17% never treated with an antiseizure medication; 90% with loss of consciousness during seizures; 10% without formal education; 31% with university level education; 62% using tap water; 48% with a serious seizure-related injury), the point prevalence of depression was 66% (95% confidence interval [CI]: 58%-74%): 43% of PWE had mild depression, 19% moderate, 4% moderate to severe, and 0.1% severe. In a multivariate analysis, the occurrence of a seizure in the past month (odds ratio: 3.03, 95% CI: 2.63-3.48, p = 0.01) was associated with depression, while gender, self-perceived stigma score, serious injuries, and the number of antiseizure medications taken were not statistically significantly associated (p > 0.05). Twenty-five percent of all participants endorsed thoughts of self-harm or suicidality. CONCLUSION Two-thirds of PWE in Guinea had depression in this single-institution convenience cohort. The presence of a seizure in the last month was the factor most associated with depression and is modifiable in many PWE. The high prevalance of depression suggests that screening and addressing depressive symptoms should be incorporated into routine epilepsy care in Guinea.
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Affiliation(s)
| | - Andre C. Vogel
- Department of Neurology, Massachusetts General Hospital, Boston, USA
| | | | | | | | | | | | | | | | | | - Farrah J. Mateen
- Harvard Medical School, Boston, USA,Department of Neurology, Massachusetts General Hospital, Boston, USA
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12
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Gibson C, Bessey PQ, Gallagher JJ. The Global Burn Registry: A Work in Progress. J Burn Care Res 2020; 41:929-934. [PMID: 32483614 DOI: 10.1093/jbcr/iraa078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In 2018, the World Health Organization (WHO) launched the Global Burn Registry (GBR). Its purpose is to help improve the understanding of burn injury worldwide. The purpose of this study was to identify early findings from this database. The GBR was accessed on January 5, 2020. Cases from centers in low income (LIC) and low-middle-income countries (LMIC) were combined into a low resource (LR) group, and cases in high income (HIC) and upper-middle-income countries (UMIC) were combined into a high resource (HR) group. Statistical analysis was performed with SAS 9.4. Data are expressed as mean ± SEM. Logistic regression was used to identify risk factors for death. Revised Baux Score (RBS) was calculated. Odds ratios are expressed as mean (95% confidence interval). The LA50 was calculated from the regression of death and total burn size (TBSA) for different age groups. At the time of analysis, there were 4307 cases in the GBR treated at 28 facilities in 17 countries (5 HIC, 5 UMIC, 4 LMIC, and 3 LIC). There were 2945 cases (68%) from HR countries and 1362 (32%) from LR countries. The mean age of patients in both LR and HR was similar (24.5 ± 0.5 vs 24.2 ± 0.4 years, P = .58), but LR had larger TBSA burns (30.5 ± 0.7% vs 19.8 ± 0.4% TBSA, P < .0001). There were fewer scald burns and more flame injuries in the LR countries (28.4 ± 1.3% vs 43.3 ± 1.0% and 55.2 ± 1.4% vs 39.0 ± 0.9%, P < .0001). Case fatality and RBS were greater in LR (31.9 ± 1.3% vs 9.4 ± 0.5% and 59.4 ± 1.1% vs 45.3 ± 0.6%, P < .0001). In regression analysis, LR was an independent risk factor for death with an odds ratio of 4.2 (3.2-5.4). The LA50 for HR countries was similar to that calculated from cases in the National Burn Repository of the American Burn Association (ABA NBR). For LR countries, the LA50 was lower for all ages except those 65 and older, ranging from 30% to 43% TBSA. Only a few facilities have contributed data to the GBR so far, with LR countries less represented than HR ones. The proportion of cases in the pediatric age group is much less represented in LR countries than in HR, possibly because many burned children in LR countries do not get burn care at specialized centers. Survival in HR countries is similar to that in North America. The GBR provides early insights into global burn care. Opportunities for improvement are greatest in LR countries. New Innovations may be necessary to increase participation from burn centers in LR countries. This report provides an early look at burn care across the globe based on cases in the GBR. It may inform further efforts to characterize and improve burn care in LR countries.
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Affiliation(s)
- Cameron Gibson
- Department of Surgery, William Randolph Hearst Burn Center, Weill Cornell Medicine, New York-Presbyterian Hospital, New York City, New York
| | - Palmer Q Bessey
- Department of Surgery, William Randolph Hearst Burn Center, Weill Cornell Medicine, New York-Presbyterian Hospital, New York City, New York
| | - James J Gallagher
- Department of Surgery, William Randolph Hearst Burn Center, Weill Cornell Medicine, New York-Presbyterian Hospital, New York City, New York
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13
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Rice DR, Sakadi F, Tassiou NR, Vogel AC, Djibo Hamani AB, Bah AK, Garcia A, Patenaude BN, Fode Cisse A, Mateen FJ. Socioeconomic associations of poorly controlled epilepsy in the Republic of Guinea: cross-sectional study. Trop Med Int Health 2020; 25:813-823. [PMID: 32324940 DOI: 10.1111/tmi.13407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To explore the socioeconomic factors associated with epilepsy in the Republic of Guinea. METHODS People living with epilepsy (PLWE) were prospectively recruited at Ignace Deen Hospital, Conakry, in 2018. An instrument exploring household assets as a measure of wealth was designed and administered. Multivariate logistic regression models with fixed effects were fitted to assess the associations of sociodemographic and microeconomic factors with self-reported frequency of seizures in the prior month and regular intake of antiseizure medications (ASMs). Participants were stratified by age group: children (<13 years), adolescents (13-21) and adults (>21). RESULTS A total of 285 participants (mean age 19.5 years; 129 females; 106 children, 72 adolescents, 107 adults, median household size 8) had an average of 4.2 seizures in the prior month. 64% were regularly taking ASMs. Direct costs of epilepsy were similar across income strata, averaging 60 USD/month in the lowest and 75 USD/month in the highest wealth quintiles (P = 0.42). The poorest PLWE were more likely to spend their money on traditional treatments (average 35USD/month) than on medical consultations (average 11 USD/month) (P = 0.01), whereas the wealthiest participants were not. Higher seizure frequency was associated with a lower household education level in adolescents and children (P = 0.028; P = 0.026) and with being male (P = 0.009) in children. Adolescents in higher-educated households were more likely to take ASMs (P = 0.004). Boys were more likely to regularly take ASMs than girls (P = 0.047). CONCLUSIONS Targeted programming for children and adolescents in the households with the lowest education and for girls would help improve epilepsy care in Guinea.
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Affiliation(s)
- Dylan R Rice
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Foksouna Sakadi
- Department of Neurology, Ignace Deen Teaching Hospital, Conakry, Republic of Guinea
| | - Nana Rahma Tassiou
- Department of Neurology, Ignace Deen Teaching Hospital, Conakry, Republic of Guinea
| | - Andre C Vogel
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Aissatou Kenda Bah
- Department of Neurology, Ignace Deen Teaching Hospital, Conakry, Republic of Guinea
| | - Alex Garcia
- California Polytechnic State University, San Luis Obispo, CA, USA
| | - Bryan N Patenaude
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Abass Fode Cisse
- Department of Neurology, Ignace Deen Teaching Hospital, Conakry, Republic of Guinea
| | - Farrah J Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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14
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Anand P. Global & Community Health: The djina disease: On epilepsy in the Republic of Guinea. Neurology 2019; 92:725-727. [PMID: 30962298 DOI: 10.1212/wnl.0000000000007274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Pria Anand
- From the Department of Neurology, Massachusetts General Hospital, Boston.
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15
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Fitts W, Rahamatou NT, Abass CF, Vogel AC, Ghislain AH, Sakadi F, Hongxiang Q, Conde ML, Baldé AT, Hamani ABD, Bah AK, Anand P, Patenaude B, Mateen FJ. School status and its associations among children with epilepsy in the Republic of Guinea. Epilepsy Behav 2019; 97:275-281. [PMID: 31260925 PMCID: PMC6702082 DOI: 10.1016/j.yebeh.2019.05.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/19/2019] [Accepted: 05/28/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND In low-income countries (LICs), there are multiple barriers for children with epilepsy (CWE) to attend school. We examined potentially modifiable associations with poor school performance in CWE in the West African Republic of Guinea. METHODS Children with epilepsy of school age were recruited using public announcements and a clinical register of people with epilepsy at the Ignace Deen Hospital in Conakry in 2018. A team of Guinean and U.S. neurologists and neurologists-in-training interviewed each CWE and parent for his/her epilepsy history, household finances, educational attainment level, and perceived stigma using the Stigma Scale of Epilepsy (SSE). Each child was also tested using the Wechsler Nonverbal Scale of Ability (WNV). Low school performance was defined as either not attending school or being held back a grade level at least once. Potential predictors of low school performance were analyzed. FINDINGS Of 128 CWE (mean age: 11.6 years, 48.4% female), 11.7% (n = 15) never attended school, 23.3% (n = 30) dropped out, and 64.8% (n = 83) were currently enrolled. Of CWE attending school, 46.9% (n = 39) were held back a grade level. Overall, 54 children were defined as low performers (LPs) (42%). ;Greater than 100 lifetime seizures (odds ratio (OR) = 8.81; 95% confidence interval (CI) = 2.51, 37.4; p = 0.001) and lower total WNV score (OR = 0.954; 95% CI = 0.926, 0.977; p < 0.001) were significantly associated with poor school performance in separate models, when controlling for potential confounders. Given the strong relationship between seizure freedom and school performance, we estimated that 38 additional CWE (33.6%) could become high performers (HPs) if all CWE were adequately treated to achieve the lifetime seizure category of <10 seizures and could be cognitively intact again. Models examining SSE and household wealth quintile were not significantly associated with school performance. CONCLUSIONS Higher lifetime seizures and lower WNV score were significantly associated with low school performance in CWE in Guinea. In spite of our conservative definition of high school performance (attending without failing) and risk of referral bias at an academic center where patients were allowed to self-refer, we demonstrate that seizure control in this setting could increase the number of CWE who could attend and stay in school.
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Affiliation(s)
| | | | | | - Andre C Vogel
- Massachusetts General Hospital, Department of Neurology, Boston, MA, USA
| | | | - Foksouna Sakadi
- Ignace Deen Hospital, Department of Neurology, Conakry, Guinea
| | - Qiu Hongxiang
- University of Washington, Department of Biostatistics, Seattle, WA, USA
| | | | | | | | | | - Pria Anand
- Massachusetts General Hospital, Department of Neurology, Boston, MA, USA
| | - Bryan Patenaude
- Johns Hopkins, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Farrah J Mateen
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Department of Neurology, Boston, MA, USA.
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16
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Williams JA, Cisse FA, Schaekermann M, Sakadi F, Tassiou NR, Hotan GC, Bah AK, Hamani ABD, Lim A, Leung ECW, Fantaneanu TA, Milligan TA, Khatri V, Hoch DB, Vyas MV, Lam AD, Cohen JM, Vogel AC, Law E, Mateen FJ. Smartphone EEG and remote online interpretation for children with epilepsy in the Republic of Guinea: Quality, characteristics, and practice implications. Seizure 2019; 71:93-99. [PMID: 31229939 DOI: 10.1016/j.seizure.2019.05.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/25/2019] [Accepted: 05/31/2019] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Children with epilepsy in low-income countries often go undiagnosed and untreated. We examine a portable, low-cost smartphone-based EEG technology in a heterogeneous pediatric epilepsy cohort in the West African Republic of Guinea. METHODS Children with epilepsy were recruited at the Ignace Deen Hospital in Conakry, 2017. Participants underwent sequential EEG recordings with an app-based EEG, the Smartphone Brain Scanner-2 (SBS2) and a standard Xltek EEG. Raw EEG data were transmitted via Bluetooth™ connection to an Android™ tablet and uploaded for remote EEG specialist review and reporting via a new, secure web-based reading platform, crowdEEG. The results were compared to same-visit Xltek 10-20 EEG recordings for identification of epileptiform and non-epileptiform abnormalities. RESULTS 97 children meeting the International League Against Epilepsy's definition of epilepsy (49 male; mean age 10.3 years, 29 untreated with an antiepileptic drug; 0 with a prior EEG) were enrolled. Epileptiform discharges were detected on 21 (25.3%) SBS2 and 31 (37.3%) standard EEG recordings. The SBS2 had a sensitivity of 51.6% (95%CI 32.4%, 70.8%) and a specificity of 90.4% (95%CI 81.4%, 94.4%) for all types of epileptiform discharges, with positive and negative predictive values of 76.2% and 75.8% respectively. For generalized discharges, the SBS2 had a sensitivity of 43.5% with a specificity of 96.2%. CONCLUSIONS The SBS2 has a moderate sensitivity and high specificity for the detection of epileptiform abnormalities in children with epilepsy in this low-income setting. Use of the SBS2+crowdEEG platform permits specialist input for patients with previously poor access to clinical neurophysiology expertise.
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Affiliation(s)
- Jennifer A Williams
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Division of Clinical Neurophysiology, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Foksouna Sakadi
- Department of Neurology, Ignace Deen Hospital, Conakry, Guinea
| | | | - Gladia C Hotan
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | | | - Andrew Lim
- Department of Neurology, University of Toronto, ON, Canada; Department of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Edward C W Leung
- Division of Pediatric Neurology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Tadeu A Fantaneanu
- Division of Neurology, Department of Medicine, University of Ottawa, ON, Canada
| | - Tracey A Milligan
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Vidita Khatri
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Daniel B Hoch
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Division of Clinical Neurophysiology, Massachusetts General Hospital, Boston, MA, USA
| | - Manav V Vyas
- Department of Neurology, University of Toronto, ON, Canada; Department of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Alice D Lam
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Division of Clinical Neurophysiology, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph M Cohen
- Division of Clinical Neurophysiology, Massachusetts General Hospital, Boston, MA, USA
| | - Andre C Vogel
- Neurological Clinical Research Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Edith Law
- School of Computer Science, University of Waterloo, ON, Canada
| | - Farrah J Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Neurological Clinical Research Institute, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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17
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Anand P, Othon GC, Sakadi F, Tassiou NR, Hamani ABD, Bah AK, Allaramadji BT, Barry DN, Vogel A, Cisse FA, Mateen FJ. Epilepsy and traditional healers in the Republic of Guinea: A mixed methods study. Epilepsy Behav 2019; 92:276-282. [PMID: 30731293 PMCID: PMC6433505 DOI: 10.1016/j.yebeh.2019.01.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/11/2019] [Accepted: 01/11/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE The purpose of this study was to characterize the reasons, extent, and impact of traditional medicine use among people with epilepsy (PWE) in the Republic of Guinea. METHODS Guinea is a low-income country in sub-Saharan Africa (SSA) with limited healthcare resources. People with epilepsy and their caregivers were seen at a public referral hospital in Conakry, the capital city, where they completed semi-structured interviews with physicians regarding their beliefs about epilepsy, medical care, and engagement with traditional healers. RESULTS Of 132 participants (49% children, 44% female, 55% with a university-educated head of household), 79% had seen a traditional healer, and 71% saw a traditional healer before seeing a medical provider for their epilepsy. Participants were treated by a traditional healer for a mean of 39 months before seeing a medical provider. By contrast, 58% of participants reported taking antiepileptic drugs (AEDs) regularly; 46% reported having undergone a head computed tomography (CT) scan; 58% reported having had an electroencephalogram, and 4% reported having had a brain magnetic resonance imaging (MRI) scan. CONCLUSIONS Traditional healers in Guinea provide frontline care for PWE in Guinea with considerable delays in AED initiation, even among a cohort of PWE actively seeking medical care. Engaging with these healers is critical for both influencing community perceptions and appropriately managing epilepsy throughout the country.
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Affiliation(s)
- Pria Anand
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
| | | | - Foksouna Sakadi
- Department of Neurology, Ignace Deen Teaching Hospital, Conakry, Republic of Guinea,Department of Clinical Neurophysiology, Ibn Sina Hospital Center, Rabat, Morocco
| | | | | | - Aissatou Kenda Bah
- Department of Neurology, Ignace Deen Teaching Hospital, Conakry, Republic of Guinea
| | | | - Djenabou Negue Barry
- Department of Neurology, Ignace Deen Teaching Hospital, Conakry, Republic of Guinea
| | - Andre Vogel
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Fodé Abass Cisse
- Department of Neurology, Ignace Deen Teaching Hospital, Conakry, Republic of Guinea
| | - Farrah Jasmine Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
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