Epilepsy in Africa: Past, present, and future

Status of epilepsy in the tropics: An overlooked perspective

Epilepsy is one of the most common serious chronic neurological diseases affecting people of all ages globally. It is characterized by recurrent seizures. About 50 million people worldwide have epilepsy. Indubitably, people with epilepsy (PWE) may be without access to appropriate treatment. Many studies have examined the molecular mechanisms and clinical aspects of epilepsy; nonetheless, the treatment gap exists in some special areas. In the tropics, the specific geographical and ecological conditions and a lack of medical resources result in neglect or delay of diagnosis for PWE. Herein, we summarized the epidemiology of epilepsy in the tropics and discussed the disease burden and existing problems, aiming to offer a medical environment for patients in need and highlight the importance of reducing the epileptic disease burden in tropical countries.

A qualitative study exploring caregivers' experiences, perspectives, and expectations for precision medicine in epilepsy in South Africa

PURPOSE

Successful implementation of innovative Precision Medicine initiatives in the management of children with complex epilepsy is largely dependent on the caregivers' engagement with the technology as well as its accessibility and acceptability. We investigated the feasibility of implementing these initiatives in the South African setting by gathering information on the caregivers' experiences, perspectives, and expectations for Precision Management of Epilepsy (PME) initiatives.

METHODS

We purposively recruited 12 participants from a cohort of 40 caregivers of children with complex epilepsy recruited for a PME study attending Red Cross War Memorial Children's Hospital (RCWMCH) in Cape Town, South Africa. Face-to-face semi-structured interviews were conducted using a pragmatic qualitative approach and themes were extracted using a thematic framework approach.

RESULTS

All participants had ideas about the cause of epilepsy, but many did not think that epilepsy is a medical condition. There were several difficulties in adhering to medical treatment which was sometimes combined with traditional remedies and practices. Understanding of Precision Medicine in the context of research was limited and although participants were unclear about benefits, most were optimistic about the future. mHealth devices introduced new feelings and challenges for many participants. The four themes which emerged were: (1) Cause of epilepsy: uncertainty and conflicting views; (2) Need for healing; (3) PME mHealth devices; and (4) Feasibility of implementation of PME initiatives.

CONCLUSION

For Precision Medicine to be widely accepted and beneficial, how people understand the cause of epilepsy, difficulties in adherence to treatment, and personal experiences need to be addressed.

Medication Belief and Adherence among Patients with Epilepsy

BACKGROUND

Medication adherence and belief are crucial to achieving the desired goal of therapy in epileptic patients. However, there is a lack of study regarding medication adherence and belief in our setting. Therefore, the purpose of this study was to investigate medication adherence and belief and associated factors among ambulatory patients with epilepsy.

METHOD

A cross-sectional study was conducted on randomly selected epileptic patients at the neurologic clinic of Ayder Comprehensive Specialized Hospital, Ethiopia. Medication adherence and belief were assessed using self-reported questionnaires which were developed based on the review of different literatures. Data were analyzed using binary logistic regression analysis.

RESULT

We included a total of 292 patients. Almost two-thirds (65.4%) of the patients were nonadherent to their medications. The most common cause of nonadherence was forgetfulness (48.7%) followed by inability to get medicine (28.8) and safety concern (23.5%). The majority (78.4%) of the patients had high medication necessity belief while 44.1% had high concern belief about the potential adverse effect of their medications. Overall, 39.4% of the patients had a negative belief toward their medications. Comorbidity (AOR: 3.51, 95% CI: 1.20-10.31), seizure encounter within the last 3 months (AOR: 5.45, 95% CI: 2.48-12.00), low medication necessity belief (AOR: 3.38, 95% CI: 1.14-10.00), high medication concern belief (AOR: 4.23, 95% CI: 2.07-8.63), and negative medication belief (AOR: 4.17, 95% CI: 1.74-10.02) were predictors of medication nonadherence.

CONCLUSION

Majority of the epileptic patients were nonadherent to their medications, and more than one-third of the patients had a negative medication belief. Low medication necessity belief, high medication concern belief, negative medication belief, comorbidity, and seizure encounter were predictors of medication nonadherence. Therefore, healthcare providers should design educational programs to enhance the patients' believe about their medication in order to improve medication adherence and overall treatment outcome.