Prevalence and burden of epilepsy in Nigeria: A systematic review and meta-analysis of community-based door-to-door surveys

Knowledge of epilepsy surgery: A survey among medical doctors in Nigeria

BACKGROUND

Epilepsy surgery has been shown to significantly improve the quality of life of patients with drug resistant epilepsy. Despite this, epilepsy surgery remains remarkably underutilized in Nigeria. There are high misconceptions about epilepsy and its management among physicians and trainees.

METHODS

This study aims to identify knowledge gaps in epilepsy surgery among medical doctors in Nigeria and factors associated with their level of knowledge of the procedure. A cross-sectional study was carried out among 566 medical doctors in Nigeria, at different levels of post-graduate training (House officers, Medical officers, Resident doctors and Consultants). An online survey with a 24-item questionnaire adapted from a standardized pro forma was utilized. Binary and multiple logistic regression were used to identify associations between the independent variable and outcome variable (good or poor knowledge) RESULTS: Majority of the respondents were medical officers (post-intern physicians) comprising 65.7 % of the participants. Significant predictors of poor knowledge included being a medical officer [P=0.006], working in north-central [P=0.017] and north-western Nigeria [P=0.045], seeing less than 20 epilepsy patients per month [1-10 patients, P=0.015; 11-20 patients, P=0.011], and enrolment in online epilepsy course [P=0.004].

CONCLUSION

Comprehensive education and awareness about epilepsy surgery are important in overcoming the knowledge gap and improving access to care.

Epidemiology of Huntington's Disease in Latin America: A Systematic Review and Meta-Analysis

BACKGROUND

Latin America has played a crucial role in advancing our understanding of Huntington's disease (HD). However, previous global reviews include limited data from Latin America. It is possible that English-based medical search engines may not capture all the relevant studies.

METHODS

We searched databases in Spanish, Portuguese, and English. The names of every country in Latin America in English-based search engines were used to ensure we found any study that had molecular ascertainment and provided general epidemiological information or subpopulation data. Additionally, we contacted experts across the region.

RESULTS

The search strategy yielded 791 citations; 24 studies met inclusion criteria, representing 12 of 36 countries. The overall pooled prevalence was 0.64 per 100,000 (prediction interval, 0.06-7.22); for cluster regions, it was 54 per 100,000 (95% CI, 34.79-84.92); for juvenile HD, it was 8.7% (prediction interval, 5.12-14.35), and 5.9% (prediction interval, 2.72-13.42) for late-onset HD. The prevalence was higher for Mexico, Peru, and Brazil. However, there were no significant differences between Central America and the Caribbean versus South America.

CONCLUSION

The prevalence of HD appears to be similar across Latin America. However, we infer that our findings are underestimates, in part because of limited research and underdiagnosis of HD because of limited access to molecular testing and the availability of neurologists and movement disorders specialists. Future research should focus on identifying pathways to improve access to molecular testing and education and understanding differences among different ancestral groups in Latin America. © 2024 International Parkinson and Movement Disorder Society.

Prevalence and genotypic associations of epilepsy in Prader-Willi Syndrome: A systematic review and meta-analysis

OBJECTIVE

To estimate the prevalence of epilepsy and febrile seizures and their association with genotype, i.e., 15q11-q13 deletions, uniparental chromosome 15 disomy (UPD) and other mutations, in the population with Prader-Willi syndrome (PWS).

METHODS

A systematic search of Medline, Scopus, Web of Science and the Cochrane Library was conducted. Studies estimating the prevalence of seizures, epilepsy and febrile seizures in the PWS population were included. Meta-analyses of the prevalence of epilepsy and febrile seizures and their association with genotype using the prevalence ratio (PR) were performed.

RESULTS

Fifteen studies were included. The prevalence of epilepsy was 0.11 (0.07, 0.15), similar to the prevalence of febrile seizures, with a prevalence of 0.09 (0.05, 0.13). The comparison "deletion vs. UPD" had a PR of 2.03 (0.90, 4.57) and 3.76 (1.54, 9.18) for epilepsy and febrile seizures.

CONCLUSIONS

The prevalence of seizure disorders in PWS is higher than in the general population. In addition, deletions in 15q11-q13 may be associated with a higher risk of seizure disorders. Therefore, active screening for seizure disorders in PWS should improve the lives of these people. In addition, genotype could be used to stratify risk, even for epilepsy, although more studies or larger sample sizes are needed.

The development of The Epileptic Seizure Parental Burden Scale: A validity and reliability study

OBJECTIVE

It is common for parents to shoulder the burden of care for their children with chronic diseases. However, there are no robust scales to measure the burden of care of parents of children with epilepsy. This study aimed to develop the "Epileptic Seizure Parental Burden Scale (ESPBS)" and evaluate its psychometric properties.

MATERIALS AND METHODS

This was a methodological study. The sample consisted of 333 voluntary parents of children with epilepsy. Data were analyzed using the Statistical Package for Social Sciences (SPSS v. 25) at a significance level of p < .05. Content validity, item-total correlation, explanatory factor analysis (EFA), confirmatory factor analysis (CFA), the "upper- and lower-27 percent rule," Cronbach's alpha coefficient, and the split-half reliability method were used for psychometric analysis.

RESULTS

The scale consisted of 15 items and two subscales. The Kaiser-Meyer-Olkin (KMO) was 0. 961, for which Bartlett's test of sphericity was significant (X2 = 5079.527, p < .001), indicating sampling adequacy and correlation between the items for factor analysis. The scale had item-total item correlations of 0.311 to 0.741. The Explanatory Factor Analysis (EFA) revealed a two-factor structure. According to the confirmatory factor analysis, x2/df, GFI, AGFI, CFI, and RMSEA were 2.012, 0.93, 0.91, 0.97, and 0.055, respectively. These values were very close to a good fit. The items had factor loadings of 0.508 to 0.890. The total scale explained 60.432% of the total variance. The scale had a Cronbach's alpha of 0.93. The split-half reliability indicated a significant (p < .001) and high (r = 0.890) correlation.

CONCLUSION

The Epileptic Seizure Parental Burden Scale (ESPBS) has high psychometric properties. It is a valid and reliable instrument that can measure the epileptic seizure burden of parents of children with epilepsy.

Unraveling the Myths Around Epilepsy: A Cross-Sectional Study of Knowledge, Attitude, and Practices Among Pakistani Individuals

INTRODUCTION

Across its historical trajectory, epilepsy has frequently been linked to evil forces, particularly in the sub-continent. This research was created to find out if educated Pakistanis still believe that epilepsy is caused by being possessed by spirits (Jinns). The objective of the study is to assess the knowledge, attitudes, and practices (KAP) regarding epilepsy within the educated populace of Pakistan.

METHOD

 After approval from the Ethical Review Committee, a population-based cross-sectional design was conducted in Chakwal District, Pakistan between February 1, 2018, and June 1, 2020, to evaluate the general knowledge and attitudes of the public toward epilepsy. A non-probability convenience sampling technique was utilized to recruit participants from different socioeconomic backgrounds across Chakwal District, and only individuals aged 18 years or older with at least 12 years of education were eligible to participate. A previously validated structured questionnaire was used to document findings. The study focused on several variables, such as knowledge about epilepsy and the percentage of people who have witnessed seizures, as well as sources of knowledge, subjective causes of epilepsy, beliefs in cure, transmission, and treatment options.

RESULTS

The survey included 512 participants, and the age distribution was as follows: 18-29 years old accounted for 18% of the respondents, 30-44 years old accounted for 35%, and 45-60 years old accounted for 31%. There was a female predominance with a frequency of 312 (60.9%). When asked about their sources of knowledge about epilepsy, the majority of participants (59.57%) reported learning about epilepsy from friends and relatives. A smaller percentage (18.36%) reported learning about epilepsy from schools, while another 20.31% heard about epilepsy from media and relatives.

CONCLUSION

The results of this research show that the general populace of Pakistan has a serious dearth of comprehension and information about epilepsy. Participants frequently held misconceptions about epilepsy being a hereditary disease and a mental condition, highlighting the need for focused education and information efforts to dispel these falsehoods. The fact that most participants got their knowledge about epilepsy from peers and family also emphasizes the value of peer education and social networks in spreading awareness of the disease.

Integrating mental health into primary care: evaluation of the Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) pilot project

Background

The Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) project trains non-specialist and primary health care workers in Imo State, Nigeria. This project adapted the World Health Organization’s Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG), emphasizing stigma reduction among trainees. This convergent mixed-methods proof-of-concept study evaluates the HAPPINESS pilot project mhGAP-IG training’s impact on mental illness stigma among trainees and barriers, facilitators, and opportunities to consider for project improvement.

Methods

Trainees (n = 13) completed a 43-item questionnaire before and after their 5-day training to assess perceptions of mental disorders and attitudes towards people with mental illness. These responses were analyzed using paired-sample t-tests for four subscales of the questionnaire: acceptance of socializing with people with mental illness, normalizing activities and relationships with people with mental illness, supernatural causation of mental illness, and endorsement of a biopsychosocial approach to mental illness. Semi-structured key informant interviews (n = 11) with trainees, trainers, and local health officials who participated in or supported the HAPPINESS project were thematically analyzed to understand their experiences and perspectives of the project’s barriers, facilitators, and opportunities.

Results

Trainees showed significant improvements on socializing, normalizing, and supernatural causation subscales of the stigma questionnaire (p < 0.05). No significant effect was seen on the biopsychosocial subscale; however, evidence of biopsychosocial beliefs was found in interview responses. Key informant interviews revealed that the HAPPINESS project enhanced trainees’ diagnostic and treatment abilities, mental health awareness, and empathy towards patients. Misinformation, stigma, inadequate funding, and lack of road access to clinics were identified as barriers to mental health care integration into general care in Imo State. Respondents also suggested ways that the HAPPINESS project could be improved and expanded in the future.

Conclusions

This study adds to the limited evidence on the implementation of mhGAP-IG in Nigeria. Using mixed methods, it evaluates how mhGAP-IG can impact perceptions and knowledge of stigma among primary care trainees. It also highlights barriers, facilitators, and opportunities to consider for project growth. Future efforts should focus on clinical support, supervision, health outcomes, as well as scaling up and assessing the cost-effectiveness of the HAPPINESS project intervention.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07703-1.

Epileptic disorders in Becker and Duchenne muscular dystrophies: a systematic review and meta-analysis

Dystrophin alterations in the brain have been associated with an increased risk of epilepsy in Becker and Duchenne muscular dystrophies (BMD and DMD). Moreover, an association between the mutation site and the risk of epilepsy is not ruled out. The aim of this systematic review and meta-analysis was to estimate the prevalence of epilepsy in BMD and DMD populations and to establish a possible association between the site of mutation in the dystrophin gene and the risk of epilepsy. Systematic searches of Medline, Scopus, Web of Science, and Cochrane Library were conducted to identify relevant studies published from inception to January 2022. Observational studies of participants with BMD/DMD estimating the prevalence of epilepsy were included. The main outcome was the prevalence of epilepsy, and the secondary outcome was the prevalence ratio considering genotype. A random effects meta-analysis was performed for the prevalence of epilepsy. Eight studies were included in the systematic review and meta-analysis. The prevalence of epilepsy was 7% (95% CI 3-11%) in BMD, 5% (95% CI 2-8%) in DMD, and 5% (95% CI 3-7%) in the overall estimate. No association was observed between mutation site and the prevalence of epilepsy. BMD/DMD is strongly associated with the prevalence of epilepsy, with a higher prevalence in BMD/DMD populations than in the general population, probably owing to alterations in Dp427. The current evidence does not support the hypothesis that Dp140 or Dp71 affect epilepsy risk.

Epidemiology of Epilepsy in Nigeria: A Community-Based Study From 3 Sites

BACKGROUND

We determined the prevalence, incidence, and risk factors for epilepsy in Nigeria.

METHODS

We conducted a door-to-door survey to identify cases of epilepsy in 3 regions. We estimated age-standardized prevalence adjusted for nonresponse and sensitivity and the 1-year retrospective incidence for active epilepsy. To assess potential risk factors, we conducted a case-control study by collecting sociodemographic and risk factor data. We estimated odds ratios using logistic regression analysis and corresponding population attributable fractions (PAFs).

RESULTS

We screened 42,427 persons (age ≥6 years), of whom 254 had confirmed active epilepsy. The pooled prevalence of active epilepsy per 1,000 was 9.8 (95% confidence interval [CI] 8.6-11.1), 17.7 (14.2-20.6) in Gwandu, 4.8 (3.4-6.6) in Afikpo, and 3.3 (2.0-5.1) in Ijebu-Jesa. The pooled incidence per 100,000 was 101.3 (95% CI 57.9-167.6), 201.2 (105.0-358.9) in Gwandu, 27.6 (3.3-128.0) in Afikpo, and 23.9 (3.2-157.0) in Ijebu-Jesa. Children's significant risk factors included febrile seizures, meningitis, poor perinatal care, open defecation, measles, and family history in first-degree relatives. In adults, head injury, poor perinatal care, febrile seizures, family history in second-degree relatives, and consanguinity were significant. Gwandu had more significant risk factors. The PAF for the important factors in children was 74.0% (71.0%-76.0%) and in adults was 79.0% (75.0%-81.0%).

CONCLUSION

This work suggests varied epidemiologic numbers, which may be explained by differences in risk factors and population structure in the different regions. These variations should differentially determine and drive prevention and health care responses.

Using community health workers as an alternative approach for epidemiological research on epilepsy in six health districts in Mali

BACKGROUND

In Mali, the burden of epilepsy is underestimated due to socio-cultural barriers that keep most people with epilepsy out of the local health facilities. The objective of this study was to evaluate the performance of trained community health workers (CHWs) in identifying epilepsy cases (active case detection) as compared to the passive cases detection (PCD) during outpatient visits at the community health centers in the health districts (HDs) of Kolokani, Kayes, Kéniéba, Sikasso, Kadiolo, and Tominian.

METHODS

A two-phase cross-sectional study was conducted from February to December 2019. In phase 1, trained CHWs conducted a census in 1017 villages organized into 174 community health centers which are part of the six study HDs to identify suspected epilepsy cases (SEC). Investigators used a modified epilepsy screening questionnaire from a validated standard questionnaire with the following three (3) questions: (i) Does or did the subject have a loss of consciousness and/or a loss of urine and/or drooling? (ii) Does or did the subject have an uncontrollable shake or abnormal movements of limb(s) (convulsions), with sudden onset and duration of a few minutes? (iii) Has or had the subject ever been told that he or she has epilepsy? During phase 2, neurologists confirmed the supposedly SEC (censed by the CHWs) in the first 30 villages with the highest number of SEC in each HD that were reported during phase 1.

RESULTS

Of a total of 4830 SEC, 422 (10%) were identified by PCD during routine outpatient visits and 4408 (90%) through the active case detection (ACD) using the trained CHWs. The majority of SEC reported by the CHWs (PCD) were confirmed by neurologists, i.e. 82.9% (1645/1985). Phenobarbital was available in only 26 (14.9%) of the 174 surveyed health centers. Confirmed cases of epilepsy were reported in all the 174 health centers with prevalence varying from 91/100,00 to 285/100,000.

CONCLUSION

Active case detection of epilepsy using trained CHWs is an effective approach for epidemiological studies of epilepsy in the community settings as compared to the passive approach.

Plasma fatty acid abnormality in Sudanese drug-resistant epileptic patients

Intervention studies have demonstrated that the n-3 fatty acids, docosahexaenoic and eicosapentaenoic acids, ameliorate seizure frequency in patients with drug-resistant epilepsy (DRE). There is a scarcity of fatty acid status of patients with epilepsy. We have investigated blood fatty acids of patients with DRE and assessed the indices of elongase and desaturase activities. DRE patients (n = 83) and healthy controls (n = 31) were recruited form Soba University Hospital Neurology Referral Clinic and Ibn-Auf paediatric Teaching Hospital Neurology Referral Clinic, Khartoum, Sudan. Fatty acid composition of plasma total lipids, phosphatidylcholine and neutral lipids were analysed. The patients compared with their healthy counterparts had higher levels of C14:0, C16:0, C18:0, C20:0, C22:0 (p<0.05) and C24:0, and total saturates (p<0.05). Similarly, the proportions of C16:1n-7, 18:1n-7, C18:1n-9, C20:1n-9, C24:1n-9 and total monounsaturated fatty acids; p<0.005) were higher in the drug-resistant patients. Conversely, the patients had lower levels of n-6 (C18:2n-6, C18:3n-6, C20:4n-6, n-6 metabolites and total n-6; p<0.005 and C20:2n-6 and C20:3n-6; p<0.05) and n-3 (C20:5n-3, C22:5n-3, C22:6n-3, ∑EPA and DHA, n-3 metabolites and total n-3; p<0.05) fatty acids. Indices of elongase and desaturase activities - The plasma total lipid ratios of C16:0/C14:0 (p = 0.001), C18:0/C16:0 (p = 0.001), C16:1n-7/C16:0 (p = 0.027), C18:1n-9/C18:0 (p = 0.022) and C22:4n-6/C20:4n-6 (p = 0.008) were higher and C18:3n-6/C18:2n-6 (p = 0.05), C20:4n-6/C20:3n-6 (p = 0.032) and C20:4n-6/C18:2n-6 (p>0.05) lower in the patients with drug-resistant epilepsy than in the healthy control subjects. DRE is associated with blood fatty acid perturbation and abnormal activities of long-chain fatty acid elongase (ELOVL-6), stearoyl-coenzyme A desaturase-1 (SCD-1), delta 6-fatty acid desaturase (D6D) and delta 5 fatty acid desaturase (D5D). N-3 fatty acids are known to ameliorate seizures frequency and dampen neuronal hyperexcitability. Therefore, patients with DRE should be regularly monitored and, if necessary, supplemented with n-3 fatty acids.

Evaluating the impact of pharmaceutical care services on the clinical outcomes of epilepsy: a randomised controlled trial

BACKGROUND

The involvement of pharmacists in the provision of specialised care to patients with epilepsy is poor.

OBJECTIVE

To evaluate the impact of pharmaceutical care services on the clinical outcomes of epilepsy.

SETTING

Two selected major referral epilepsy treatment centres in southern Nigeria were used for the study. Patients were recruited from the Neurology and Medical out-patient clinics of the hospitals.

METHOD

An open randomised controlled study was carried out on epilepsy patients receiving clinical care at the selected hospitals. Patients in the intervention group were offered pharmaceutical care services. The impact of the pharmaceutical care services on the clinical outcomes of epilepsy (seizure frequency and severity) was evaluated.

MAIN OUTCOME MEASURE

The effect of pharmaceutical care services on seizure frequency and severity in patients with epilepsy.

RESULTS

There was a statistically significant difference between the usual care (UC) and the pharmaceutical care (PC) group on the clinical outcomes of epilepsy post-PC intervention. Comparison between the groups (UC versus PC) revealed that patients in the PC group had a significantly lower seizure frequency score than those in the UC group at 3 months and 6 months-(pre-intervention: 3.09 versus 3.34; t = -1.685; p = 0.094) (3 months 2.45 versus 1.68; t = 4.494; p = 0.001), (6 months: 1.97 versus 0.92; t = -3.137; p = 0.001). Also, comparisons between the groups (UC versus PC) showed that patients in the PC group had a significantly lower seizure severity score than those in the UC group at 3 months and 6 months-(pre-intervention 18.46 versus 20.38; t = -3.102; p = 0.01) (3 months: 17.51 versus 14.79; t = 4.202; p = 0.001) (6 months 16.41 versus 11.66; t = 8.930; p = 0.001).

CONCLUSION

Pharmaceutical care interventions may significantly reduce seizure frequency and severity in patients with epilepsy.

IMPACT OF FINDINGS ON PRACTICE

These findings provide justification for the integration of pharmaceutical care services with other elements of health care for epilepsy patients.

Awareness, attitude, and understanding toward epilepsy among workers in a State Specialist Hospital in Maiduguri, Northeastern Nigeria

Background

Epilepsy is a common presentation at clinics in Psychiatric Hospitals, Teaching Hospitals, and general practice. In developing countries and Africa especially, awareness, attitude, and understanding are generally poor. People still believe in spirits as the cause of epilepsy.

Objectives

The objectives were to assess the awareness; attitude and knowledge of Hospital workers in general practice concerning epilepsy.

Methodology

The respondents were workers of all cadres who were working at a State Specialist Hospital and the study used a survey method proposed by Caveness and Gallup, with modifications and adaptations on the self-administered questionnaire.

Results

One hundred and forty-four staffs of State Specialist Hospital completed the questionnaire containing items addressing demographics, awareness, attitude, and knowledge. Of these respondents, 89 were males and 55 were females. The mean age was 34.34 years. 96.5% heard of the disease, 77.8% knew someone with the disease, 64.6% will not object to their children playing with someone with epilepsy and 37.5% will not allow a relative to marry someone with epilepsy. Fifty-five percent (55%) of the respondents said; they will not employ such patients, and that patients with epilepsy should not be employed with others. Knowledge towards epilepsy was good, where 71.5% felt it was caused by a brain disorder.

Conclusion

We found out that awareness and knowledge of epilepsy among Hospital staff were generally good. However, the attitude of healthcare workers had reservations towards patients with epilepsy (PWE) either working for them or working with other people. This attitude arose from deeply ingrained cultural misconceptions acquired over time. Thus, there is a need for consistent hospital staff education, aimed at allaying fears, mistrust as well as to lessen the stigma towards epileptics.

Knowledge and current practices of physiotherapists on the physical activity and exercise in the rehabilitation of children with epileptic seizures

BACKGROUND

Physiotherapists play a key role in the rehabilitation of children with epileptic seizures. Regular physical exercise generates psychological and physiological benefits for people with epilepsy.

DESIGN

This study was a cross-sectional design.

PURPOSE

The purpose of this study was to evaluate the knowledge and current practices of physiotherapists on the physical activity and exercise in the rehabilitation of children with epileptic seizures in Nigeria.

METHODS

Physiotherapists with minimum bachelor's degrees were invited to participate in the study using an electronic questionnaire. The subjects (N = 117) answered a questionnaire comprising 33 simple closed-ended questions with three domains: personal information, knowledge, and current practices.

RESULTS

Out of the 117 physiotherapists, 77.7% (n = 91) had postgraduate degrees, 16.2% (n = 19) had bachelor's degree in physiotherapy, and only 5.9% (n = 7) had Doctor of Physical Therapy (DPT). The results also indicated that 79.5% (n = 93) of physiotherapists had sufficient knowledge about epilepsy, and 86.3% (n = 101) of physiotherapists were using current skills/physical activity to rehabilitate children with epileptic seizures.

CONCLUSIONS

It was concluded that physiotherapists had sufficient knowledge about epilepsy and were using current skills/physical activity in the rehabilitation of children with epileptic seizures.

Prevalence of active epilepsy, lifetime epilepsy prevalence, and burden of epilepsy in Sub-Saharan Africa from meta-analysis of door-to-door population-based surveys

BACKGROUND

There is marked variation in the prevalence of epilepsy across Sub-Saharan Africa (SSA). In order to accurately estimate the clinical and public health impacts of epilepsy in the region, robust and reliable epidemiological data are required for appropriate estimation of logistical, economical, and social impacts of epilepsy including policy formulation and intervention in the region.

OBJECTIVE

We sought to evaluate the prevalence of active epilepsy (AE) and lifetime epilepsy prevalence in SSA using available data collected at community level.

METHODS

We carefully searched online databases and identified the required articles using prespecified criteria. Random-effects model (REM) was used to estimate the active and lifetime prevalence from data generated from studies in SSA.. The burden of epilepsy, in terms of the number of people with the disease, was also obtained. Heterogeneity in the analysis was further explored using subgroup analysis and meta-regression techniques.

RESULT

A total of 39 and 12 community-based door-to-door surveys addressing AE and lifetime epilepsy, respectively, from different countries of SSA met the inclusion criteria for the study. Random-effects model estimates of overall prevalence of epilepsy were 9 per 1000 persons (95% confidence interval (CI): 8.0-9.9 per 1000 persons) for AE and 16 per 1000 persons (95% CI: 12.3-19.7 per 1000 persons) for lifetime epilepsy. The prevalence was highest in the Central Africa subregion with 30.2 per 1000 persons (95% CI: 6.2 to 66.7 per 1000 persons). The prevalence of AE in the rural settlement was twice that of the urban settlements. About 9,596,551 (95% CI: 8,530,267-10,556,206) people with AE and 17,060,535 (95% CI: 13,115,286-21,005,784) people with lifetime epilepsy live in SSA.

CONCLUSION

This study estimates the active (9/1000) and lifetime (16/1000) epilepsy with a remarkable burden of the disease in SSA. However, the prevalence, which is higher in the rural setting, varies within the subregion of SSA.