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Huang L, Zhou K, Chen S, Chen Y, Zhang J. Automatic detection of epilepsy from EEGs using a temporal convolutional network with a self-attention layer. Biomed Eng Online 2024; 23:50. [PMID: 38824547 PMCID: PMC11143608 DOI: 10.1186/s12938-024-01244-w] [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] [Received: 01/12/2024] [Accepted: 05/08/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Over 60% of epilepsy patients globally are children, whose early diagnosis and treatment are critical for their development and can substantially reduce the disease's burden on both families and society. Numerous algorithms for automated epilepsy detection from EEGs have been proposed. Yet, the occurrence of epileptic seizures during an EEG exam cannot always be guaranteed in clinical practice. Models that exclusively use seizure EEGs for detection risk artificially enhanced performance metrics. Therefore, there is a pressing need for a universally applicable model that can perform automatic epilepsy detection in a variety of complex real-world scenarios. METHOD To address this problem, we have devised a novel technique employing a temporal convolutional neural network with self-attention (TCN-SA). Our model comprises two primary components: a TCN for extracting time-variant features from EEG signals, followed by a self-attention (SA) layer that assigns importance to these features. By focusing on key features, our model achieves heightened classification accuracy for epilepsy detection. RESULTS The efficacy of our model was validated on a pediatric epilepsy dataset we collected and on the Bonn dataset, attaining accuracies of 95.50% on our dataset, and 97.37% (A v. E), and 93.50% (B vs E), respectively. When compared with other deep learning architectures (temporal convolutional neural network, self-attention network, and standardized convolutional neural network) using the same datasets, our TCN-SA model demonstrated superior performance in the automated detection of epilepsy. CONCLUSION The proven effectiveness of the TCN-SA approach substantiates its potential as a valuable tool for the automated detection of epilepsy, offering significant benefits in diverse and complex real-world clinical settings.
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Affiliation(s)
- Leen Huang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Keying Zhou
- Department of Pediatrics, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China
- Department of Pediatrics, Second Clinical Medical College of Jinan University, Shenzhen, 518020, Guangdong, China
- Department of Pediatrics, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Siyang Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Yanzhao Chen
- Department of Pediatrics, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China
- Department of Pediatrics, Second Clinical Medical College of Jinan University, Shenzhen, 518020, Guangdong, China
- Department of Pediatrics, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Jinxin Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China.
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Zierath DK, Davidson S, Manoukian J, Knox KM, White HS, Meeker S, Ericsson A, Barker-Haliski M. Diet composition and sterilization modifies intestinal microbiome diversity and burden of Theiler's virus infection-induced acute seizures. Epilepsia 2024; 65:1777-1790. [PMID: 38491947 DOI: 10.1111/epi.17946] [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] [Received: 10/19/2023] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE Brain infection with Theiler's murine encephalomyelitis virus (TMEV) in C57BL/6J mice can induce acquired epileptogenesis. Diet alters acute seizure incidence in TMEV-infected mice; yet it is unclear whether intestinal dysbiosis may also impact acute or chronic behavioral comorbidities. This study thus assessed the impact of diet formulation and sterilization on acute seizure presentation, gut microbiome composition, and epilepsy-related chronic behavioral comorbidities. METHODS Baseline fecal samples were collected from male C57BL/6J mice (4- to 5-weeks-old; Jackson Labs) upon facility arrival. Mice were randomized to either autoclaved (AC) or irradiated diet (IR) (Prolab RMH 3000) or IR (Picolab 5053). Three days later, mice underwent intracerebral TMEV or phosphate-buffered saline (PBS) injection. Fecal samples were collected from a subset of mice at infection (Day 0) and Day 7 post-infection. Epilepsy-related working memory deficits and seizure threshold were assessed 6 weeks post-infection. Gut microbiome diversity was determined by 16S rRNA amplicon sequencing of fecal samples. RESULTS TMEV-infected mice displayed acute handling-induced seizures, regardless of diet: 28 of 57 IR Picolab 5053 (49.1%), 30 of 41 IR Prolab RMH 3000 (73.2%), and 47 of 77 AC Prolab RMH 3000 (61%) mice displayed seizures. The number of observed seizures differed significantly by diet: IR Picolab 5053 diet-fed mice had 2.2 ± 2.8 seizures (mean ± standard deviation), IR Prolab RMH 3000 diet-fed mice had 3.5 ± 2.9 seizures, and AC Prolab RMH 3000 diet-fed mice had 4.4 ± 3.8 seizures during the 7-day monitoring period. Gut microbiome composition differed significantly in TMEV-infected mice fed the AC Prolab RMH 3000 diet, with measured differences in gram-positive bacteria. These mice also displayed worsened long-term working memory deficits. SIGNIFICANCE Diet-induced differences in intestinal dysbiosis in the TMEV model are associated with marked changes in acute seizure presentation, symptomatic recovery, and onset of chronic behavioral comorbidities of epilepsy. Our study reveals a novel disease-modifying impact of dietary manipulation on intestinal bacterial species after TMEV-induced acute seizures.
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Affiliation(s)
- Dannielle K Zierath
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Stephanie Davidson
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Jonathan Manoukian
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Kevin M Knox
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - H Steve White
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Stacey Meeker
- Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Aaron Ericsson
- Department of Veterinary Pathobiology, University of Missouri, Columbia, Missouri, USA
| | - Melissa Barker-Haliski
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
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Pan G, Han Y, Wang TC, Chen ZY, Wang XQ, Sun HB, Liu YH, Wang Q, Lin WH, Li JM, Zhou SZ, Zhang YH. Attention deficit hyperactivity disorder in children with epilepsy: a multicenter cross-sectional analysis in China. World J Pediatr 2024:10.1007/s12519-024-00813-2. [PMID: 38806855 DOI: 10.1007/s12519-024-00813-2] [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: 10/05/2023] [Accepted: 04/07/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND The diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) comorbid with epilepsy have been insufficiently addressed in China. We conducted a study in China to investigate the current status, diagnosis, and treatment of ADHD in children to further our understanding of ADHD comorbid with epilepsy, strengthen its management, and improve patients' quality of life. METHODS We carried out a multicenter cross-sectional survey of children with epilepsy across China between March 2022 and August 2022. We screened all patients for ADHD and compared various demographic and clinical factors between children with and without ADHD, including gender, age, age at epilepsy onset, duration of epilepsy, seizure types, seizure frequency, presence of epileptiform discharges, and treatment status. Our objective was to explore any possible associations between these characteristics and the prevalence of ADHD. RESULTS Overall, 395 epilepsy patients aged 6-18 years were enrolled. The age at seizure onset and duration of epilepsy ranged from 0.1-18 to 0.5-15 years, respectively. Focal onset seizures were observed in 212 (53.6%) patients, while 293 (76.3%) patients had epileptiform interictal electroencephalogram (EEG) abnormalities. Among the 370 patients treated with anti-seizure medications, 200 (54.1%) had monotherapy. Although 189 (47.8%) patients had ADHD, only 31 received treatment for it, with the inattentive subtype being the most common. ADHD was more common in children undergoing polytherapy compared to those on monotherapy. Additionally, poor seizure control and the presence of epileptiform interictal EEG abnormalities may be associated with a higher prevalence of ADHD. CONCLUSIONS While the prevalence of ADHD was higher in children with epilepsy than in normal children, the treatment rate was notably low. This highlights the need to give more importance to the diagnosis and treatment of ADHD in children with epilepsy.
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Affiliation(s)
- Gang Pan
- Department of Neurology, Children's Hospital of Fudan University, 399 Wan Yuan Road, Minhang District, Shanghai, China
| | - Ying Han
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Tian-Cheng Wang
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
| | - Zi-Yi Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiang-Qing Wang
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hong-Bin Sun
- Department of Neurology, Sichuan Provincial People Hospital, Chengdu, China
| | - Yong-Hong Liu
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Qun Wang
- Department of Neurology, Beijing Tiantan Hospital, Captial Medical University, Beijing, China
| | - Wei-Hong Lin
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Jin-Mei Li
- Department of Neurology, Sichuan University West China Hospital, Chengdu, China
| | - Shui-Zhen Zhou
- Department of Neurology, Children's Hospital of Fudan University, 399 Wan Yuan Road, Minhang District, Shanghai, China.
| | - Yue-Hua Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China.
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Kaddu Mukasa M, Akpalu A, Ejilemele A, Ogunrin OA. Editorial: Epilepsy research in the developing countries: the neuro-ethical issues, cross-cultural differences, and relevance to comprehensive management. Front Neurol 2024; 15:1429745. [PMID: 38846041 PMCID: PMC11153827 DOI: 10.3389/fneur.2024.1429745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 06/09/2024] Open
Affiliation(s)
- Mark Kaddu Mukasa
- Neurology Unit, Department of Medicine, Makerere University, Kampala, Uganda
| | - Albert Akpalu
- Neurology Unit, Korle Bu Teaching Hospital, Accra, Ghana
| | - Adetoun Ejilemele
- Department of Pathology and Immunology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, United States
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Kamoen O, Jada SR, Rovarini JM, Abd-Elfarag G, Amaral LJ, Bol Y, Siewe Fodjo JN, Colebunders R. Evaluating epilepsy management in an onchocerciasis-endemic area: Case of Maridi, South Sudan. Seizure 2024:S1059-1311(24)00133-X. [PMID: 38714396 DOI: 10.1016/j.seizure.2024.05.001] [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: 12/05/2023] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/09/2024] Open
Abstract
PURPOSE The epilepsy prevalence in Maridi County, South Sudan, in 2018 was 43.8 (95% CI: 40.9-47.0) per 1000 persons; 85.2% of the identified persons with epilepsy (PWE) met the criteria of onchocerciasis-associated epilepsy. To address this health problem, an epilepsy clinic was established at Maridi County Hospital in 2020. In August 2023, the impact of the clinic on the lives of PWE and their families was evaluated. METHODS At the Maridi epilepsy clinic, data routinely collected by primary healthcare workers as part of patient care was reviewed. We also analyzed findings from two household surveys conducted in 2018 and 2022, which assessed the impact of the clinic on epilepsy care. Moreover, four households, each with four PWE, were visited in a high epilepsy prevalence area. PWE were examined by a neurologist, and in-depth interviews were conducted with family members. RESULTS The proportion of PWE on anti-seizure medication increased by 39.7% (95%CI: 35.3-44.2) between 2018 and 2022. The proportion of PWE reporting daily seizures decreased from 27.3% in 2018 to 5.3% in 2022. Of the 754 PWE seen in the clinic in July 2023, only 17 (2.3%) reported side effects. During household visits in July 2023, 13/173 (7.5%) of the visited PWE were found without remaining anti-seizure medication. A high level of epilepsy-related stigma was observed in all visited households. CONCLUSION The Maridi epilepsy clinic positively impacted the lives of PWE in Maridi. Similar initiatives should be accessible for all PWE living in onchocerciasis-endemic areas. Evidence-based information about OAE is needed to decrease misconceptions and epilepsy-related stigma.
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Affiliation(s)
- Olivia Kamoen
- Department of Neurology, Heilig Hart Ziekenhuis, Lier, Belgium
| | | | | | - Gasim Abd-Elfarag
- Access for Humanity, Juba, South Sudan; School of Public Health, University of Juba, Juba, South Sudan; Health and Social Sciences Research Institute-South Sudan, Juba, South Sudan
| | | | - Yak Bol
- Neglected Tropical Disease Programme, Ministry of Health, Juba, South Sudan
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Birbeck GL, Mwenechanya M, Ume‐Ezeoke I, Mathews M, Bositis CM, Kalungwana L, Bearden D, Elafros M, Gelbard HA, Theodore WH, Koralnik IJ, Okulicz JF, Johnson BA, Musonda N, Siddiqi OK, Potchen MJ, Sikazwe I. Long-term outcomes after new onset seizure in children living with HIV: A cohort study. Epilepsia Open 2024; 9:750-757. [PMID: 38366961 PMCID: PMC10984287 DOI: 10.1002/epi4.12921] [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] [Received: 12/15/2023] [Revised: 01/17/2024] [Accepted: 02/04/2024] [Indexed: 02/19/2024] Open
Abstract
OBJECTIVE To determine the long-term outcomes, including mortality and recurrent seizures, among children living with HIV (CLWH) who present with new onset seizure. METHODS Zambian CLWH and new onset seizure were enrolled prospectively to determine the risk of and risk factors for recurrent seizures. Demographic data, clinical profiles, index seizure etiology, and 30-day mortality outcomes were previously reported. After discharge, children were followed quarterly to identify recurrent seizures and death. Given the high risk of early death, risk factors for recurrent seizure were evaluated using a model that adjusted for mortality. RESULTS Among 73 children enrolled, 28 died (38%), 22 within 30-days of the index seizure. Median follow-up was 533 days (IQR 18-957) with 5% (4/73) lost to follow-up. Seizure recurrence was 19% among the entire cohort. Among children surviving at least 30-days after the index seizure, 27% had a recurrent seizure. Median time from index seizure to recurrent seizure was 161 days (IQR 86-269). Central nervous system opportunistic infection (CNS OI), as the cause for the index seizure was protective against recurrent seizures and higher functional status was a risk factor for seizure recurrence. SIGNIFICANCE Among CLWH presenting with new onset seizure, mortality risks remain elevated beyond the acute illness period. Recurrent seizures are common and are more likely in children with higher level of functioning even after adjusting for the outcome of death. Newer antiseizure medications appropriate for co-usage with antiretroviral therapies are needed for the care of these children. CNS OI may represent a potentially reversible provocation for the index seizure, while seizures in high functioning CLWH without a CNS OI may be the result of a prior brain injury or susceptibility to seizures unrelated to HIV and thus represent an ongoing predisposition to seizures. PLAIN LANGUAGE SUMMARY This study followed CLWH who experienced a new onset seizure to find out how many go on to have more seizures and identify any patient characteristics associated with having more seizures. The study found that mortality rates continue to be high beyond the acute clinical presentation with new onset seizure. Children with a CNS OI causing the new onset seizure had a lower risk of later seizures, possibly because the trigger for the seizure can be treated. In contrast, high functioning children without a CNS OI were at higher risk of future seizures.
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Affiliation(s)
- Gretchen L. Birbeck
- Department of NeurologyUniversity of RochesterRochesterNew YorkUSA
- University Teaching Hospitals Children's HospitalLusakaZambia
- Chikankata Epilepsy Care TeamMazabukaZambia
| | | | | | - Manoj Mathews
- University Teaching Hospitals Children's HospitalLusakaZambia
| | - Christopher M. Bositis
- Department of Family and Community MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | | | - David Bearden
- Department of NeurologyUniversity of RochesterRochesterNew YorkUSA
- University Teaching Hospitals Children's HospitalLusakaZambia
| | - Melissa Elafros
- Department of NeurologyUniversity of MichiganAnn ArborMichiganUSA
| | | | | | - Igor J. Koralnik
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Jason F. Okulicz
- Department of MedicineSan Antonio Military Medical CenterSan AntonioTexasUSA
| | - Brent A. Johnson
- Department of BiostatisticsUniversity of RochesterRochesterNew YorkUSA
| | - Namwiya Musonda
- University Teaching Hospitals Neurology Research OfficeLusakaZambia
| | - Omar K. Siddiqi
- University Teaching Hospitals Children's HospitalLusakaZambia
- Department of NeurologyBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - Michael J. Potchen
- Department of Imaging SciencesUniversity of RochesterRochesterNew YorkUSA
- Zambian College of Medicine and SurgeryLusakaZambia
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Biset G, Abebaw N, Gebeyehu NA, Estifanos N, Birrie E, Tegegne KD. Prevalence, incidence, and trends of epilepsy among children and adolescents in Africa: a systematic review and meta-analysis. BMC Public Health 2024; 24:771. [PMID: 38475724 DOI: 10.1186/s12889-024-18236-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/29/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Epilepsy contributes to a significant disease burden in children and adolescents worldwide. The incidence of childhood epilepsy is threefold higher in low and middle income countries compared in high-income countries. Epilepsy is a serious neurological condition associated with stigma and discrimination, an impaired quality of life, and other mental health related problems. OBJECTIVE This study is aimed to synthesize existing evidence and estimate the pooled prevalence and incidence of epilepsy in children and adolescents in Africa. METHODS A comprehensive and systematic search of relevant databases was conducted. The quality of each study was assessed using the Newcastle-Ottawa Quality Assessment Scale adapted for meta-analysis. Two reviewers screened retrieved articles, conducted critical appraisals, and extracted the data. Heterogeneity between studies was assessed by visual inspection of forest plots and statistically using Cochran's Q statistics and the I2 test. Publication bias was checked by visual inspection of funnel plots as well as statistically using Egger's correlation and Begg's regression tests. Finally, the pooled prevalence and incidence of childhood epilepsy were computed with 95% confidence intervals. RESULT In this review and meta-analysis 42 studies with 56 findings were included to compute the pooled prevalence of childhood epilepsy. On the other hand, 6 studies were included to estimate the combined incidence. The pooled prevalence of cumulative epilepsy was 17.3 per 1000 children. Whereas the pooled prevalence of active and lifetime epilepsy was 6.8 and 18.6 per 1000 children respectively. The pooled incidence of childhood epilepsy was 2.5 per 1000 children. CONCLUSION Nearly 1 in 50 children are suffering from epilepsy in Africa. However, little attention has been paid to the prevention and treatment of childhood epilepsy. Mass epilepsy screening, scaling up treatment coverage, and designing strict treatment follow up and monitoring mechanisms are recommended.
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Affiliation(s)
- Gebeyaw Biset
- Department of Pediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, P.O.BOX: 1145, Ethiopia.
| | - Nigusie Abebaw
- Department of Midwifery, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Natnael Atnafu Gebeyehu
- School of Midwifery, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Natan Estifanos
- Department of Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Endalk Birrie
- Department of Pediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, P.O.BOX: 1145, Ethiopia
| | - Kirubel Dagnaw Tegegne
- Department of Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Garrez I, Teuwen DE, Sebera F, Mutungirehe S, Ndayisenga A, Kajeneza D, Umuhoza G, Kayirangwa J, Düll UE, Dedeken P, Boon PAJM. Very high epilepsy prevalence in rural Southern Rwanda: The underestimated burden of epilepsy in sub-Saharan Africa. Trop Med Int Health 2024; 29:214-225. [PMID: 38124297 DOI: 10.1111/tmi.13963] [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: 12/23/2023]
Abstract
OBJECTIVES Up to 85% of people living with epilepsy (PwE) reside in low-and middle-income countries. In sub-Saharan Africa, the lifetime prevalence of epilepsy is 16 per 1000 persons. In Northern rural Rwanda, a 47.7 per 1000 prevalence has been reported. As variations in prevalence across geographical areas have been observed, we studied the prevalence in Southern rural Rwanda using the same robust methodology as applied in the North. METHODS We conducted a three-stage, cross-sectional, door-to-door survey in two rural villages in Southern Rwanda from June 2022 to April 2023. First, trained enumerators administered the validated Limoges questionnaire for epilepsy screening. Second, neurologists examined the persons who had screened positively to confirm the epilepsy diagnosis. Third, cases with an inconclusive assessment were separately reexamined by two neurologists to reevaluate the diagnosis. RESULTS Enumerators screened 1745 persons (54.4% female, mean age: 24 ± 19.3 years), of whom 304 (17.4%) screened positive. Epilepsy diagnosis was confirmed in 133 (52.6% female, mean age: 30 ± 18.2 years) and active epilepsy in 130 persons. Lifetime epilepsy prevalence was 76.2 per 1000 (95% CI: 64.2-89.7‰). The highest age-specific rate occurred in the 29-49 age group. No gender-specific differences were noted. In 22.6% of the PwE, only non-convulsive seizures occurred. The treatment gap was 92.2%, including a diagnosis gap of 79.4%. CONCLUSION We demonstrated a very high epilepsy prevalence in Southern rural Rwanda, with over 20% of cases having only non-convulsive seizures, which are often underdiagnosed in rural Africa. In line with previous Rwandan reports, we reiterate the high burden of the disease in the country. Geographic variation in prevalence throughout Africa may result from differences in risk and aetiological factors. Case-control studies are underway to understand such differences and propose adapted health policies for epilepsy prevention.
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Affiliation(s)
- Ieme Garrez
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Dirk E Teuwen
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Fidèle Sebera
- Department of Neurology, Ndera Neuro-Psychiatric Teaching Hospital, Kigali, Rwanda
- Centre Hospitalier Universitaire Kigali, Kigali, Rwanda
| | | | | | | | - Georgette Umuhoza
- Department of Neurology, Ndera Neuro-Psychiatric Teaching Hospital, Kigali, Rwanda
| | | | - Uta E Düll
- Medicalized Health Center, Gikonko, Rwanda
| | - Peter Dedeken
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
- Heilig Hart Ziekenhuis, Lier, Belgium
| | - Paul A J M Boon
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
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Tadesse G, Tinsae T, Nakie G, Rtbey G, Andualem F, Tadesse A, Melkam M, Takelle GM, Fentahun S. Prevalence and factors associated with depressive symptoms among patients with epilepsy in Ethiopia: a national-based systematic review and meta-analysis. Front Neurol 2024; 15:1352648. [PMID: 38500809 PMCID: PMC10946423 DOI: 10.3389/fneur.2024.1352648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/15/2024] [Indexed: 03/20/2024] Open
Abstract
Background Depression is a major public health problem and negatively affects the quality of life of patients with epilepsy. Despite multiple studies investigating the magnitude and predictors, the results have been inconsistent. Therefore, this study aimed to estimate the pooled prevalence and factors associated with depressive symptoms among patients with epilepsy in Ethiopia. Methods The primary articles were searched using databases like PubMed, Google Scholar, CINAHL, SCOPUS, EMBASE, and African Journal Online. A total of 10 primary articles that assessed the prevalence and factors associated with depressive symptoms among patients with epilepsy in Ethiopia were included. A Microsoft Excel spreadsheet was used to extract the data, which was then exported to Stata version 14 for further analysis. The statistical heterogeneity was evaluated using the I2 test. Due to heterogeneity, a random effect meta-analysis model was employed. Publication bias was checked through Egger's weighted regression test and funnel plot. Results A total of 10 primary studies with 3,532 participants were included. The pooled prevalence of depressive symptoms among patients with epilepsy was found to be 41.69% (95% CI, 37.70, 45.68). The pooled prevalence of depressive symptoms was 48.61, 42.98, 40.68, 38.27, and 34.80% in Oromia, SNNPs, Amhara, Addis Ababa, and Tigray, respectively, based on a sub-group analysis per regional state. Perceived stigma (AOR = 3.30, 95% CI: 1.40, 7.80), seizure frequency (AOR = 3.81, 95% CI: 1.03, 14.09), and perceived stress (AOR = 4.6, 95% CI: 1.05, 20.06) were factors associated with depressive symptoms. Conclusion We found that depressive symptoms affects at least four out of ten patients with epilepsy, indicating an immense burden. Depressive symptoms were extremely prevalent in those who had high levels of stigma, a monthly seizure frequency of once or more, and perceived stress. Therefore, physicians should take extra precautions when treating patients with epilepsy who have certain conditions. Systematic review registration This study was registered according to The International Prospective Register of Systemic Review (PROSPERO) with the registration ID (CRD42023484308).
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Affiliation(s)
- Gebresilassie Tadesse
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Techilo Tinsae
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Girum Nakie
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gidey Rtbey
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantahun Andualem
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asnake Tadesse
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mamaru Melkam
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Girmaw Medfu Takelle
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Setegn Fentahun
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Kegele J, Wagner T, Kowenski T, Wiesmayr M, Gatterer C, Alber M, Matuja W, Schmutzhard E, Lerche H, Winkler AS. Long-term clinical course and treatment outcomes of individuals with Nodding Syndrome. J Neurol Sci 2024; 457:122893. [PMID: 38278097 DOI: 10.1016/j.jns.2024.122893] [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: 03/03/2023] [Revised: 12/28/2023] [Accepted: 01/13/2024] [Indexed: 01/28/2024]
Abstract
Nodding Syndrome is a poorly understood epilepsy disorder in sub-Saharan Africa. The cause(s) of the disease, risk factors and long-term outcomes are unknown or controversial. The objectives of this study were to describe the long-term clinical course and treatment outcomes of individuals suffering from Nodding Syndrome. In addition, we aimed to provide a comprehensive characterization of the epileptological and social features of patients with Nodding Syndrome. From 11/2014 to 4/2015, we conducted a hospital-based, cross-sectional and observational study in Mahenge, Tanzania. Seventy-eight individuals (female:male ratio: 40:38, age at examination: 21.1 ± 6.39 (SD) years) have been enrolled, of whom 38 (49%) had also been examined in 2005 and in 2009. The 10-year clinical course analysis of this revisited subgroup revealed a calculated case fatality of 0.8-2.3%. Progressive physical or cognitive deterioration has not been observed in any of the 78 individuals and more than half of the people studied (38/69; 55%) managed to live and work independently. 14/78 individuals (18%) were seizure-free, (no head nodding, no other seizure types), 13 of whom were taking antiseizure medication. Phenytoin was more effective against head nodding seizures (14/19 (74%)) than monotherapy with other available antiseizure medication (phenobarbitone 12/25 (48%) and carbamazepine 7/22 (32%), p = 0.02, chi-square test). Our ten-year clinical outcome data show that Nodding Syndrome is not a fatal disease, however, the response to treatment is worse than in epilepsy patients in general. Phenytoin may be more effective than carbamazepine and phenobarbitone, but further studies are needed to confirm this observation.
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Affiliation(s)
- Josua Kegele
- Department of Neurology and Epileptology, Hertie Institute of Clinical Brain Research, University of Tübingen, Hoppe-Seyler Straße 3, 72076 Tuebingen, Germany.
| | - Thomas Wagner
- Centre for Pediatric and Adolescent Medicine, University Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Teresa Kowenski
- Medical University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria
| | - Matthias Wiesmayr
- Medical University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria
| | | | - Michael Alber
- Pediatric Neurology and Developmental Medicine, University of Tübingen, Hoppe-Seyler Straße 3, 72076 Tuebingen, Germany.
| | - Wiliam Matuja
- Department of Neurology, Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - Erich Schmutzhard
- Department of Neurology, Medical University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria.
| | - Holger Lerche
- Department of Neurology and Epileptology, Hertie Institute of Clinical Brain Research, University of Tübingen, Hoppe-Seyler Straße 3, 72076 Tuebingen, Germany.
| | - Andrea S Winkler
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany; Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Forskningsveien 3A, 0373 Oslo, Norway; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
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11
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Urio OH, Kija E, Weckhuysen S, Makungu H, Naburi H. Drug resistant epilepsy and associated factors among children with epilepsies in tanzania: a cross-sectional study. BMC Neurol 2024; 24:8. [PMID: 38166885 PMCID: PMC10759687 DOI: 10.1186/s12883-023-03508-9] [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: 03/01/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Epilepsy contributes to high morbidity among children and adolescents in developing countries. A quarter of all children with epilepsy will be resistant to anti-seizure medications (ASMs), with associated neurocognitive impairments and risk of higher mortality. This study aimed to estimate and characterize drug-resistant epilepsy (DRE) (defined as failure to achieve sustained remission after adequate trials of two tolerated and appropriately chosen ASMs) and its associated factors among children and adolescents with epilepsies attending the pediatric neurology clinic at Muhimbili National Hospital (MNH), Dar es Salaam Tanzania. METHODS This cross-sectional study was conducted from June 2020 to June 2021. Children with epilepsies and who had been treated with ASMs for at least 3 months were eligible for inclusion. Exclusion criteria included children whose caregivers denied consent and those who exhibited acute medical conditions necessitating admission on the scheduled visit day. Data on demographic characteristics, perinatal history, detailed history of the seizures semiology, drug history, magnetic resonance imaging (MRI), and electroencephalography (EEG) results were obtained from caregivers and medical records available during recruitment. Seizures and epilepsies were classified using the 2017 International League Against Epilepsy (ILAE) classification. Logistic regression was used to determine factors associated with DRE. RESULTS A total of 236 children and adolescents aged between 4 months and 15 years (Median age 72 months (IQR = 42-78)) were enrolled in this study. We found the proportion of DRE to be 14.8% in this cohort. Of the thirty-five patients with DRE, 60% had generalized epilepsy and almost 25% had a diagnosis of an epilepsy syndrome, the most common being Lennox-Gastaut syndrome (LGS). Structural abnormalities on brain MRI were seen in almost 80% of all patients with DRE, the most prevalent being cystic encephalomalacia, which was observed in 34% of patients. Patients using both ASMs and alternative therapies accounted for 9% of this cohort. The onset of seizures during the first month of life (aOR = 1.99; 95%CI 1.7-4.6; p = 0.031) and high initial seizure frequency (aOR = 3.6; 95%CI 1.6-8;p = 0.002) were found to be independently associated with DRE. CONCLUSION The proportion of DRE in Tanzania is high. Patients with neonatal onset seizures and high initial seizure frequency should be followed up closely to ensure early diagnosis of DRE.
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Affiliation(s)
- Obrey H Urio
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Edward Kija
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Hilda Makungu
- Department of radiology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Helga Naburi
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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12
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Bankole NDA, Dokponou YCH, De Koning R, Dalle DU, Kesici Ö, Egu C, Ikwuegbuenyi C, Adegboyega G, Yang Ooi SZ, Dada OE, Erhabor J, Mukambo E, Olobatoke TA, Takoutsing BD, Bandyopadhyay S. Epilepsy care and outcome in low- and middle-income countries: A scoping review. J Neurosci Rural Pract 2024; 15:8-15. [PMID: 38476408 PMCID: PMC10927051 DOI: 10.25259/jnrp_527_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/25/2023] [Indexed: 03/14/2024] Open
Abstract
Objectives Epilepsy is a common neurological condition in low- and middle-income countries (LMICs). This study aims to systematically review, analyze, evaluate, and synthesize information on the current state of medical and surgical management and outcomes of epilepsy in LMICs. Materials and Methods Systematic searches were conducted on MEDLINE, EMBASE, World Health Organization Global Index Medicus, African Journals Online, WOS, and Scopus, covering the period from the inception of the databases to August 18th, 2021, focusing on studies reporting management and outcomes of epilepsy in LMICs. Results A total of 2298 unique studies were identified, of which, 48 were included (38035 cases). The mean age was 20.1 ± 19.26 years with a male predominance in 60.92% of cases. The type of seizure commonly reported in most of the studies was absence seizures (n = 8302, 21.82%); partial focal seizure (n = 3891, 10.23%); and generalized tonic-clonic seizures (n = 3545, 9.32%) which were the next most common types of seizures. Mesiotemporal epilepsy was less frequently reported (n = 87, 0.22%). Electroencephalogram was commonly used (n = 2516, 6.61%), followed by computed tomography scan (n = 1028, 2.70%), magnetic resonance imaging (n = 638, 1.67%), and video telemetry (n = 484, 1.27%) in the care of patients with seizures. Primary epilepsy was recorded in 582 patients (1.53%) whereas secondary epilepsy was present in 333 patients (0.87%). Carbamazepine was the most used anti-epileptic drug (n = 2121, 5.57%). Surgical treatment was required for 465 (1.22%) patients. Conclusion In LMICs, epilepsy is underreported. There is still a lack of adequate tools for the diagnosis of primary or secondary epilepsy as well as adequate access to medical management of those reported.
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Affiliation(s)
| | | | - Rosaline De Koning
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - David Ulrich Dalle
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Özgür Kesici
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Chinedu Egu
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - Gideon Adegboyega
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - Olaoluwa E. Dada
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Joshua Erhabor
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Emmanuel Mukambo
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - Berjo D. Takoutsing
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Soham Bandyopadhyay
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
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13
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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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14
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Kassahun Bekele B, Nebieridze A, Moses Daniel I, Byiringiro C, Nazir A, Algawork Kibru E, Wojtara M, Uwishema O. Epilepsy in Africa: a multifaceted perspective on diagnosis, treatment, and community support. Ann Med Surg (Lond) 2024; 86:624-627. [PMID: 38222688 PMCID: PMC10783313 DOI: 10.1097/ms9.0000000000001536] [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: 06/04/2023] [Accepted: 11/13/2023] [Indexed: 01/16/2024] Open
Abstract
Epilepsy is the most widespread neurological disorder in Africa, affecting an estimated 25 million people. The disorder is characterized by recurrent seizures, which can be caused by a variety of factors, including past trauma, central nervous system infections, and genetic disorders. Diagnosis and treatment of epilepsy are challenging in African patients due to several factors, including the low socioeconomic status of the residents and limited access to appropriate medication. Phenobarbital remains the only drug widely available to patients, but it is not always effective and can have significant side effects. In addition to the medical challenges, individuals with epilepsy also face a lot of social stigmas in Africa. Widespread superstitions and false beliefs lead to prejudices against these people, making it difficult for them to live fulfilling social lives. With the development of new treatment modalities, such as gene therapy, stem cell therapy, and P-glycoprotein inhibitors, it is more important now than ever to increase the research output for the African region to create the best possible treatment and maximize patient outcomes.
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Affiliation(s)
- Bezawit Kassahun Bekele
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda
- George Washington University, Milken Institute of Public Health, Washington, DC
- Addis Ababa University, School of Medicine, Addis Ababa, Ethiopia
| | - Anano Nebieridze
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda
- David Tvildiani Medical University, Tbilisi, Georgia
| | - Itopa Moses Daniel
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda
- University of Ilorin, College of Health Sciences, Nigeria
| | - Clever Byiringiro
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda
- Adventist School of Medicine of East-Central Africa—ASOME-HEALTH, Mogadishu, Somalia
| | - Abubakar Nazir
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda
- Department of Medicine, King Edward Medical University, Pakistan
| | - Ermias Algawork Kibru
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda
- Addis Ababa University, School of Medicine, Addis Ababa, Ethiopia
| | - Magda Wojtara
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda
- University of Michigan Medical School; Ann Arbor, MI
| | - Olivier Uwishema
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda
- Clinton Global Initiative University, New York, NY
- Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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15
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Zhang YJ, Kong XM, Lv JJ, Yang CH, Li XY, Yang XT, Guo ZL, Cheng ZH. Analysis of the global burden of disease study highlights the global, regional, and national trends of idiopathic epilepsy epidemiology from 1990 to 2019. Prev Med Rep 2023; 36:102522. [PMID: 38116287 PMCID: PMC10728447 DOI: 10.1016/j.pmedr.2023.102522] [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: 08/28/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023] Open
Abstract
Epilepsy is a profound disorder, accounting for roughly 1% of the global disease burden. It can result in premature death and significant disability. To comprehensively understand the current dynamics and trends of idiopathic epilepsy, a deep insight into its epidemiological attributes is vital. We evaluated the incidence, prevalence, mortality, and disability-adjusted life years associated with idiopathic epilepsy from 1990 to 2019 using data and methodologies from the Global Burden of Disease Study. In 2019, there were approximately 2,898,222 individuals diagnosed with idiopathic epilepsy. Intriguingly, from 1990 to 2019, the age-standardized incidence rate of idiopathic epilepsy was consistently lower in women compared to men. Over these three decades, global mortality connected to idiopathic epilepsy increased by 13.95%. However, within the same period, age-standardized death rates for idiopathic epilepsy decreased from 1.94 per 100,000 population to 1.46 per 100,000 population. Predictions indicate an increase in the incidence of idiopathic epilepsy across all age brackets through 2035, especially among the elderly aged 80 and above. Mortality rates are projected to climb for those aged 80 and above while remaining relatively unchanged in other age demographics. Idiopathic epilepsy continues to be a significant contributor to both disability and death. The findings of our study underscore the critical importance of incorporating idiopathic epilepsy management into modern healthcare frameworks. Such strategic inclusion can enhance public awareness of relevant risk factors and the range of available therapeutic interventions.
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Affiliation(s)
- Yuan-jie Zhang
- Department of Neurosurgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, Shanghai, PR China
| | - Xiang-meng Kong
- Department of Cardiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, Shanghai, PR China
| | - Jia-jie Lv
- Department of Vascular Surgery, School of Medicine, Shanghai Putuo People's Hospital, Tongji University, Shanghai, PR China
- Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, Shanghai, PR China
| | - Cheng-Hao Yang
- Department of Vascular Surgery, School of Medicine, Shanghai Putuo People's Hospital, Tongji University, Shanghai, PR China
| | - Xin-yu Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, PR China
| | - Xi-tao Yang
- Department of Neurosurgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, Shanghai, PR China
| | - Zhi-lin Guo
- Department of Neurosurgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, Shanghai, PR China
| | - Zhi-hua Cheng
- Department of Neurosurgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, Shanghai, PR China
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16
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Nasir M, Abebaw E, Ahmed M, Ketema DB. Clinical Characteristics, Treatment Outcome and Associated Factors of Epilepsy Among Children at Hospitals of North-West Ethiopia. Pediatric Health Med Ther 2023; 14:385-404. [PMID: 37927397 PMCID: PMC10625381 DOI: 10.2147/phmt.s436022] [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: 09/13/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023] Open
Abstract
Background Epilepsy is an important cause of neurological morbidity in children and adolescents. Clinical parameters are the main diagnostic tools, especially in developing countries. Although cost-effective treatments for epilepsy are available, studies have shown that uncontrolled seizures can occur in many patients. Objective To assess clinical characteristics, treatment outcomes, and associated factors for controlled epilepsy among children with epilepsy who underwent follow-up at the Debre Markos Comprehensive Specialized Hospital, North-west Ethiopia from October 28, 2020, to April 28, 2021. Methods An institutional-based retrospective cohort study was conducted from October 28, 2020, to April 28, 2021. A total of 385 participants who fulfilled the inclusion criteria were included in the study. A pretested, structured, interviewer-administered questionnaire with a chart review was used to collect data. The data were entered into the Epi-data software version 4.4.2.1 and then exported to the Stata version 14 statistical package for analysis. Descriptive statistics were used to describe the sociodemographic and clinical characteristics, treatment profiles, and treatment outcomes of patients with epilepsy. Bivariate and multivariate analyses were used to identify factors associated with treatment outcomes. Results The most frequent type of seizure among the 385 respondents was Generalized-tonic-clonic seizures (88.1%). The proximate cause of seizures was identified in 15% of patients, of whom 45 had a perinatal history (8.8%), head injury (3.6%), and CNS infection (2.3%). One-third of patients had poor seizure control. Caregiver relationship (father AOR=0.58; 95th CI:0.35,0.97) and poor adherence (AOR=2.97; 95th CI:1.82, 4.86) were significantly associated with treatment outcome. Conclusion One-third of children with epilepsy have poor seizure control. Poor adherence to treatment is implicated in poor control. Counseling caregivers on proper treatment and adherence to anti-epileptic medication is recommended to improve treatment outcome in children.
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Affiliation(s)
- Mohammed Nasir
- Pediatrics Department, Hawassa University, Hawassa, Ethiopia
| | - Ermias Abebaw
- Pediatrics Department, ALERT Comprehensive Specialized Hospital, Addis Ababa, Ethiopia
| | - Muluken Ahmed
- Pediatrics Department, Arba Minch University, Arba Minch, Ethiopia
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Zierath DK, Davidson S, Manoukian J, White HS, Meeker S, Ericsson A, Barker-Haliski M. Diet composition and sterilization modifies intestinal microbiome diversity and burden of Theiler's virus infection-induced acute seizures. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.17.562694. [PMID: 37905123 PMCID: PMC10614857 DOI: 10.1101/2023.10.17.562694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Objective Central nervous system infection with Theiler's murine encephalomyelitis virus (TMEV) in C57BL/6J mice can model acquired epileptogenesis. Diet alters the acute seizure incidence in TMEV-infected mice; yet it is unclear whether intestinal dysbiosis may also impact acute or chronic behavioral comorbidities. This study thus assessed the impact of diet sterilization in a specific pathogen-free vivarium on acute seizure presentation, the composition of the gut microbiome, and chronic behavioral comorbidities of epilepsy. Methods Baseline fecal samples were collected from male C57BL/6J mice (4-5 weeks-old; Jackson Labs) upon arrival. Mice were randomized to either autoclaved (AC) or irradiated (IR) diet (Prolab RMH 3000 - UU diets) or IR (Picolab 5053 - UW IR diet). Mice then underwent intracerebral TMEV or PBS injection three days later. Fecal samples were collected from a subset of mice at infection (Day 0) and Day 7 post-infection. Epilepsy-related working memory deficits and seizure threshold were assessed 6 weeks post-infection. Gut microbiome diversity was determined by 16S rRNA amplicon sequencing of fecal samples. Results TMEV-infected mice displayed acute handling-induced seizures, regardless of diet: 28/57 UW IR (49.1%), 30/41 UU IR (73.2%), and 47/77 UU AC (61%) mice displayed seizures. The number of observed seizures significantly differed: UW IR mice had 2.2±2.8 seizures (mean±standard deviation), UU IR mice had 3.5±2.9 seizures, and UU AC mice had 4.4±3.8 seizures during the 7-day monitoring period. The composition of the gut microbiome significantly differed in TMEV-infected mice fed the UU AC diet, with most measured differences occurring in Gram-positive bacteria. TMEV-infected mice fed the UU AC diet displayed worsened chronic working memory. Significance Intestinal dysbiosis evokes stark differences in acute seizure presentation in the TMEV model and vastly influences the trajectory of post-TMEV infection-induced behavioral comorbidities of epilepsy. Our study reveals a novel disease-modifying contribution of intestinal bacterial species after TMEV-induced acute seizures.
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Affiliation(s)
- Dannielle K. Zierath
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA
| | - Stephanie Davidson
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA
| | - Jonathan Manoukian
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA
| | - H. Steve White
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA
| | - Stacey Meeker
- Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, OH
| | - Aaron Ericsson
- Department of Veterinary Pathobiology, University of Missouri, Columbia, MO
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Gupta N, Singh R, Seas A, Antwi P, Kaddumukasa MN, Kakooza Mwesige A, Kaddumukasa M, Haglund MM, Fuller AT, Koltai DC, Ukachukwu AEK. Epilepsy among the older population of sub-Saharan Africa: Analysis of the global burden of disease database. Epilepsy Behav 2023; 147:109402. [PMID: 37677904 DOI: 10.1016/j.yebeh.2023.109402] [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: 05/18/2023] [Revised: 08/05/2023] [Accepted: 08/19/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Epilepsy is considered one of the most burdensome neurologic diseases by the World Health Organization due to the high risk of morbidity and mortality. Few studies have investigated the epidemiology of idiopathic epilepsy in Sub-Saharan Africa (SSA). This study aims to characterize the disease burden of epilepsy among the older population in SSA via a large international database. METHODS Descriptive epidemiological data from the Global Burden of Disease (GBD) database was collected for idiopathic epilepsy in all regions of SSA. The "older" population was defined as 55 years of age and above. The variables of interest included mortality, incidence, prevalence, and disability-adjusted life years (DALYs) rates per one hundred thousand populations. RESULTS The average mortality rate was highest in Western SSA (6.34 per 100,000), and all regions were significantly higher than the global average (p < 0.001). DALYs and incidence rates of idiopathic epilepsy in all regions of SSA were significantly higher than the global averages (p < 0.01). Globally, the older population had a significantly higher mortality rate than the younger population (2.78 vs 1.62, respectively; p < 0.01). The older population had a higher mortality rate than the younger population in each region of SSA (p < 0.01). Conversely, for DALYs, the younger population had a higher disease burden than the older population globally and in each region of SSA (p < 0.01). CONCLUSION This study is the first to examine the epidemiologic profile of idiopathic epilepsy in the older population in SSA. Our results indicate that, when compared with the global population, older adults in SSA suffer a greater disease burden and mortality. This study reports the immense need for increased resources and awareness regarding epilepsy in the elderly population of Africa.
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Affiliation(s)
- Nithin Gupta
- Duke Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Campbell School of Osteopathic Medicine, Lillington, NC, USA
| | - Rohin Singh
- Duke Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Department of Neurosurgery, University of Rochester, Rochester, NY, USA
| | - Andreas Seas
- Duke Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA; Department of Biomedical Engineering, Duke University Pratt School of Engineering, Durham, NC, USA
| | - Prince Antwi
- Duke Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Department of Neurosurgery, Duke University, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Martin N Kaddumukasa
- Department of Medicine, Makerere University College of Health Sciences, and Mulago Hospital, Kampala, Uganda
| | - Angelina Kakooza Mwesige
- Department of Paediatrics & Child Health, Makerere University College of Health Sciences and Mulago Hospital, Kampala, Uganda; Astrid Lindgren Children's Hospital, Neuropediatric Research Unit, Karolinska Instituet, Sweden
| | - Mark Kaddumukasa
- Department of Medicine, Makerere University College of Health Sciences, and Mulago Hospital, Kampala, Uganda
| | - Michael M Haglund
- Duke Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Department of Neurosurgery, Duke University, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Anthony T Fuller
- Duke Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Department of Neurosurgery, Duke University, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Deborah C Koltai
- Duke Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA; Department of Neurology, Duke University, Durham, NC, USA; Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC, USA
| | - Alvan-Emeka K Ukachukwu
- Duke Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Department of Neurosurgery, Duke University, Durham, NC, USA.
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Biresaw MS, Irawan A, Halász P, Szucs A. Unfavorable public attitude toward people with epilepsy in Ethiopia: A systematic review and meta-analysis study. Epilepsia Open 2023; 8:1054-1063. [PMID: 37394990 PMCID: PMC10472419 DOI: 10.1002/epi4.12785] [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: 05/08/2023] [Accepted: 06/30/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVE This systematic review and meta-analysis aims to show the pooled prevalence of unfavorable public attitude toward people with epilepsy (UPATPWE) as well as the effect estimates of associated factors in Ethiopia. METHODS Between December 1 and 31, 2022, we searched for the English version of published research reports on public attitude toward epilepsy in Ethiopia in PubMed/Medline, Science Direct, Cochrane Library, Google Scholar, and PsycINFO. The research reports' quality was assessed using the Newcastle-Ottawa Scale. We extracted the relevant information from the searched papers in a Microsoft Excel format and imported it to STATA version 15.0, for analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reports guideline was used. A random-effects meta-analysis model was used to estimate the Der Simonian and Laird's pooled prevalence of unfavorable public attitude and its associated factors. RESULTS Nine out of the accessed 104 research papers meeting the pre-specified criteria were included in this study. The overall pooled prevalence of UPATPWE in Ethiopia is 52.06 (95% CI: 37.54, 66.59), resulting in excommunication, physical punishments, and assaults against people with epilepsy as well as frequent lack of diagnosis and proper treatment. The pooled effect estimates for witnessing a seizure episode were done and it was (AOR = 2.70 [95% CI: 1.13, 6.46]). SIGNIFICANCE As interventions and new strategies to change attitudes and facilitate a supportive, positive, and socially inclusive environment for PWE may root in education and scientific research outputs, our result hopefully evokes the policy makers' attention for building a well-designed and comprehensive health education and campaign strategy.
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Affiliation(s)
| | - Anggi Irawan
- Doctoral School of Mental Health SciencesSemmelweis UniversityBudapestHungary
| | - Peter Halász
- Department of NeurologyUniversity of Pécs Medical SchoolPécsHungary
- Epilepsy CenterNational Institute of NeurosurgeryBudapestHungary
| | - Anna Szucs
- Department of Behavioral SciencesSemmelweis UniversityBudapestHungary
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Bhwana D, Siewe Fodjo JN, Amaral LJ, Vandevenne L, Francis F, Challe DP, Mmbando BP, Colebunders R. Disability assessment among persons with epilepsy in Mahenge, an onchocerciasis-endemic area in Tanzania: A cross-sectional study. Epilepsy Behav 2023; 146:109367. [PMID: 37523798 DOI: 10.1016/j.yebeh.2023.109367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND A high prevalence of epilepsy has been observed in the onchocerciasis-endemic focus of Mahenge, Tanzania. This study sought to assess the degree of disability experienced by persons with epilepsy (PWE) in Mahenge and identify associations with sociodemographic and clinical features. METHOD This cross-sectional study was conducted in Mahenge, Tanzania, between February and July 2020. PWE were recruited from the Mahenge epilepsy clinic and four neighbouring rural villages (Mdindo, Mzogezi, Mzelezi and Sali). Data were collected using the 36-item version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaire for adults. For children aged 5-17 years, we used the Module on Child Functioning developed by UNICEF and the Washington Group. Questionnaires were administered by trained research assistants. Descriptive statistics were performed, and multivariable analyses (gamma and logistic regressions) were conducted. RESULTS A total of 321 adults (45.5% males) and 48 children (55.3% males) with epilepsy participated. The overall median WHODAS 2.0 score was 4.8% (IQR: 0.9-18.9). The most affected disability domain was 'participating in the society' (median score: 12.5%, IQR: 0-29.2). Fifteen (31.3%) of the children with epilepsy had a disability in at least one domain of the child functioning module, with the 'accepting change' domain harbouring the highest proportion of disabled children (12.5%). Higher seizure frequency and longer epilepsy duration were associated with more disability. CONCLUSION PWE in Mahenge experience variable degrees of disability. The affected domains indicate the need for societal rehabilitation of PWE in various community and/or social activities. Peer-support groups were instituted at the study sites to address these needs.
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Affiliation(s)
- Dan Bhwana
- National Institute of Medical Research, Tanga, P.O Box 5004, Tanzania.
| | | | - Luís-Jorge Amaral
- Global Health Institute, University of Antwerp, 2610 Antwerp, Belgium.
| | - Lauren Vandevenne
- Global Health Institute, University of Antwerp, 2610 Antwerp, Belgium.
| | - Filbert Francis
- National Institute of Medical Research, Tanga, P.O Box 5004, Tanzania.
| | - Daniel P Challe
- National Institute of Medical Research, Tanga, P.O Box 5004, Tanzania.
| | - Bruno P Mmbando
- National Institute of Medical Research, Tanga, P.O Box 5004, Tanzania.
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21
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Otabil KB, Ankrah B, Bart-Plange EJ, Donkoh ES, Avarikame FA, Ofori-Appiah FO, Babae TN, Kudzordzi PC, Darko VA, Ameyaw J, Bamfo JG, Sakibu RA, Antwi-Berko D, Fodjo JNS, Basáñez MG, Schallig HDFH, Colebunders R. Prevalence of epilepsy in the onchocerciasis endemic middle belt of Ghana after 27 years of mass drug administration with ivermectin. Infect Dis Poverty 2023; 12:75. [PMID: 37587500 PMCID: PMC10433588 DOI: 10.1186/s40249-023-01117-9] [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] [Received: 02/28/2023] [Accepted: 06/29/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND In onchocerciasis-endemic areas with high ongoing Onchocerca volvulus transmission, a high prevalence of epilepsy has been reported. This study aimed to determine the prevalence and clinical characteristics of epilepsy in the Bono Region of Ghana following 27 years of implementation of ivermectin mass drug administration (MDA). METHODS Between October 2020 and August 2021, cross-sectional surveys were conducted in nine communities in the Tain District and Wenchi Municipality of the Bono Region of Ghana. In the first stage, a random door-to-door approach was used to screen the population for epilepsy using a pre-tested questionnaire. Persons suspected of having epilepsy were invited for a second-stage neurological examination for case verification. Community O. volvulus microfilarial infection status and Ov16 seropositivity were also determined. Ninety-five confidence intervals (95% CI) for prevalence values were calculated using the Wilson Score Interval. RESULTS Of the 971 participants, 500 (51.5%) were females, and the median age (interquartile range) was 26 (15‒43) years. Fourteen participants (1.4%, 95% CI: 1.0‒2.0) were diagnosed as having epilepsy with generalized seizures being the most frequent seizure type (85.7%, 12/14). The overall microfilarial prevalence of O. volvulus was 10.3% (November 2020) and 9.9% (August 2021); the Ov16 seroprevalence was 22.2% (June 2021). Only 63.2% took ivermectin in the last round of MDA distribution in March 2021. CONCLUSIONS The 1.4% prevalence of epilepsy in the Bono region is similar to the median epilepsy prevalence in sub-Saharan Africa. However, the persistent microfilarial prevalence and low ivermectin study coverage call for the Ghana Onchocerciasis Elimination Programme to step up its efforts to ensure that the gains achieved are consolidated and improved to achieve the elimination of onchocerciasis by 2030.
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Affiliation(s)
- Kenneth Bentum Otabil
- NeTroDis Research Group, Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Bono Region, Sunyani, Ghana.
- Department of Biological Science, School of Sciences, University of Energy and Natural Resources, Bono Region, Sunyani, Ghana.
- Global Health Institute, University of Antwerp, Antwerp, Belgium.
| | - Blessing Ankrah
- NeTroDis Research Group, Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Bono Region, Sunyani, Ghana
| | - Emmanuel John Bart-Plange
- NeTroDis Research Group, Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Bono Region, Sunyani, Ghana
- Department of Medical Laboratory Science, School of Sciences, University of Energy and Natural Resources, Bono Region, Sunyani, Ghana
| | - Emmanuel Sam Donkoh
- Department of Medical Laboratory Science, School of Sciences, University of Energy and Natural Resources, Bono Region, Sunyani, Ghana
| | - Fiona Amoabil Avarikame
- Department of Medical Laboratory Science, School of Sciences, University of Energy and Natural Resources, Bono Region, Sunyani, Ghana
| | - Fredrick Obeng Ofori-Appiah
- Department of Medical Laboratory Science, School of Sciences, University of Energy and Natural Resources, Bono Region, Sunyani, Ghana
| | - Theophilus Nti Babae
- NeTroDis Research Group, Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Bono Region, Sunyani, Ghana
| | - Prince-Charles Kudzordzi
- NeTroDis Research Group, Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Bono Region, Sunyani, Ghana
| | - Vera Achiaa Darko
- NeTroDis Research Group, Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Bono Region, Sunyani, Ghana
- STU Clinic, Sunyani Technical University, Bono Region, Sunyani, Ghana
| | - Joseph Ameyaw
- Happy Family Hospital, Bono East Region, Nkoranza, Ghana
| | | | - Raji Abdul Sakibu
- Department of Biological Science, School of Sciences, University of Energy and Natural Resources, Bono Region, Sunyani, Ghana
| | - Daniel Antwi-Berko
- Department of Medical Laboratory Science, School of Sciences, University of Energy and Natural Resources, Bono Region, Sunyani, Ghana
| | | | - María-Gloria Basáñez
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis (MRC GIDA), and London Centre for Neglected Tropical Disease Research, School of Public Health, Imperial College London, London, UK
| | - Henk D F H Schallig
- Department of Medical Microbiology, Experimental Parasitology Unit, Amsterdam University Medical Centres, Academic Medical Centre at the University of Amsterdam, Amsterdam, The Netherlands
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Siewe Fodjo JN, Van Cutsem G, Amaral LJ, Colebunders R. Mortality among persons with epilepsy in onchocerciasis-endemic and non-endemic areas of sub-Saharan Africa: A systematic review and meta-analysis. Seizure 2023; 110:253-261. [PMID: 37451075 DOI: 10.1016/j.seizure.2023.07.006] [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: 04/08/2023] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023] Open
Abstract
PURPOSE To document epilepsy-related mortality in sub-Saharan Africa (SSA) and investigate possible associations with onchocerciasis endemicity. METHODS Systematic review with meta-analysis. Searches were performed in PubMed and Google Scholar (search terms: 'epilepsy'; 'mortality/death'; 'sub-Saharan Africa'). Included studies were classified as high-risk or low-risk for onchocerciasis based on documented endemicity data. Pooled mortality rates and annual case fatality rates (CFR) were calculated, and risk factors for mortality among persons with epilepsy (PWE) were investigated using meta-regression analysis. RESULTS The 28 eligible studies reported 30 epilepsy surveys, of which 9 (30.0%) were conducted in onchocerciasis high-risk sites. The pooled epilepsy mortality rate was 20.9 (95% CI: 5.9-74.4) per 100,000 person-years, and the pooled CFR was 36.2 (95% CI: 23.9-54.4) per 1,000 PWE per year, albeit with substantial between-study heterogeneity. Compared to onchocerciasis low-risk sites, high-risk sites had higher pooled mortality (342.9 versus 10.0 per 100,000 PY; p<0.001) and CFR (57.0 versus 26.6 per 1,000 PWE per year; p = 0.001). Mortality of PWE was almost five-fold that of people without epilepsy (mortality risk ratio: 4.9; 95% CI: 3.5-6.8). Studies in onchocerciasis high-risk sites and the study which recruited only PWE with nodding syndrome were associated with higher CFR (p = 0.044 and p = 0.002, respectively). The leading causes of epilepsy-related death were status epilepticus (58.5%), drowning (15.7%), and sudden unexpected death in epilepsy (10.1%). CONCLUSION Epilepsy mortality remains high in SSA. Most reported causes of death among PWE might be averted by improving seizure control. Better epilepsy prevention and care are urgently needed, particularly in onchocerciasis-endemic settings.
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Affiliation(s)
| | - Gilles Van Cutsem
- Global Health Institute, University of Antwerp, Belgium; Translational Neurosciences, University of Luxembourg, Luxembourg; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa
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Solomon Y, Teshome Y, Ejigu S, Bezabih M. Prevalence of anti-seizure medication nonadherence and its associated factors, among people with epilepsy in North Shewa, Ethiopia, 2021. Epilepsy Behav 2023; 145:109301. [PMID: 37336134 DOI: 10.1016/j.yebeh.2023.109301] [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: 12/23/2022] [Revised: 06/02/2023] [Accepted: 06/02/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Epilepsy is a worldwide neurologic illness, characterized by recurrent unprovoked epileptic seizures and can affect people of all age groups. Patients who are receiving drug therapy for chronic diseases, such as epilepsy, must fit complex medication regimens into their everyday routines. Managing medication schedules may pose a significant burden on patients' lives. Anti-seizure medication choices should therefore be tailored to patients' factors that may limit medication use. The study aimed to determine the prevalence and Predictors of anti-seizure medication nonadherence among patients with epilepsy. METHODOLOGY An institutional-based cross-sectional study was conducted among 352 people with epilepsy who were selected by systematic random sampling method at government hospitals in North Shewa Ethiopia. Data were collected by reviewing patients' charts and interviewing people with epilepsy by using structured and pretested questionnaires. Data obtained were encoded into EPI-INFO software and exported to SPSS version 25 for analysis. Logistic regression was employed to assess independent factors associated with medication non-adherence. RESULT The prevalence of anti-seizure medication non-adherence was 40%. Being female [AOR = 3.37, 95%, CI: 1.84, 6.18], Divorced [AOR = 9.13, 95%, CI: 1.80, 46.34], Being jobless [AOR = 7.33, 95%, CI: 3.24, 16.56], Perceived poor social support [AOR = 2.73, 95%, CI: 1.28, 5.82], perceived stigma [AOR = 5.07, 95%, CI: 2.40, 10.68], polytherapy [AOR = 2.23, 95%, CI: 1.06, 4.71], drug side effects[AOR = 6.03, 95%, CI: 3.17, 11.45], buying medications [AOR = 5.81, 95%, CI: 3.63,16.79] and duration of stay on treatment [AOR = 4.31, 95%, CI: 1.863, 9.97] were significant predictors of anti-seizure medication non-adherence. CONCLUSION Non-adherence to anti-seizure medication among people with epilepsy in the study area was relatively higher as compared with study reports from different parts of the country. Health and clinical, socio-economy, and patients' psychological mindset were among the determinant factors affecting the consistency of epilepsy treatment adherence. Enhanced professional, health education for patients as well as for society and financial support, are basic pillars to reduce the constraints of effective treatment.
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Affiliation(s)
- Yerukneh Solomon
- Department of Biomedical Sciences, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia.
| | - Yonas Teshome
- Department of Biomedical Sciences, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Solomon Ejigu
- Department of Biomedical Sciences, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Mihret Bezabih
- Department of Public Health, Arba Minch College of Health Sciences, Arba Minch, Ethiopia
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Ooms GI, van Oirschot J, de Kant D, van den Ham HA, Mantel-Teeuwisse AK, Reed T. Barriers to accessing internationally controlled essential medicines in sub-saharan Africa: A scoping review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 118:104078. [PMID: 37276779 DOI: 10.1016/j.drugpo.2023.104078] [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: 11/28/2022] [Revised: 05/14/2023] [Accepted: 05/22/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Access to internationally controlled essential medicines (ICEMs), medicines that are listed on both the World Health Organization's Essential Medicines List and one of three international drug control conventions, remains problematic in Sub-Saharan Africa (SSA). Previous reviews have focused only on specific ICEMs or ICEM-related healthcare fields, but none have focused on all ICEMs as a distinct class. This scoping review therefore aims to identify the barriers to accessing ICEMs across all relevant healthcare fields in SSA. METHODS A scoping review was conducted across indexing platforms Embase, PubMed, Scopus and Web of Science of studies published between January 1 2012 and February 1 2022. Articles were eligible if they mentioned barriers to accessing ICEMs and/or ICEM-related healthcare fields, if studies were conducted in SSA, or included data on an SSA country within a multi-country study. The review was guided by the Access to Medicines from a Health System Perspective framework. RESULTS The search identified 5519 articles, of which 97 met the inclusion criteria. Many barriers to access were reported and were common across the ICEMs drug class. Main barriers were: at the individual level, the lack of knowledge about ICEMs; at the health service delivery level, low availability, stockouts, affordability, long distances to health facilities, insufficient infrastructure to store and distribute ICEMs, and lack of ICEM knowledge and training among healthcare workers; at the health sector level, lack of prioritisation of ICEM-related healthcare fields by governments and subsequent insufficient budget allocation. Cross-cutting, governance-related barriers pertained to lack of proper quantification systems, cumbersome procurement processes, and strict national laws controlling ICEMs, leading to overly restrictive prescription practices. CONCLUSION This review showed that there are a multitude of barriers to accessing ICEMs in SSA across all health system levels. Many of the barriers identified are applicable to all ICEMs, highlighting the importance of tackling barriers for this entire class of drugs together.
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Affiliation(s)
- Gaby I Ooms
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands; Health Action International, Amsterdam, the Netherlands.
| | | | | | - Hendrika A van den Ham
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - Aukje K Mantel-Teeuwisse
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - Tim Reed
- Health Action International, Amsterdam, the Netherlands
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Bhattacharyya S, Vinkeles Melchers NVS, Siewe Fodjo JN, Vutha A, Coffeng LE, Logora MY, Colebunders R, Stolk WA. Onchocerciasis-associated epilepsy in Maridi, South Sudan: Modelling and exploring the impact of control measures against river blindness. PLoS Negl Trop Dis 2023; 17:e0011320. [PMID: 37235598 DOI: 10.1371/journal.pntd.0011320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Onchocerciasis, also known as "river blindness", is caused by the bite of infected female blackflies (genus Simuliidae) that transmit the parasite Onchocerca volvulus. A high onchocerciasis microfarial load increases the risk to develop epilepsy in children between the ages of 3 and 18 years. In resource-limited settings in Africa where onchocerciasis has been poorly controlled, high numbers of onchocerciasis-associated epilepsy (OAE) are reported. We use mathematical modeling to predict the impact of onchocerciasis control strategies on the incidence and prevalence of OAE. METHODOLOGY We developed an OAE model within the well-established mathematical modelling framework ONCHOSIM. Using Latin-Hypercube Sampling (LHS), and grid search technique, we quantified transmission and disease parameters using OAE data from Maridi County, an onchocerciasis endemic area, in southern Republic of South Sudan. Using ONCHOSIM, we predicted the impact of ivermectin mass drug administration (MDA) and vector control on the epidemiology of OAE in Maridi. PRINCIPAL FINDINGS The model estimated an OAE prevalence of 4.1% in Maridi County, close to the 3.7% OAE prevalence reported in field studies. The OAE incidence is expected to rapidly decrease by >50% within the first five years of implementing annual MDA with good coverage (≥70%). With vector control at a high efficacy level (around 80% reduction of blackfly biting rates) as the sole strategy, the reduction is slower, requiring about 10 years to halve the OAE incidence. Increasing the efficacy levels of vector control, and implementing vector control simultaneously with MDA, yielded better results in preventing new cases of OAE. CONCLUSIONS/SIGNIFICANCES Our modeling study demonstrates that intensifying onchocerciasis eradication efforts could substantially reduce OAE incidence and prevalence in endemic foci. Our model may be useful for optimizing OAE control strategies.
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Affiliation(s)
- Samit Bhattacharyya
- Department of Mathematics, School of Natural Sciences, Shiv Nadar Institution of Eminence, Dadri, Uttar Pradesh, India
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | | | | | - Amit Vutha
- Department of Mathematics, Ohio State University, Columbus, Ohio, United States of America
| | - Luc E Coffeng
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Makoy Y Logora
- National Neglected Tropical Disease Programme, Ministry of Health South Sudan, Juba, South Sudan
| | | | - Wilma A Stolk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Chagas AM, Canli T, Ziadlou D, Forlano PM, Samaddar S, Chua E, Baskerville KA, Poon K, Neuwirth LS. Using Open Neuroscience to Advance Equity in the Pedagogy and Research Infrastructure in Colleges/Universities Still Financially Impacted by COVID-19: The Emergence of a Global Resource Network Aimed at Integrating Neuroscience and Society. JOURNAL OF UNDERGRADUATE NEUROSCIENCE EDUCATION : JUNE : A PUBLICATION OF FUN, FACULTY FOR UNDERGRADUATE NEUROSCIENCE 2023; 21:E2-E7. [PMID: 37588641 PMCID: PMC10426815 DOI: 10.59390/jvic5712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 08/18/2023]
Affiliation(s)
- Andre Maia Chagas
- Sussex Neuroscience, School of Life Sciences, University of Sussex, Brighton BN1 9QG, United Kingdom
- TReND in Africa, Brighton, United Kingdom
- Biomedical Science Research and Training Center, Yobe State University, Nigeria
| | - Turhan Canli
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794, USA
| | - Donya Ziadlou
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794, USA
| | | | | | - Elizabeth Chua
- Department of Psychology, Brooklyn College and Graduate Center, The City University of New York, Brooklyn, NY 11210, USA
| | | | - Kinning Poon
- Biological Sciences, SUNY Old Westbury
- SUNY Neuroscience Research Institute
| | - Lorenz S. Neuwirth
- SUNY Neuroscience Research Institute
- Department of Psychology, SUNY Old Westbury, Old Westbury, NY 11568, USA
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Nicholas A. Unlocking the hidden burden of epilepsy in Africa: Understanding the challenges and harnessing opportunities for improved care. Health Sci Rep 2023; 6:e1220. [PMID: 37081998 PMCID: PMC10111115 DOI: 10.1002/hsr2.1220] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/22/2023] Open
Abstract
Background Epilepsy is a common neurological disorder that affects many people in Africa, yet the burden of the disease is often hidden. The management of epilepsy in Africa is often inadequate due to a lack of awareness and education, limited access to diagnostic tools and treatments, inadequate coordination of care, and the stigma associated with the condition. Method A comprehensive literature review was conducted to gather information on the epidemiology, diagnosis, management, and outcomes of epilepsy in Africa. The review included studies from peer-reviewed journals, government reports, and gray literature. Results The review revealed a high burden of epilepsy in Africa. The studies also showed a significant gap in the availability and accessibility of diagnostic tools, antiepileptic drugs, and specialized therapies such as physical, occupational, and speech therapy. Additionally, the review found that cultural beliefs and practices, socioeconomic factors such as poverty and lack of access to healthcare, and the stigma associated with the condition, also pose significant challenges to managing epilepsy in Africa. Conclusion The study highlights the urgent need for improved epilepsy management in Africa. Additionally, the study calls for further research on epilepsy in Africa and collaboration between all stakeholders to improve the management of epilepsy in Africa.
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Affiliation(s)
- Aderinto Nicholas
- Department of Medicine and SurgeryLadoke Akintola University of TechnologyOgbomosoNigeria
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28
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Ngarka L, Siewe Fodjo JN, Ambomatei C, Njamnshi WY, Taryunyu Njamnshi JN, Nfor LN, Mengnjo MK, Njamnshi AK. Epidemiology of epilepsy and relationship with onchocerciasis prevalence in villages of the Ntui Health District of Cameroon. Epilepsy Behav 2023; 142:109184. [PMID: 36972641 PMCID: PMC7614422 DOI: 10.1016/j.yebeh.2023.109184] [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: 01/17/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND A strong association between epilepsy and onchocerciasis endemicity has been reported. We sought to document the epidemiology of epilepsy in onchocerciasis-endemic villages of the Ntui Health District in Cameroon and investigate how this relates to the prevalence of onchocerciasis. METHODS In March 2022, door-to-door epilepsy surveys were conducted in four villages (Essougli, Nachtigal, Ndjame, and Ndowe). Ivermectin intake during the 2021 session of community-directed treatment with ivermectin (CDTI) was investigated in all participating village residents. Persons with epilepsy (PWE) were identified through a two-step approach: administration of a 5-item epilepsy screening questionnaire followed by clinical confirmation by a neurologist. Epilepsy findings were analyzed together with onchocerciasis epidemiological data previously obtained in the study villages. RESULTS We surveyed 1663 persons in the four study villages. The 2021 CDTI coverage for all study sites was 50.9%. Overall, 67 PWE were identified (prevalence of 4.0% (IQR: 3.2-5.1) with one new-onset case during the past 12 months (annual incidence of 60.1 per 100,000 persons). The median age of PWE was 32 years (IQR: 25-40), with 41 (61.2%) being females. The majority (78.3%) of PWE met the previously published criteria for onchocerciasis-associated epilepsy (OAE). Persons with a history of nodding seizures were found in all villages and represented 19.4% of the 67 PWE. Epilepsy prevalence was positively correlated with onchocerciasis prevalence (Spearman Rho = 0.949, p = 0.051). Meanwhile, an inverse relationship was observed between distance from the Sanaga river (blackfly breeding site) and the prevalence of both epilepsy and onchocerciasis. CONCLUSION The high epilepsy prevalence in Ntui appears to be driven by onchocerciasis. It is likely that decades of CDTI have likely contributed to a gradual decrease in epilepsy incidence, as only one new case occurred in the past year. Therefore, more effective elimination measures are urgently needed in such endemic areas to curb the OAE burden.
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Affiliation(s)
- Leonard Ngarka
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon; Neurology Department, Central Hospital Yaoundé, Yaoundé, Cameroon; Neuroscience Lab, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon.
| | - Joseph Nelson Siewe Fodjo
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon; Division of Operational Research in Health, Ministry of Public Health, Yaoundé, Cameroon.
| | | | - Wepnyu Yembe Njamnshi
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon; Neuroscience Lab, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon; Division of Operational Research in Health, Ministry of Public Health, Yaoundé, Cameroon.
| | | | - Leonard N Nfor
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon; Neurology Department, Central Hospital Yaoundé, Yaoundé, Cameroon.
| | - Michel K Mengnjo
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon; Neurology Department, Central Hospital Yaoundé, Yaoundé, Cameroon.
| | - Alfred K Njamnshi
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon; Neurology Department, Central Hospital Yaoundé, Yaoundé, Cameroon; Neuroscience Lab, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon.
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Van Cutsem G, Siewe Fodjo JN, Dekker MCJ, Amaral LJ, Njamnshi AK, Colebunders R. Case definitions for onchocerciasis-associated epilepsy and nodding syndrome: A focused review. Seizure 2023; 107:132-135. [PMID: 37023626 DOI: 10.1016/j.seizure.2023.03.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
Onchocerciasis-associated epilepsy (OAE) is an important but neglected public health problem in onchocerciasis-endemic areas with insufficient or inadequate onchocerciasis control. Hence, there is a need for an internationally accepted, easy-to-use epidemiological case definition of OAE to identify areas of high Onchocerca volvulus transmission and disease burden requiring treatment and prevention interventions. By including OAE as a manifestation of onchocerciasis, we will considerably improve the accuracy of the overall onchocerciasis disease burden, which is currently underestimated. Hopefully, this will lead to increased interest and funding for onchocerciasis research and control interventions, notably the implementation of more effective elimination measures and treatment and support for affected individuals and their families.
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Hadermann A, Amaral LJ, Van Cutsem G, Siewe Fodjo JN, Colebunders R. Onchocerciasis-associated epilepsy: an update and future perspectives. Trends Parasitol 2023; 39:126-138. [PMID: 36528471 DOI: 10.1016/j.pt.2022.11.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022]
Abstract
Onchocerciasis-associated epilepsy (OAE) is an important neglected public health problem in areas with high ongoing onchocerciasis transmission. The risk that children in such areas develop epilepsy is related to their Onchocerca volvulus microfilarial (mf) load. Before the implementation of mass treatment with ivermectin, microfilariae were detected in cerebrospinal fluid (CSF). More recently, neither O. volvulus microfilariae nor DNA were detected in CSF or brain tissue; however, these samples were obtained years after seizure onset. It is possible that during fever-induced increased blood-brain barrier permeability, microfilariae enter the brain and, upon dying, cause an inflammatory reaction inducing seizures. Including OAE in the onchocerciasis disease burden estimation may mobilise extra resources for onchocerciasis disease elimination and treatment/care of OAE-affected persons/families.
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Affiliation(s)
- Amber Hadermann
- Global Health Institute, University of Antwerp, Antwerp, Belgium
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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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Odero N, Oyieke K, Gwer S, Samia P. Risk factors for seizure recurrence after initial withdrawal of anti-seizure medications in children with epilepsy at Aga Khan University Hospital, Nairobi, Kenya. Epilepsy Behav Rep 2023; 22:100596. [PMID: 37013158 PMCID: PMC10066516 DOI: 10.1016/j.ebr.2023.100596] [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: 12/19/2022] [Revised: 03/13/2023] [Accepted: 03/19/2023] [Indexed: 04/05/2023] Open
Abstract
Objectives We sought to determine risk factors associated with seizure recurrence following initial withdrawal of anti-seizure medications (ASM) among children with epilepsy. Methods This was a retrospective observational study of children aged between 2 and 18 years with a diagnosis of epilepsy who underwent withdrawal of anti-seizure medication following remission of seizures. All eligible medical records between January 2011 and December 2019 were included. Demographic, clinical, imaging and electroencephalography data of all eligible patients were analyzed against seizure remission within 24 months after withdrawal of ASM, using appropriate parametric and non-parametric tests. Results A total of 49 records of children who underwent withdrawal of ASM out of a total of 613 patients on follow up during the same period were included. The median age at ASM withdrawal was 70 months (IQR 52-112 months) and 14 (28.6%) were female. Thirteen patients (26.5%) had seizure recurrence within 24 months following withdrawal of ASM. Focal onset seizure type was associated with significant risk of seizure recurrence (OR 13.7; 95% CI 0.97, 193.54; P value = 0.011). Age at epilepsy diagnosis, abnormal EEG at initiation of treatment and at the time of de-escalation, abnormal MRI findings, first or second degree relative with epilepsy, history of developmental delay, seizure burden, use of 2 or more ASMs and duration of seizure-freedom before de-escalation of ASM were not associated with increased risk of relapse. Conclusion Focal onset seizure type is associated with increased with risk of seizure recurrence in this cohort.
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Affiliation(s)
- Nicholas Odero
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya
- Corresponding author at: Aga Khan University Hospital, Department of Paediatrics, 3rd Parklands Avenue, Off Limuru Road, P.O Box 30270, GPO, 00100 Nairobi, Kenya.
| | - Katherine Oyieke
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya
| | - Samson Gwer
- School of Medicine, Kenyatta University, Nairobi, Kenya
| | - Pauline Samia
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya
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Afif S, Rehan ST, Ul Hussain H, Islam MS. Low-intensity focused ultrasound, a novel approach to epilepsy treatment in developing countries. Brain Behav 2023; 13:e2852. [PMID: 36542525 PMCID: PMC9847596 DOI: 10.1002/brb3.2852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/12/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022] Open
Abstract
Approximately 80% of patients with epilepsy reside in poor resource settings. Despite the continued advancements and development of new treatment approaches, epilepsy remains a major health problem in developing countries. Consistent findings of epidemiologic studies reflect that both prevalence and treatment gap are higher in the developing world. The objective of this short review was to evaluate current treatment options and low-intensity, pulsed-focused ultrasound (FUS) as a potential new treatment option for epilepsy. Although some of the patients could be candidates for surgery, many factors, including poor health-care infrastructure, socioeconomic status, risks and complications associated with the surgery, and patients' preferences and attitudes toward the surgical procedure, limit the adherence to get surgical therapies. Low-intensity FUS, a novel and noninvasive therapeutic approach, has the potential to be approved by regulatory bodies and added to the list of standard treatment options for epilepsy. Improved understanding of epilepsy's prevalence and incidence in developing worlds, identification of potential new therapeutic options, and their evaluation through continuous studies and clinical trials are needed to reduce the burden of epilepsy and the treatment gap.
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Affiliation(s)
- Sadaf Afif
- Touro College of Osteopathic Medicine, New York, New York, USA
| | - Syeda Tayyaba Rehan
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Hassan Ul Hussain
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Md Saiful Islam
- Department of Public Health and Informatics, Jahangirnagar University, Savar Dhaka, Bangladesh.,Centre for Advanced Research Excellence in Public Health, Savar Dhaka, Bangladesh
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Ssempijja F, Dare SS, Bukenya EEM, Kasozi KI, Kenganzi R, Fernandez EM, Vicente-Crespo M. Attenuation of Seizures, Cognitive Deficits, and Brain Histopathology by Phytochemicals of Imperata cylindrica (L.) P. Beauv (Poaceae) in Acute and Chronic Mutant Drosophila melanogaster Epilepsy Models. J Evid Based Integr Med 2023; 28:2515690X231160191. [PMID: 36866635 PMCID: PMC9989407 DOI: 10.1177/2515690x231160191] [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: 09/16/2021] [Revised: 08/09/2022] [Accepted: 02/06/2023] [Indexed: 03/04/2023] Open
Abstract
Imperata cylindrica is a globally distributed plant known for its antiepileptic attributes, but there is a scarcity of robust evidence for its efficacy. The study investigated neuroprotective attributes of Imperata cylindrica root extract on neuropathological features of epilepsy in a Drosophila melanogaster mutant model of epilepsy. It was conducted on 10-day-old (at the initiation of study) male post-eclosion bang-senseless paralytic Drosophila (parabss1) involved acute (1-3 h) and chronic (6-18 days) experiments; n = 50 flies per group (convulsions tests); n = 100 flies per group (learning/memory tests and histological examination). Administrations were done in 1 g standard fly food, per os. The mutant flies of study (parabss1) showed marked age-dependent progressive brain neurodegeneration and axonal degeneration, significant (P < 0.05) bang sensitivity and convulsions, and cognitive deficits due to up-regulation of the paralytic gene in our mutants. The neuropathological findings were significantly (P < 0.05) alleviated in dose and duration-dependent fashions to near normal/normal after acute and chronic treatment with extract similar to sodium valproate. Therefore, para is expressed in neurons of brain tissues in our mutant flies to bring about epilepsy phenotypes and behaviors of the current juvenile and old-adult mutant D. melanogaster models of epilepsy. The herb exerts neuroprotection by anticonvulsant and antiepileptogenic mechanisms in mutant D. melanogaster due to plant flavonoids, polyphenols, and chromones (1 and 2) which exert antioxidative and receptor or voltage-gated sodium ion channels' inhibitory properties, and thus causing reduced inflammation and apoptosis, increased tissue repair, and improved cell biology in the brain of mutant flies. The methanol root extract provides anticonvulsant and antiepileptogenic medicinal values which protect epileptic D. melanogaster. Therefore, the herb should be advanced for more experimental and clinical studies to confirm its efficacy in treating epilepsy.
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Affiliation(s)
- Fred Ssempijja
- Department of Anatomy, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
- Department of Anatomy, Faculty of Biomedical Sciences, Kampala International University, Western Campus, P.O Box 71, Ishaka, Bushenyi, Uganda
| | - Samuel Sunday Dare
- Department of Anatomy, Faculty of Biomedical Sciences, Kampala International University, Western Campus, P.O Box 71, Ishaka, Bushenyi, Uganda
- School of Medicine, Kabale University, P.O Box 317, Kabale, Uganda
| | - Edmund E. M. Bukenya
- Department of Anatomy, Faculty of Biomedical Sciences, Kampala International University, Western Campus, P.O Box 71, Ishaka, Bushenyi, Uganda
- School of Medicine, Kabale University, P.O Box 317, Kabale, Uganda
| | | | - Ritah Kenganzi
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, Kampala International University Teaching Hospital, P.O Box 71, Ishaka, Bushenyi, Uganda
| | - Edgar Mario Fernandez
- Department of Anatomy, Faculty of Biomedical Sciences, Kampala International University, Western Campus, P.O Box 71, Ishaka, Bushenyi, Uganda
| | - Marta Vicente-Crespo
- Institute of Biomedical Research, Kampala International University Western Campus, P.O Box 71, Bushenyi, Uganda
- Department of Biochemistry, Faculty of Biomedical Sciences, Kampala International University Western Campus, P.O Box 71, Bushenyi, Uganda
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Sun H, Ma D, Cheng Y, Li J, Zhang W, Jiang T, Li Z, Li X, Meng H. The JAK-STAT Signaling Pathway in Epilepsy. Curr Neuropharmacol 2023; 21:2049-2069. [PMID: 36518035 PMCID: PMC10556373 DOI: 10.2174/1570159x21666221214170234] [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: 05/06/2022] [Revised: 11/08/2022] [Accepted: 11/21/2022] [Indexed: 12/16/2022] Open
Abstract
Epilepsy is defined as spontaneous recurrent seizures in the brain. There is increasing evidence that inflammatory mediators and immune cells are involved in epileptic seizures. As more research is done on inflammatory factors and immune cells in epilepsy, new targets for the treatment of epilepsy will be revealed. The Janus kinase-signal transducer and transcriptional activator (JAKSTAT) signaling pathway is strongly associated with many immune and inflammatory diseases, At present, more and more studies have found that the JAK-STAT pathway is involved in the development and development of epilepsy, indicating the JAK-STAT pathway's potential promise as a target in epilepsy treatment. In this review, we discuss the composition, activation, and regulation of the JAK-STAT pathway and the relationship between the JAK-STAT pathway and epilepsy. In addition, we summarize the common clinical inhibitors of JAK and STAT that we would expect to be used in epilepsy treatment in the future.
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Affiliation(s)
- Huaiyu Sun
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Di Ma
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Yu Cheng
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Jiaai Li
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Wuqiong Zhang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Ting Jiang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Zhaoran Li
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Xuewei Li
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Hongmei Meng
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
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Barker-Haliski M, Nishi T, White HS. Soticlestat, a novel cholesterol 24-hydroxylase inhibitor, modifies acute seizure burden and chronic epilepsy-related behavioral deficits following Theiler's virus infection in mice. Neuropharmacology 2023; 222:109310. [PMID: 36341806 DOI: 10.1016/j.neuropharm.2022.109310] [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: 07/27/2022] [Revised: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
Temporal lobe epilepsy is the most common form of acquired epilepsy and can arise due to multiple inciting events, including central nervous system (CNS) infection. CNS infection with the Theiler's murine encephalomyelitis virus (TMEV) in male C57Bl/6J mice leads to acute, drug-resistant handling-induced seizures. Cholesterol 24-hydroxylase (CH24H) is a brain-specific enzyme that converts cholesterol into 24S-hydroxycholesterol; the primary mechanism of cholesterol catabolism in the brain. The novel CH24H inhibitor, soticlestat (SOT; or TAK-935), demonstrates the potential to restore excitatory/inhibitory balance in multiple preclinical models of hyperexcitability. This study thus sought to characterize the anticonvulsant potential of SOT in the TMEV model. Treatment with SOT (30 mg/kg, p.o.; n = 30) 0-7 days post-infection (DPI) reduced overall seizure burden and severity. SOT administration significantly delayed onset of infection-induced Racine stage 5 seizures, from 8.6 ± 0.6 (VEH-treated) to 10.8 ± 0.8 (SOT-treated) observation sessions. Infected mice were then allowed 36 days treatment-free recovery before assessing impact of earlier drug administration on epilepsy-related cognitive and behavioral comorbidities, including a non-habituated open field (OF) task. Total OF distance traveled was significantly less in SOT-treated mice compared to VEH-treated mice, suggesting attenuated TMEV-induced spatial memory deficits, or reduced chronic hyperexcitability. Mice with history of SOT treatment also spent significantly more time and traveled farther in the OF center, indicative of reduced epilepsy-induced anxiety-like behavior. These studies suggest that SOT is a mechanistically novel agent for symptomatic seizure control. Moreover, acute SOT administration during an epileptogenic insult may attenuate the resulting long-term behavioral comorbidities of epilepsy.
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Affiliation(s)
| | - Toshiya Nishi
- Research, Takeda Pharmaceutical Company Limited, Fujisawa, 251-8555, Japan; Takeda Pharmaceutical Company Limited, Cambridge, MA, 02139, USA.
| | - H Steve White
- University of Washington, Department of Pharmacy, Seattle, WA, USA
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Barker-Haliski M, Pitsch J, Galanopoulou AS, Köhling R. A companion to the preclinical common data elements for phenotyping seizures and epilepsy in rodent models. A report of the TASK3-WG1C: Phenotyping working group of the ILAE/AES joint translational task force. Epilepsia Open 2022. [PMID: 36461665 DOI: 10.1002/epi4.12676] [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: 11/18/2021] [Accepted: 05/23/2022] [Indexed: 12/04/2022] Open
Abstract
Epilepsy is a heterogeneous disorder characterized by spontaneous seizures and behavioral comorbidities. The underlying mechanisms of seizures and epilepsy across various syndromes lead to diverse clinical presentation and features. Similarly, animal models of epilepsy arise from numerous dissimilar inciting events. Preclinical seizure and epilepsy models can be evoked through many different protocols, leaving the phenotypic reporting subject to diverse interpretations. Serendipity can also play an outsized role in uncovering novel drivers of seizures or epilepsy, with some investigators even stumbling into epilepsy research because of a new genetic cross or unintentional drug effect. The heightened emphasis on rigor and reproducibility in preclinical research, including that which is conducted for epilepsy, underscores the need for standardized phenotyping strategies. To address this goal as part of the TASK3-WG1C Working Group of the International League Against Epilepsy (ILAE)/American Epilepsy Society (AES) Joint Translational Task Force, we developed a case report form (CRF) to describe the common data elements (CDEs) necessary for the phenotyping of seizure-like behaviors in rodents. This companion manuscript describes the use of the proposed CDEs and CRF for the visual, behavioral phenotyping of seizure-like behaviors. These phenotyping CDEs and accompanying CRF can be used in parallel with video-electroencephalography (EEG) studies or as a first visual screen to determine whether a model manifests seizure-like behaviors before utilizing more specialized diagnostic tests, like video-EEG. Systematic logging of seizure-like behaviors may help identify models that could benefit from more specialized diagnostic tests to determine whether these are epileptic seizures, such as video-EEG.
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Affiliation(s)
- Melissa Barker-Haliski
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Julika Pitsch
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Aristea S Galanopoulou
- Saul R. Korey Department of Neurology, Isabelle Rapin Division of Child Neurology, Laboratory of Developmental Epilepsy, Albert Einstein College of Medicine, Bronx, New York, USA
- Dominick P Purpura Department of Neuroscience, Isabelle Rapin Division of Child Neurology, Laboratory of Developmental Epilepsy, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Rüdiger Köhling
- Oscar-Langendorff-Institut für Physiologie, Universitätsmedizin Rostock, Rostock, Germany
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Minani S, Devleesschauwer B, Gasogo A, Ntirandekura JB, Gabriël S, Dorny P, Trevisan C. Assessing the burden of Taenia solium cysticercosis in Burundi, 2020. BMC Infect Dis 2022; 22:851. [PMCID: PMC9661784 DOI: 10.1186/s12879-022-07849-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Taenia solium cysticercosis is a zoonotic disease that is endemic in many low- and middle-income countries where risk factors for disease transmission are present. The economic impact of cysticercosis on public health and on the pig production sector is not well known in many of those countries, including Burundi. This study aimed at estimating the burden of T. solium cysticercosis in Burundi including data on humans and pigs.
Methods
Epidemiological and economic data were collected from literature up to July 30, 2021 and governmental and non-governmental agencies. Direct and indirect costs for neurocysticercosis (NCC)-associated epilepsy and losses due to porcine cysticercosis were estimated to assess the economic burden, while the health burden was estimated using zoonotic disability-adjusted life years (zDALYs). Different probability distributions (Uniform, Beta, Dirichlet and Gamma) were applied depending on the type of epidemiological parameter. Monte Carlo simulations and 100,000 iterations were used to calculate the 95% uncertainty interval (UI) for each parameter and perform sensitivity analyses.
Results
In Burundi, 4.26 million USD (95% UI, 1,858,308–8,190,951) were estimated as economic impact due to T. solium cysticercosis in humans and pigs, of which 40.2% (95% UI, 10.3–75.1) of the total costs were due to NCC-associated epilepsy and 59.8% (95% UI, 24.9–89.7) of the losses due to porcine cysticercosis. The cost per NCC-associated epilepsy case was 72 USD (95% UI, 25–168), representing 30.8% of the GDP per capita in 2020. The probable incident cases and deaths for NCC-associated epilepsy were 9065 (95% UI, 2370–16,716) and 61 (95% UI, 16–114), respectively. More than 2 zDALYs (95% UI, 1.1–3.4) per thousand person-years was estimated, of which an average of 1.3 DALYs [0;0] (95% UI, 0.3–2.6) was due to NCC- associated epilepsy and 0.8 animal loss equivalents (ALEs) (95% UI, 0.3–1.5) due to porcine cysticercosis.
Conclusions
This study provides evidence of a significant burden of T. solium cysticercosis for Burundi’s population. We urge policy makers to use these evidence-based results and put T. solium cysticercosis on the public health agenda of the country. This study recommends urgent action to find solutions for integrated control strategies for T. solium cysticercosis in Burundi.
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Apolot D, Erem G, Nassanga R, Kiggundu D, Tumusiime CM, Teu A, Mugisha AM, Sebunya R. Brain magnetic resonance imaging findings among children with epilepsy in two urban hospital settings, Kampala-Uganda: a descriptive study. BMC Med Imaging 2022; 22:175. [PMID: 36203127 PMCID: PMC9541090 DOI: 10.1186/s12880-022-00901-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Epilepsy is one of the most common neurological conditions in children worldwide. Its presentation is heterogeneous, with diverse underlying aetiology, clinical presentation, and prognosis. Structural brain abnormalities are among the recognized causes of epilepsy. Brain Magnetic Resonance Imaging (MRI) is the imaging modality of choice for epilepsy workup. We aimed to determine the prevalence and describe the structural abnormalities identified in the brain MRI studies performed on children with epilepsy from two urban hospitals in Kampala, Uganda. Methods This was a cross-sectional descriptive study performed at two urban hospital MRI centres. The study population was 147 children aged 1 day to 17 years with confirmed epilepsy. Brain MRI was performed for each child and a questionnaire was used to collect clinical data. Results The prevalence of structural abnormalities among children with epilepsy was 74.15% (109 out of 147). Of these, 68.81% were male, and the rest were female. Among these, the majority, 40.14% (59 of 144) were aged 1 month to 4 years. Acquired structural brain abnormalities were the commonest at 69.22% with hippocampal sclerosis (HS) leading while disorders of cortical development were the most common congenital causes. An abnormal electroencephalogram (EEG) was significant for brain MRI abnormalities among children with epilepsy with 95% of participants with an abnormal EEG study having epileptogenic structural abnormalities detected in their brain MRI studies. Conclusion and recommendation Two-thirds of children with epilepsy had structural brain abnormalities. Abnormal activity in the EEG study was found to positively correlate with abnormal brain MRI findings. As such, EEG study should be considered where possible before MRI studies as a determinant for children with epilepsy who will be having imaging studies done in the Ugandan setting.
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Affiliation(s)
- Denise Apolot
- Department of Radiology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Geoffrey Erem
- Department of Radiology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rita Nassanga
- Department of Radiology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Daniel Kiggundu
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Crescent Max Tumusiime
- Department of Radiology, Mother Kevin Postgraduate Medical School, Uganda Martyrs University School of Medicine, Kampala, Uganda.,St.Francis hospital, Nsambya, Uganda
| | - Anneth Teu
- Department of Radiology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Alex Mwesigwa Mugisha
- Department of Radiology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert Sebunya
- Department of Pediatrics, Mother Kevin Postgraduate Medical School, Uganda Martyrs University School of Medicine, Kampala, Uganda.,St.Francis hospital, Nsambya, Uganda
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Kandeda AK, Nodeina S, Mabou ST. An aqueous extract of Syzygium cumini protects against kainate-induced status epilepticus and amnesia: evidence for antioxidant and anti-inflammatory intervention. Metab Brain Dis 2022; 37:2581-2602. [PMID: 35916986 DOI: 10.1007/s11011-022-01052-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 07/12/2022] [Indexed: 10/16/2022]
Abstract
Temporal lobe epilepsy is the most common drug-resistant epilepsy. To cure epilepsy, drugs must target the mechanisms at the origin of seizures. Thus, the present investigation aimed to evaluate the antiepileptic- and anti-amnesic-like effects of an aqueous extract of Syzygium cumini against kainate-induced status epilepticus in mice, and possible mechanisms of action. Mice were divided into 7 groups and treated as follows: normal group or kainate group received po distilled water (10 mL/kg), four test groups received Syzygium cumini (28.8, 72, 144, and 288 mg/kg, po), and the positive control group treated intraperitoneally (ip) with sodium valproate (300 mg/kg). An extra group of normal mice was treated with piracetam (200 mg/kg, po). Treatments were administered 60 min before the induction of status epilepticus with kainate (15 mg/kg, ip), and continued daily throughout behavioral testing. Twenty-four hours after the induction, T-maze and Morris water maze tasks were successively performed. The animals were then sacrificed and some markers of oxidative stress and neuroinflammation were estimated in the hippocampus. The extract significantly prevented status epilepticus and mortality. In the T-maze, the aqueous extract markedly increased the time spent and the number of entries in the discriminated arm. In the Morris water maze, the extract significantly increased the time spent in the target quadrant during the retention phase. Furthermore, the aqueous extract induced a significant reduction of oxidative stress and neuroinflammation. These results suggest that the aqueous extract of Syzygium cumini has antiepileptic- and anti-amnesic-like effects, likely mediated in part by antioxidant and anti-inflammatory activities.
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Affiliation(s)
- Antoine Kavaye Kandeda
- Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé I, P.O. Box 812, Yaoundé, Cameroon.
- Department of Animal Biology and Physiology, University of Yaoundé I, P.O. Box 812, Yaoundé, Cameroon.
| | - Saleh Nodeina
- Department of Biological Sciences, Faculty of Science, University of Ngaoundéré, P.O. Box 454, Ngaoundéré, Cameroon
| | - Symphorien Talom Mabou
- Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé I, P.O. Box 812, Yaoundé, Cameroon
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Keller L, Stelzle D, Schmidt V, Carabin H, Reinhold AK, Keller C, Welte TM, Richter V, Amos A, Boeckman L, Harrison W, Winkler AS. Community-level prevalence of epilepsy and of neurocysticercosis among people with epilepsy in the Balaka district of Malawi: A cross-sectional study. PLoS Negl Trop Dis 2022; 16:e0010675. [PMID: 36108075 PMCID: PMC9477368 DOI: 10.1371/journal.pntd.0010675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Epilepsy and neurocysticercosis (NCC) prevalence estimates in sub-Saharan Africa are still scarce but show important variation due to the population studied and different screening and diagnosis strategies used. The aims of this study were to estimate the prevalence of epileptic seizures and epilepsy in the sampled population, and the proportion of NCC among people with epilepsy (PWE) in a large cross-sectional study in a rural district of southern Malawi.
Methods
We conducted a community-based door-to-door screening study for epileptic seizures in Balaka, Malawi between October and December 2012. Past epileptic seizures were reported through a 15-item questionnaire answered by at least one person per household generating five major criteria. People who screened positive were further examined by a neurologist to establish diagnosis. Patients diagnosed with epilepsy were examined and offered Taenia solium cyst antigen and antibody serological tests, and a CT scan for the diagnosis of NCC.
Results
In total, screening information on 69,595 individuals was obtained for lifetime occurrence of epileptic seizures. 3,100 (4.5%) participants screened positive, of whom 1,913 (62%) could be followed-up and underwent further assessment. Lifetime prevalence was 3.0% (95% Bayesian credible interval [CI] 2.8 to 3.1%) and 1.2% (95%BCI 0.9 to 1.6%) for epileptic seizures and epilepsy, respectively. NCC prevalence among PWE was estimated to be 4.4% (95%BCI 0.8 to 8.5%). A diagnosis of epilepsy was ultimately reached for 455 participants.
Conclusion
The results of this large community-based study contribute to the evaluation and understanding of the burden of epilepsy in the population and of NCC among PWE in sub-Saharan Africa.
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Affiliation(s)
- Luise Keller
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dominik Stelzle
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
| | - Veronika Schmidt
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
- Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Hélène Carabin
- Département de Pathologie et Microbiologie, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, Canada
- Département de médecine sociale et préventive, École de santé publique de l’université de Montréal, Montréal, Canada
- Centre de Recherche en Santé Publique (CReSP) de l’université de Montréal et du CIUSS du Centre Sud de Montréal, Montréal, Canada
- Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), Université de Montréal, Saint-Hyacinthe, Canada
| | - Ann-Kristin Reinhold
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Anaesthesiology, University Hospital Würzburg, Würzburg, Germany
| | - Claudius Keller
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
| | - Tamara M. Welte
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Vivien Richter
- Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Action Amos
- National Epilepsy Association Malawi, International Bureau of Epilepsy, School of Health Social Sciences University of Edinburgh, Edinburgh, United Kingdom
| | - Lindsay Boeckman
- The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Wendy Harrison
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Andrea S. Winkler
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
- Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
- * E-mail:
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Shumet S, Wondie M, Ayano G, Asfaw H, Kassew T, Mesafint G. Antiepileptic Drug Adherence and Its Associated Factors among Epilepsy Patients on Follow-ups at Amanuel Mental Specialized Hospital, Ethiopia. Ethiop J Health Sci 2022; 32:913-922. [PMID: 36262706 PMCID: PMC9554767 DOI: 10.4314/ejhs.v32i5.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/15/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Medication adherence is a fundamental determinant of effective treatment. However, people with epilepsy have poor compliance with their treatment because of the chronic nature of the disease. Limited studies have been conducted to address antiepileptic medication adherence in Africa, including Ethiopia. Thus, the aim of this study was to assess antiepileptic drug adherence and its asociated factors among patients with epilepsy attending outpatient department of Amanuel Mental Specialized Hospital. METHODS A cross-sectional study design was conducted on 439 patients with epilepsy in Amanuel Mental Specialized Hospital. Medication adherence reporting scale-5 (MARS-5) was used to assess adherence to antiepileptic drugs. The Oslo social support, Jacob perceived stigma scale, and hospital anxiety and depression scale (HADS) were the instruments used to assess associated factors. Simple and multiple linear regression analysis models were fitted. Then, the adjusted unstandardized beta (β) coefficient at a 95% confidence level was used. RESULTS The mean(SD) score of antiepileptic medication adherence was 16.38(±3.76) with 95%CI:(16.03, 16.72). Depressive symptoms (β= -1.35, 95% CI: (-2.04, -0.65)), anxiety symptoms (β=-1.12,95%CI:(-1,79,-0.44), perceived stigma (β= -1.64, 95% CI:-2.16,-1.12), being single (β=-0.67, 95%CI:-1.20,-0.14), presence of seizure per month(β=-2.11,95% CI: (-2.81,-1.41) and antiepileptic drug adverse effect(β=-0.07,95%CI:-0.11,-0.03) were factors associated with anti-epileptic medication adherence. CONCLUSIONS The results suggest that the mean score of adherence to antiepileptic drugs was poor as compared to other settings. Antiepileptic medication adherence screening tool should be included in the patient's treatment protocol.
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Affiliation(s)
- Shegaye Shumet
- Department of psychiatry, University of Gondar, Gondar, Ethiopia
| | - Mesele Wondie
- Department of psychiatry, University of Gondar, Gondar, Ethiopia
| | - Getinet Ayano
- Amanuel Mental Specialized Hospital, Addis Abeba, Ethiopia
| | - Henock Asfaw
- School of nursing and midwifery, college of health and medical science, Haramaya University
| | - Tilahun Kassew
- Department of psychiatry, University of Gondar, Gondar, Ethiopia
| | - Gebremeskel Mesafint
- Department of Psychiatry, College of health science, Mizan-Tapi University, Mizan-Aman, Ethiopia
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Stelzle D, Kaducu J, Schmidt V, Welte TM, Ngowi BJ, Matuja W, Escheu G, Hauke P, Richter V, Ovuga E, Pfausler B, Schmutzhard E, Amos A, Harrison W, Keller L, Winkler AS. Characteristics of people with epilepsy in three Eastern African countries - a pooled analysis. BMC Neurol 2022; 22:321. [PMID: 36028820 PMCID: PMC9414166 DOI: 10.1186/s12883-022-02813-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/20/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Epilepsy is one of the most common neurological disorders worldwide. Yet, its treatment gap is large in some areas and especially in sub-Saharan Africa data on clinical, radiological and semiological characteristics, as well as on treatment of persons with epilepsy (PWE) are still scarce. METHODS We pooled data from four cross-sectional studies on epilepsy in eastern Africa. Two studies from Malawi and Uganda were community-based; two studies in Tanzania (urban Dar es Salaam and rural Haydom) were hospital-based. Clinical characteristics of PWE were assessed by the same questionnaire. Additionally, data on treatment were collected and computed tomography (CT) scans were performed. RESULTS Overall, 1179 PWE were included in our analysis (581 (49.3%) female, median age 22 years (IQR 15-32 years)). Up to 25% of the patients had focal onset seizures. Those showed a higher rate of remarkable CT scan findings, with especially post-ischaemic and neurocysticercosis-associated lesions, compared to PWE with generalized onset seizures (35.1% vs. 20%). The majority of the patients experienced tonic-clonic seizures (70-85%). Only 67-78% of PWE received anti-seizure medication (ASM) treatment in the community-based studies, mostly monotherapy with phenobarbital, phenytoin or carbamazepine. Yet, underdosage was frequent and a large proportion of PWE received alternative non-ASM treatment consisting of herbal treatment (up to 83%) and/or scarification (up to 20%). CONCLUSIONS Epilepsy is common in sub-Saharan Africa, often caused by neurocysticercosis or ischaemic strokes. PWE suffer from high seizure rates and subsequent injuries, as well as from socio-economic consequences due to insufficient ASM treatment. This pooled analysis illustrates the need for structural programmes for adequate identification, education, assessment and treatment of PWE in sub-Saharan Africa.
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Affiliation(s)
- Dominik Stelzle
- grid.6936.a0000000123222966Center for Global Health, Department of Neurology, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Joyce Kaducu
- grid.415705.2Ministry of Health, Kampala, Republic of Uganda
| | - Veronika Schmidt
- grid.6936.a0000000123222966Center for Global Health, Department of Neurology, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany ,grid.5510.10000 0004 1936 8921Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Tamara M. Welte
- grid.6936.a0000000123222966Center for Global Health, Department of Neurology, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany ,grid.411668.c0000 0000 9935 6525Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Bernard J. Ngowi
- grid.416716.30000 0004 0367 5636National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania ,grid.8193.30000 0004 0648 0244University of Dar Es Salaam, Mbeya College of Health and Allied Sciences, Mbeya, Tanzania
| | - William Matuja
- grid.25867.3e0000 0001 1481 7466Department of Neurology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gabrielle Escheu
- Department of Neurology, Kliniken Ostallgaeu-Kaufbeuren, Kaufbeuren, Germany
| | - Peter Hauke
- Department of Neurology, Kliniken Ostallgaeu-Kaufbeuren, Kaufbeuren, Germany
| | - Vivien Richter
- grid.411544.10000 0001 0196 8249Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Emilio Ovuga
- grid.442626.00000 0001 0750 0866Department of Mental Health, University of Gulu, Gulu, Uganda
| | - Bettina Pfausler
- grid.5361.10000 0000 8853 2677Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Erich Schmutzhard
- grid.5361.10000 0000 8853 2677Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Action Amos
- National Epilepsy Association Malawi, International Bureau of Epilepsy, Lilongwe, Malawi
| | - Wendy Harrison
- grid.7445.20000 0001 2113 8111Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Luise Keller
- grid.6936.a0000000123222966Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Andrea S. Winkler
- grid.6936.a0000000123222966Center for Global Health, Department of Neurology, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany ,grid.5510.10000 0004 1936 8921Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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Negative effects of brain regulatory T cells depletion on epilepsy. Prog Neurobiol 2022; 217:102335. [PMID: 35931355 DOI: 10.1016/j.pneurobio.2022.102335] [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: 11/22/2021] [Revised: 07/18/2022] [Accepted: 08/01/2022] [Indexed: 11/22/2022]
Abstract
The infiltration of immune cells is observed in the epileptogenic zone; however, the relationship between epilepsy and regulatory T cells (Tregs) remains only partially understood. We aimed to investigate brain-infiltrating Tregs to reveal their underlying role in epilepsy. We analyzed the infiltration of Tregs in the epileptogenic zones from patients with epilepsy and a pilocarpine-induced temporal lobe epilepsy (TLE) model. Next, we evaluated the effects of brain Treg depletion on neuroinflammation, neuronal loss, oxidative stress, seizure activity and behavioral changes in the pilocarpine model. We also explored the impact of Treg expansion in the brain on seizure activity. There were a large number of Tregs in the epileptogenic zones of human and experimental epilepsy. The number of brain Tregs was negatively correlated with the frequency of seizures in patients with epilepsy. Our further findings demonstrated that brain Treg depletion promoted astrocytosis, microgliosis, inflammatory cytokine production, oxidative stress, and neuronal loss in the hippocampus after status epilepticus (SE). Moreover, brain Treg depletion increased seizure activity and contributed to behavioral impairments in experimental chronic TLE. Interestingly, intracerebroventricular injection of CCL20 amplified Tregs in brain tissue, thereby inhibiting seizure activity. Taken together, our study highlights the therapeutic potential of regulating Tregs in epileptic brain tissue.
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Girma B, Nigussie J, Tamir T, Bekele E. Public knowledge toward Epilepsy and its determinants in Ethiopia: A systematic review and meta-analysis. Epilepsy Behav 2022; 133:108764. [PMID: 35690571 DOI: 10.1016/j.yebeh.2022.108764] [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: 02/09/2022] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Epilepsy is a global problem that affects all countries and people of all ages. However, the disease burden is high in low- and middle-income countries. Poor public knowledge of epilepsy increases the rate of stigma and discrimination. However, in our country, there is a scarcity of summarized evidence about the level of public knowledge toward epilepsy. Therefore, to fill this gap, conducting this review and meta-analysis has a preponderant significance. METHODS Articles were explored from PubMed, PsycINFO, Hinari, Science Direct, web of science, and African journal of online (AJOL) databases, Google, and Google scholar. For data extraction and analysis purposes, Microsoft Excel spreadsheet and STATA software version 16 were used. To write this report, we used the Preferred Reporting Items for systematic reviews and Meta-Analysis. To assess the pooledmagnitudeof public knowledge toward epilepsy, we used arandom-effects meta-analysis model. We checked the Heterogeneity by I2. To detect publication bias, Begg's test, Egger's test, and funnel plot were conducted. Furthermore, subgroup analysis was conducted. Association was expressed through a pooled odds ratio with a 95% confidence interval. RESULT Our review and meta-analysis included 9 studies with 5658 participants. The pooled magnitude of poor knowledge toward epilepsy was 48.54% [95% CI (33.57, 63.51)]. I2 was 99.4% (P < 0.01). Begg's and Egger's test results were 0.92 and 0.06, respectively. Cannot read and write OR: 2.86 [95 CI (2.04, 4.00]) and not witnessing seizure episode OR: 3.00 [95% CI (2.46, 3.66)]) were significant determinants of poor knowledge. CONCLUSION In this review and meta-analysis, around half of the participants had poor knowledge about epilepsy. Individuals who cannot read and write, and could not witness seizure episodes had more likely to have poor knowledge toward epilepsy as compared to their counterparts. Health education through different methods should be provided to the public, and our educational system should focus on this global problem. Furthermore, it is better to give training for community key informants.
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Affiliation(s)
- Bekahegn Girma
- Dilla University, College of Medicine and Health Science, Department of Nursing, Dilla, Ethiopia.
| | - Jemberu Nigussie
- Dilla University, College of Medicine and Health Science, Department of Nursing, Dilla, Ethiopia
| | - Takla Tamir
- Dilla University, College of Medicine and Health Science, Department of Nursing, Dilla, Ethiopia
| | - Etaferaw Bekele
- Dilla University, College of Medicine and Health Science, Department of Nursing, Dilla, Ethiopia
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Samia P, Hassell J, Hudson J, Ahmed A, Shah J, Hammond C, Kija E, Auvin S, Wilmshurst J. Epilepsy research in Africa: A scoping review by the ILAE Pediatric Commission Research Advocacy Task Force. Epilepsia 2022; 63:2225-2241. [PMID: 35729725 DOI: 10.1111/epi.17321] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Despite the high prevalence of epilepsy in Africa, evaluation of epilepsy research trends on the continent is lacking. Without establishing effective research, improvement in care for people with epilepsy cannot be effectively strategized or targeted. METHODS A scoping review of the peer-reviewed literature on epilepsy from Africa (1989-2019) was conducted. The aim was to understand from this what areas are well researched versus underresearched based on published epilepsy topics. RESULTS A total of 1227 publications were identified and assessed. A significant increase in publications occurred over the 30 years assessed. African author leadership was evident in most reports. Nine countries had >50 publications identified; the remaining 45 countries had <50 or no publications. Research studies were typically of lower quality (case series and observational studies). Research themes were more focused on clinical epilepsy (descriptive observational studies) and social aspects (qualitative surveys). However, there were a number of unique and strong themes, specifically for neurocysticercosis and nodding syndrome, where strong research collaborations were evident, basic science understandings were explored, and interventional models were established. SIGNIFICANCE Despite Africa being the continent with the most countries, it is lacking in the quantity, quality, and for some areas, relevance of research on epilepsy. Targeted approaches are needed to upskill the strength of research undertaken with more basic science, interventional, and randomized controlled studies. Themes of research need to promote those with unique African content but also to align with current international research areas that have impact on care delivery, such as epilepsy surgery and epilepsy genetics. For this to be possible, it is important to strengthen research hubs with collaborations that empower Africa to own its epilepsy research journey.
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Affiliation(s)
- Pauline Samia
- Department of Paediatrics and Child Health, Medical College, Aga Khan University, Nairobi, Kenya.,Brain and Mind institute, Aga Khan University, Nairobi, Kenya.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Jane Hassell
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK.,Gertrude's Garden Children's Hospital, Nairobi, Kenya
| | - Jessica Hudson
- Department of Paediatrics, Oxford University Hospitals, Oxford, UK
| | - Azim Ahmed
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jasmit Shah
- Brain and Mind institute, Aga Khan University, Nairobi, Kenya.,Department of Internal Medicine, Aga Khan University, Nairobi, Kenya
| | - Charles Hammond
- Department of Child Health, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Edward Kija
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Stéphane Auvin
- Department of Pediatric Neurology, Public Hospital Network of Paris, Robert Debré Hospital, Neuro Diderot, National Institute of Health and Medical Research, University of Paris, Paris, France.,University Institute of France, Paris, France
| | - Jo Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.,Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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Zena D, Tadesse A, Bekele N, Yaregal S, Sualih N, Worku E. Seizure control and its associated factors among epileptic patients at Neurology Clinic, University of Gondar hospital, Northwest Ethiopia. SAGE Open Med 2022; 10:20503121221100612. [PMID: 35646350 PMCID: PMC9134420 DOI: 10.1177/20503121221100612] [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: 02/11/2022] [Accepted: 04/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background Epilepsy is characterized by two or more unprovoked recurrent seizures, which often respond to available antiseizure medications. However, seizure control among epileptic patients in the developing world is low. Factors determining seizure control among epileptic patients were not evidently explored in the study setting. Objectives This study aimed to determine the magnitude of uncontrolled seizures and associated factors among epileptic patients at the University of Gondar hospital. Methods This cross-sectional study was conducted at the University of Gondar hospital, Northwest Ethiopia. A convenience sampling method was used to recruit study subjects. Controlled seizure was defined as seizure freedom for the past 1 year. Logistic regression analysis was used to identify factors associated with seizure control. A p-value < 0.05 was used to declare a significant association. Results A total of 320 study subjects were included in the study. The mean (±SD) age of patients was 27.5 ± 7.6 years. More than half (182/320, 57%) of epileptic patients had uncontrolled seizures. Five or more pretreatment seizure episodes (adjusted odds ratio = 3.98, 95% confidence interval: 1.81-8.75, p = 0.001), less than 2 years on anti-seizure medications (adjusted odds ratio = 8.64, 95% confidence interval: 3.27-22.85, p < 0.001), taking 2 or more ASMs (adjusted odds ratio = 2.48, 95% confidence interval: 1.23-5.02, p = 0.011), poor adherence to ASMs (adjusted odds ratio = 9.37, 95% confidence interval: 4.04-21.75, p < 0.001), and living at a single trip distance from hospital equaled 1 h or more (adjusted odds ratio = 4.20, 95% confidence interval: 2.11-8.41, p < 0.001) were significantly associated with uncontrolled seizures. Conclusion The dose of a preferred anti-seizure medication should be optimized before combinations of anti-seizure medications are used. Adherence to anti-seizure medications should be reinforced for better seizure control. Epilepsy care should be integrated into primary health care services in the catchment region.
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Affiliation(s)
- Dawit Zena
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abilo Tadesse
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nebiyu Bekele
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Samson Yaregal
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nuria Sualih
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Edilawit Worku
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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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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Cherkaoui G, Cheikh A, Razine R, Bnouhanna W, Regragui W, Benomar A, Cherrah Y. Trends in the consumption and cost of antiepileptics in Morocco between 2008 and 2018. Rev Epidemiol Sante Publique 2022; 70:75-81. [PMID: 35337700 DOI: 10.1016/j.respe.2022.01.127] [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: 12/01/2020] [Revised: 12/16/2021] [Accepted: 01/27/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Epilepsy is one of the most common chronic neurological diseases. In Morocco, it is the second most common reason for consulting a neurologist. Its prevalence was estimated in Casablanca in 1998 at 1.1%. This study was carried out with the aim of evaluating, on the one hand, the consumption of antiepileptics and, on the other hand, the impact of their generic drugs on the pharmaceutical market between 2008 and 2018 in Morocco. MATERIALS AND METHODS We used sales data for antiepileptic drugs collected from the Moroccan subsidiary of IQVIA, a multinational healthcare data science company, and we converted them into a defined daily dose (DDD/1000 inhabitants). RESULTS The consumption of antiepileptic drugs increased from 442 to 641 DDD/1000 inhabitants between 2008 and 2018, all molecules combined, recording a 45% increase in the period studied. From an economic point of view, the calculation of the average cost of DDD, all molecules combined, gives an average cost of 2.42 dollars/DDD in 2018 versus 3.53 dollars/DDD in 2008 (1 dirham = 0.11 dollar), which corresponds to a decrease of -30%. This is due mainly to the introduction of generic drugs. CONCLUSION These results show that while the average cost of a DDD has decreased, the consumption of antiepileptics has increased in Morocco over the years. Several events that have marked the drug market in Morocco have contributed to this trend, including the arrival on the market of several new molecules indicated for the treatment of epilepsy, the decrease in drug prices in 2014 and the policy of promoting generic drugs.
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Affiliation(s)
- Ghita Cherkaoui
- Department of Pharmacotoxicology, Faculty of Medicine and Pharmacy, Mohammed V University - Rabat.
| | - Amine Cheikh
- Faculty of Pharmacy, Abulcasis University of Health Sciences - Rabat
| | - Rachid Razine
- Laboratory of Biostatistics, Clinical Research and Epidemiology, Faculty of Medicine and Pharmacy, Mohammed V University - Rabat
| | - Wadii Bnouhanna
- Faculty of Medicine and Pharmacy, Mohammed V University - Rabat; Neurology department B, specialties hospital CHU Ibn Sina - Rabat
| | - Wafae Regragui
- Faculty of Medicine and Pharmacy, Mohammed V University - Rabat; Neurology department B, specialties hospital CHU Ibn Sina - Rabat
| | - Ali Benomar
- Faculty of Medicine, Abulcasis University of Health Sciences - Rabat; Department of Neurology, Medicine D, Cheikh Zaid International Hospital - Rabat
| | - Yahia Cherrah
- Department of Pharmacotoxicology, Faculty of Medicine and Pharmacy, Mohammed V University - Rabat; Faculty of Pharmacy, Abulcasis University of Health Sciences - Rabat
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Dima SA, Shibeshi MS. Antiepileptic drug adherence in children in southern Ethiopia: A cross sectional study. PLoS One 2022; 17:e0263821. [PMID: 35176045 PMCID: PMC8853530 DOI: 10.1371/journal.pone.0263821] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 01/27/2022] [Indexed: 12/01/2022] Open
Abstract
Background Epilepsy is one of the commonest chronic neurological disorders with serious health consequences. Treatment adherence is one of the determinants of seizure control. This study was designed to determine factors affecting antiepileptic drug adherence among children with epilepsy. Methods A cross sectional study was conducted on 192 children with epilepsy (≤14 years of age) on follow-up at a pediatric neurology clinic in Southern Ethiopia from January 1st to August 30th, 2019. Medication Adherence was measured using the eight-item Morisky’s medication adherence scale. Logistic regression analysis was done to determine factors associated with antiepileptic drug adherence. Result One hundred twenty-five (65%) of the study subjects were adherent to their medication. On multivariable analysis, factors predictive of good adherence included family size of ≤5 [AOR = 2.34, (95% CI: 1.07, 5.10); P = 0.03] and duration of epilepsy (<1year [AOR = 5.83, (95% CI: 1.48, 22.92); P = 0.012] and 1-2year [AOR = 4.58, (95% CI: 1.12, 18.77); P = 0.035]). Monthly family income of <1000 Ethiopian Birr [AOR = 0.18, (95% CI: 0.06, 0.61); P = 0.005] and presence of seizure attack in the past 3months [AOR = 0.23, 95% (CI: 0.10, 0.55); P = 0.001] predicted poor antiepileptic drug adherence. Conclusion Adherence to antiepileptic drugs in children is low in our setting; low family income and occurrence of seizures while on treatment predicted poor adherence. Supplying free antiepileptic drugs to poor children and regular provision of information about expected treatment response to children with epilepsy and their caretakers may help improve adherence.
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Affiliation(s)
- Shamil Ahmed Dima
- Department of Pediatrics and Child Health, Madda Walabu University, Gobba, Ethiopia
- * E-mail:
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