1
|
Toudou-Daouda M, Ibrahim-Mamadou AK. Clinical and etiological profile of epilepsy at the regional hospital center of Tahoua (Niger): A 4-year retrospective study. Brain Behav 2021; 11:e2301. [PMID: 34291611 PMCID: PMC8413756 DOI: 10.1002/brb3.2301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/25/2021] [Accepted: 07/12/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE We aimed to evaluate epilepsy management at the regional hospital center (RHC) of Tahoua (Niger) to determine the intrahospital deficiencies to optimize to improve the management of people with epilepsy. METHODS A descriptive retrospective study was carried out at the Psychiatric Unit of the RHC of Tahoua between January 1, 2016 and December 31, 2019. We collected from the registers of consultation all patients followed by nurse technicians in mental health for epilepsy whose diagnosis was made by nonspecialist physicians or internists. The study included patients with epilepsy who had a medical follow-up at least 6 months. RESULTS Of the 2022 patients seen during the period of the study, 246 patients were consulted for epilepsy with a hospital frequency of 12.2%. The mean age was 22.38 years, with a slight predominance of men (57.7%). Only generalized tonic-clonic seizures (95.1%) and focal-aware seizures (4.9%) were reported. The main etiologies were cerebral malaria (18.7%), bacterial meningitis (8.1%), and head trauma (4.9%). In 60.2% of cases, the etiology was undetermined, but the etiological diagnosis investigation was incomplete (CT scan not done). Only the first-generation antiepileptic drugs were used. Only 2.8% of the patients had drug-resistant epilepsy, and 97.2% of the patients had controlled seizures. CONCLUSION The study shows a predominance of infectious causes, particularly cerebral malaria. We found a high proportion of epilepsies with unknown etiologies with incomplete workup. The RHC of Tahoua should facilitate access to the CT scan for people with epilepsy to improve etiological diagnosis investigation.
Collapse
|
2
|
Olagunju AT, Bioku AA, Ohaeri JU, Oluwaniyi SO, Li A, Olagunju TO, Esezobor CI, Onwuameze OE, Chaimowitz GA. A comparative study of perceived burden in parent caregivers of adolescents with epilepsy in a resource-restricted setting: Investigating the explanatory factors of perceived burden. Epilepsy Behav 2021; 120:107992. [PMID: 33962249 DOI: 10.1016/j.yebeh.2021.107992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Parent caregivers often play vital roles in the care of adolescents with epilepsy (AWE) in resource-restricted settings; however, little is known about the burden borne by these parents. This study investigated the burden perceived by parents of AWE and described the explanatory factors. METHODS An equal number (n = 121) of age- and gender-matched parent caregivers of AWE (cases) and parents of adolescents with sickle cell disease (comparison group) were interviewed with the Parent Illness Intrusiveness Rating Scale to assess disruptions in their relationships and lifestyle. Parents of AWE were assessed for psychological distress with the 12-item General Health Questionnaire, and AWE were interviewed with the Hospital Depression-Anxiety Scale. RESULTS The majority of the cases and the comparison group were mothers (76%), with mean (SD) ages of 44.11 (SD = 6.92) versus 43.59 (SD = 6.39) years, respectively. The prevalence rate of psychological distress in cases was 38%, and depressive-anxiety symptom was prevalent in 39.7% of AWE. The level of perceived burden was significant in all parent caregivers, albeit higher in cases relative to the comparison group across multiple domains, including relationship/personal development, intimacy, instrumental and global. A high level of burden in parents of AWE was predicted by a poor family financial and material support to the adolescents, increased contact hours with adolescents, psychological distress in the parent caregivers, and anxiety-depressive symptoms in AWE after controlling for cofounders. CONCLUSION The study findings underscore the need for psychosocial support to bolster resilience and adaptive coping styles in parents of AWE, particularly in resource-restricted settings. A culturally sensitive interdisciplinary blueprint of locally viable actions model for psychosocial support for parent caregivers of AWE is strongly suggested. Future studies are indicated to shed more light on the modifiable risks of perceived burden, and the effectiveness of psychosocial interventions in parents of AWE.
Collapse
Affiliation(s)
- Andrew T Olagunju
- Department of Psychiatry and Behavioral Neurosciences, McMaster University/St Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Department of Psychiatry, University of Lagos, Mushin, Lagos State, Nigeria; Discipline of Psychiatry, The University of Adelaide, Adelaide, SA, Australia.
| | | | - Jude U Ohaeri
- Department of Psychological Medicine, University of Nigeria, Nsukka, Enugu State, Nigeria
| | | | - Angela Li
- Department of Psychiatry and Behavioral Neurosciences, McMaster University/St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Tinuke O Olagunju
- Department of Health Research Method, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Obiora E Onwuameze
- Department of Psychiatry, Southern Illinois University School of Medicine, Springfield, IL 62794, USA
| | - Gary A Chaimowitz
- Department of Psychiatry and Behavioral Neurosciences, McMaster University/St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| |
Collapse
|
3
|
Assadeck H, Toudou Daouda M, Moussa Konate M, Mamadou Z, Hassane Djibo F, Douma Maiga D, Sanoussi S. Clinical and etiological characteristics of epilepsy in people from Niger: a hospital-based study from a tertiary care referral center of Niamey, Niger. Epilepsia Open 2019; 4:318-327. [PMID: 31168499 PMCID: PMC6546149 DOI: 10.1002/epi4.12325] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/06/2019] [Accepted: 04/28/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Epilepsy constitutes a major public health concern in the world particularly in developing countries, especially in sub-Saharan African countries. We designed this study to evaluate epilepsy management at a tertiary referral center in Niger to obtain a comprehensive understanding to determine the intrahospital deficiencies to improve and to make recommendations in terms to improve epilepsy management in Niger. METHODS We conducted a retrospective study at the Neurology Outpatient Clinic of the National Hospital of Niamey (Niger) between May 2013 and May 2018 (5 years), collecting all cases of patients diagnosed with epilepsy by the neurologists. From the registers of consultation, we collected for each patient the demographic, clinical, etiological, and therapeutic data, as well as the outcomes during follow-up visits. RESULTS Of the 4576 patients seen during the period of the study, 1350 patients consulted for epilepsy with a hospital frequency of 29.5%. The mean age of the patients was 18.55 ± 17.15 years (range: 3 months to 83 years) with a predominance of the male sex (sex ratio at 1.5). Patients younger than 20 years were the most represented (61.6%). All patients underwent EEG. Only 463 patients (35.2%) underwent brain imaging. Generalized tonic-clonic seizures were the most frequent (50%) followed by typical absences seizures (11.8%). Cerebrovascular disease, central nervous system infections, and head injuries were the main etiologies. First-generation AEDs were the most prescribed (99%). The proportion of patients with drug-resistance was 9.6%. SIGNIFICANCE Our study shows limited access to newer generation AEDs and diagnostic tests of epilepsy in Niger. Considerable efforts should be made to facilitate for people living with epilepsy the accessibility to diagnostic tests and newer generation AEDs in order to improve the quality of epilepsy management in Niger.
Collapse
Affiliation(s)
- Hamid Assadeck
- Department of NeurologyNational Hospital of NiameyNiameyNiger
- Faculty of Medicine and Pharmacy, Department of Medicine and Medical SpecialtiesAbdou Moumouni UniversityNiameyNiger
| | | | | | - Zakaria Mamadou
- Department of NeurologyNational Hospital of NiameyNiameyNiger
| | | | - Dijbo Douma Maiga
- Faculty of Medicine and Pharmacy, Department of Medicine and Medical SpecialtiesAbdou Moumouni UniversityNiameyNiger
- Department of PsychiatryNational Hospital of NiameyNiameyNiger
| | - Samuila Sanoussi
- Department of NeurosurgeryNational Hospital of NiameyNiameyNiger
- Faculty of Medicine and Pharmacy, Department of Surgery and Surgical SpecialtiesAbdou Moumouni UniversityNiameyNiger
| |
Collapse
|
4
|
Ciccone O, Chabala C, Tembo O, Mathew M, Grollnek AK, Patel AA, Birbeck GL. A retrospective observational study of EEG findings and antiepileptic drug use among children referred for EEG to Zambia's University Teaching Hospital. Epilepsia Open 2018; 3:503-510. [PMID: 30525119 PMCID: PMC6276775 DOI: 10.1002/epi4.12267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2018] [Indexed: 12/26/2022] Open
Abstract
Objective Despite the heavy burden of epilepsy in Sub‐Saharan Africa, there remains a relative paucity of neurophysiology services and limited published data on electroencephalography (EEG) features among African children. The aim of this study was to describe clinical characteristics, EEG findings, and antiepileptic drug (AED) use among children referred for EEG to the University Teaching Hospital in Zambia. Methods EEG referrals and reports from 2013–2015 were reviewed. Within the context of routine care, EEG studies were interpreted by readers with advanced training in child neurology and clinical neurophysiology. Clinical data provided in the referral including seizure semiology and EEG findings were systematically extracted and analyzed. Results A total of 1,217 EEG reports were reviewed, with 1,187 included in the analysis. Median age was 7 years (interquartile range [IQR] 3–11) and 57% were male. Seventy‐three percent of 554 had documented seizure onset before 5 years of age. Among the 23% with seizure etiology documented, 78% were associated with perinatal injuries and central nervous system (CNS) infections. EEG abnormalities were found in 75% of the studies. Clinical semiology per referral identified focal seizures in 29%, but EEG findings increased this proportion to 63% (p = 0.004). Sixty‐two percent were taking AEDs, with 85% on monotherapy. The most commonly used AED was carbamazepine (49%).There was no association between the choice of AED and clinical semiology (all p's > 0.05). Significance This tertiary care center study identified >60% of referred children to have localization‐related epilepsies, with at least 18% of epilepsies being from potentially preventable causes. These findings are consistent with multi‐country, population‐based data from elsewhere in Africa. Seizure semiology assessed in routine, nonspecialist care does not predict AED choice, and the presence of focality is underestimated in routine care.
Collapse
Affiliation(s)
- Ornella Ciccone
- University Teaching Hospitals Children's Hospital Lusaka Zambia.,University of Zambia School of Medicine Lusaka Zambia
| | - Chishala Chabala
- University Teaching Hospitals Children's Hospital Lusaka Zambia.,University of Zambia School of Medicine Lusaka Zambia
| | - Owen Tembo
- University Teaching Hospitals Children's Hospital Lusaka Zambia
| | - Manoj Mathew
- University Teaching Hospitals Children's Hospital Lusaka Zambia.,University of Zambia School of Medicine Lusaka Zambia
| | | | - Archana A Patel
- Department of Neurology Boston Children's Hospital Boston Massachusetts U.S.A
| | - Gretchen L Birbeck
- Epilepsy Division Department of Neurology University of Rochester Rochester New York U.S.A.,Epilepsy Care Team Chikankata Hospital Mazabuka Zambia
| |
Collapse
|
5
|
Ajiboye PO, Abiodun OA, Ogbebor AI. An investigation of the patterns and outcomes of Electroencephalographic (EEG) recording requests in the management of neuropsychiatric disorders in a teaching Hospital in Nigeria. Afr Health Sci 2017; 17:852-858. [PMID: 29085413 PMCID: PMC5656214 DOI: 10.4314/ahs.v17i3.28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate the relevance of Electroencephalography (EEG) in the management of various neuropsychiatric conditions in University of Ilorin Teaching Hospital (UITH), Ilorin. Background EEG is still relevant in the diagnosis and management of patients with seizure disorders and extends to other neuropsychiatric conditions. However, very few studies have examined the use of EEG in developing countries, including Nigeria. Methods The EEG records of 154 patients between January 2012 and December 2012 were reviewed. EEG unit's records, including EEG request forms and EEG reports were examined. Socio demographic data, clinical data and the neurologist's comments on the EEG recordings were extracted and recorded on the proforma form. Results A total of 142(92.2%) of the patients out of 154 had complete records and were studied. Majority (84.5%) of the patients were below the age of 30 years. Various types of seizure disorders accounted for 80% of the provisional diagnosis. The EEG diagnosis based on the interpretation of the EEG records showed that 96 (67.6%) of the patients had normal records. Conclusion EEG still plays a very important role in the investigation of neuropsychiatric conditions especially epilepsy in developing countries. EEG facilities should be readily available.
Collapse
Affiliation(s)
- Peter Omoniyi Ajiboye
- Department of Behavioural Sciences University of Ilorin/ University of Ilorin Teaching Hospital
| | - Olatunji Alao Abiodun
- Department of Behavioural Sciences University of Ilorin/ University of Ilorin Teaching Hospital
| | | |
Collapse
|
6
|
Haddad N, Melikyan G, Al Hail H, Al Jurdi A, Aqeel F, Elzafarany A, Abuhadra N, Laswi M, Alsamman Y, Uthman B, Deleu D, Mesraoua B, Alarcon G, Azar N, Streletz L, Mahfoud Z. Epilepsy in Qatar: Causes, treatment, and outcome. Epilepsy Behav 2016; 63:98-102. [PMID: 27588359 DOI: 10.1016/j.yebeh.2016.07.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 07/29/2016] [Accepted: 07/30/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Qatar is a small country on the Eastern coast of the Arabian Peninsula. Its population is a unique mixture of native citizens and immigrants. We aimed to describe the features of epilepsy in Qatar as such information is virtually lacking from the current literature. METHODS We summarized information retrospectively collected from 468 patients with epilepsy seen through the national health system adult neurology clinic. RESULTS Epilepsy was classified as focal in 65.5% of the cases and generalized in 23%. Common causes of epilepsy were as follows: stroke (9%), hippocampal sclerosis (7%), infections (6%), and trauma (6%). Sixty-six percent of patients were receiving a single antiepileptic drug, with levetiracetam being the most frequently prescribed drug (41% of subjects). When the patients were divided by geographical background, remote infections caused the epilepsy in 15% of Asian patients (with neurocysticercosis accounting for 10%) but only in 1% of Qatari and 3% of Middle East/North African subjects (with no reported neurocysticercosis) (p<0.001). Cerebrovascular and neurodegenerative etiologies were the most prominent in Qataris, accounting for 14% (p=0.005) and 4% (p=0.03) of cases, respectively. The choice of antiepileptic drugs varied also according to the regional background, but the seizure freedom rate did not, averaging at 54% on the last clinic visit. SIGNIFICANCE To our knowledge, this is the first detailed information about epilepsy in Qatar. The geographical origin of patients adds to the heterogeneity of this disorder. Neurocysticercosis should be in the etiological differential diagnosis of epilepsy in patients coming from Southeast Asian countries, despite the fact that it is not endemic to Qatar. The choice of antiepileptic drugs is influenced by the availability of individual agents in the patients' native countries but had no bearing on the final seizure outcome.
Collapse
Affiliation(s)
- Naim Haddad
- Weill Cornell Medicine-Qatar, PO Box 24144, Education City, Doha, Qatar; Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | - Gayane Melikyan
- Weill Cornell Medicine-Qatar, PO Box 24144, Education City, Doha, Qatar; Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | - Hassan Al Hail
- Weill Cornell Medicine-Qatar, PO Box 24144, Education City, Doha, Qatar; Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | - Ayman Al Jurdi
- Weill Cornell Medicine-Qatar, PO Box 24144, Education City, Doha, Qatar.
| | - Faten Aqeel
- Weill Cornell Medicine-Qatar, PO Box 24144, Education City, Doha, Qatar.
| | | | - Nour Abuhadra
- Weill Cornell Medicine-Qatar, PO Box 24144, Education City, Doha, Qatar.
| | - Mujahed Laswi
- Weill Cornell Medicine-Qatar, PO Box 24144, Education City, Doha, Qatar.
| | - Yasser Alsamman
- Weill Cornell Medicine-Qatar, PO Box 24144, Education City, Doha, Qatar.
| | - Basim Uthman
- Weill Cornell Medicine-Qatar, PO Box 24144, Education City, Doha, Qatar; Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | - Dirk Deleu
- Weill Cornell Medicine-Qatar, PO Box 24144, Education City, Doha, Qatar; Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | - Boulenouar Mesraoua
- Weill Cornell Medicine-Qatar, PO Box 24144, Education City, Doha, Qatar; Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | - Gonzalo Alarcon
- Weill Cornell Medicine-Qatar, PO Box 24144, Education City, Doha, Qatar; Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | - Nabil Azar
- Weill Cornell Medicine-Qatar, PO Box 24144, Education City, Doha, Qatar; Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | - Leopold Streletz
- Weill Cornell Medicine-Qatar, PO Box 24144, Education City, Doha, Qatar; Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | - Ziyad Mahfoud
- Weill Cornell Medicine-Qatar, PO Box 24144, Education City, Doha, Qatar.
| |
Collapse
|
7
|
Lagunju IOA, Oyinlade AO, Atalabi OM, Ogbole G, Tedimola O, Famosaya A, Ogunniyi A, Ogunseyinde AO, Ragin A. Electroencephalography as a tool for evidence-based diagnosis and improved outcomes in children with epilepsy in a resource-poor setting. Pan Afr Med J 2015; 22:328. [PMID: 26977236 PMCID: PMC4769815 DOI: 10.11604/pamj.2015.22.328.7065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 11/27/2015] [Indexed: 11/11/2022] Open
Abstract
Introduction Electroencephalography (EEG) remains the most important investigative modality in the diagnostic evaluation of individuals with epilepsy. Children living with epilepsy in the developing world are faced with challenges of lack of access to appropriate diagnostic evaluation and a high risk of misdiagnosis and inappropriate therapy. We appraised EEG studies in a cohort of Nigerian children with epilepsy seen in a tertiary center in order to evaluate access to and the impact of EEG in the diagnostic evaluation of the cases. Methods Inter-ictal EEG was requested in all cases of pediatric epilepsy seen at the pediatric neurology clinic of the University College Hospital, Ibadan, Nigeria over a period of 18 months. Clinical diagnosis without EEG evaluation was compared with the final diagnosis post- EEG evaluation. Results A total of 329 EEGs were recorded in 329 children, aged 3months to 16 years, median 61.0 months. Clinical evaluation pre-EEG classified 69.3% of the epilepsies as generalized. The a posteriori EEG evaluations showed a considerably higher proportion of localization-related epilepsies (33.6%). The final evaluation post EEG showed a 21% reduction in the proportion of cases labeled as generalized epilepsy and a 55% increase in cases of localization-related epilepsy(p<0.001). Conclusion Here we show that there is a high risk of misdiagnosis and therefore the use of inappropriate therapies in children with epilepsy in the absence of EEG evaluation. The implications of our findings in the resource-poor country scenario are key for reducing the burden of care and cost of epilepsy treatment on both the caregivers and the already overloaded tertiary care services.
Collapse
Affiliation(s)
- Ike Oluwa Abiola Lagunju
- Department of Paediatrics, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Alexander Opebiyi Oyinlade
- Department of Paediatrics, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Omolola Mojisola Atalabi
- Department of Radiology, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Godwin Ogbole
- Department of Radiology, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Olushola Tedimola
- Department of Paediatrics, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Abimbola Famosaya
- Department of Paediatrics, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Department of Medicine, College of Medicine, University of Ibadan/University College Hospital, Ibadan
| | | | - Ann Ragin
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| |
Collapse
|