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Singh G, Braga P, Carrizosa J, Prevos-Morgant M, Mehndiratta MM, Shisler P, Triki C, Wiebe S, Wilmshurst J, Blümcke I. The international league against epilepsy primary healthcare educational curriculum: Assessment of educational needs. Epileptic Disord 2024. [PMID: 38924272 DOI: 10.1002/epd2.20256] [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: 03/25/2024] [Revised: 05/30/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE To assess the need for an epilepsy educational curriculum for primary healthcare providers formulated by the International League Against Epilepsy (ILAE) and the importance attributed to its competencies by epilepsy specialists and primary care providers and across country-income settings. METHODS The ILAE primary care epilepsy curriculum was translated to five languages. A structured questionnaire assessing the importance of its 26 curricular competencies was posted online and publicized widely to an international community. Respondents included epilepsy specialists, primary care providers, and others from three World Bank country-income categories. Responses from different groups were compared with univariate and ordinal logistic regression analyses. RESULTS Of 785 respondents, 60% noted that a primary care epilepsy curriculum did not exist or they were unaware of one in their country. Median ranks of importance for all competencies were high (very important to extremely important) in the entire sample and across different groups. Fewer primary care providers than specialists rated the following competencies as extremely important: definition of epilepsy (p = .03), recognition of seizure mimics (p = .02), interpretation of test results for epilepsy care (p = .001), identification of drug-resistant epilepsy (0.005) and management of psychiatric comorbidities (0.05). Likewise, fewer respondents from LMICs in comparison to UMICs rated 15 competencies as extremely important. SIGNIFICANCE The survey underscores the unmet need for an epilepsy curriculum in primary care and the relevance of its competencies across different vocational and socioeconomic settings. Differences across vocational and country income groups indicate that educational packages should be developed and adapted to needs in different settings.
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Affiliation(s)
- Gagandeep Singh
- Department of Neurology, Dayanand Medical College & Hospital, Ludhiana, India
| | - Patricia Braga
- Institute of Neurology, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | | | | | | | | | - Chahnez Triki
- Department of Child Neurology, LR19ES15 Neuropediatrie, Sfax Medical School, University of Sfax, Sfax, Tunisia
| | - Samuel Wiebe
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Jo Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Ingmar Blümcke
- Institute of Neuropathology, Unversitätsklinikum Erlangen, Erlangen, Germany
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Strzelczyk A, Lagae L, Wilmshurst JM, Brunklaus A, Striano P, Rosenow F, Schubert‐Bast S. Dravet syndrome: A systematic literature review of the illness burden. Epilepsia Open 2023; 8:1256-1270. [PMID: 37750463 PMCID: PMC10690674 DOI: 10.1002/epi4.12832] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023] Open
Abstract
We performed a systematic literature review and narrative synthesis according to a pre-registered protocol (Prospero: CRD42022376561) to identify the evidence associated with the burden of illness in Dravet syndrome (DS), a developmental and epileptic encephalopathy characterized by drug-resistant epilepsy with neurocognitive and neurobehavioral impairment. We searched MEDLINE, Embase, and APA PsychInfo, Cochrane's database of systematic reviews, and Epistemonikos from inception to June 2022. Non-interventional studies reporting on epidemiology (incidence, prevalence, and mortality), patient and caregiver health-related quality of life (HRQoL), direct and indirect costs and healthcare resource utilization were eligible. Two reviewers independently carried out the screening. Pre-specified data were extracted and a narrative synthesis was conducted. Overall, 49 studies met the inclusion criteria. The incidence varied from 1:15 400-1:40 900, and the prevalence varied from 1.5 per 100 000 to 6.5 per 100 000. Mortality was reported in 3.7%-20.8% of DS patients, most commonly due to sudden unexpected death in epilepsy and status epilepticus. Patient HRQoL, assessed by caregivers, was lower than in non-DS epilepsy patients; mean scores (0 [worst] to 100/1 [best]) were 62.1 for the Kiddy KINDL/Kid-KINDL, 46.5-54.7 for the PedsQL and 0.42 for the EQ-5D-5L. Caregivers, especially mothers, were severely affected, with impacts on their time, energy, sleep, career, and finances, while siblings were also affected. Symptoms of depression were reported in 47%-70% of caregivers. Mean total direct costs were high across all studies, ranging from $11 048 to $77 914 per patient per year (PPPY), with inpatient admissions being a key cost driver across most studies. Mean costs related to lost productivity were only reported in three publications, ranging from approximately $19 000 to $20 000 PPPY ($17 596 for mothers vs $1564 for fathers). High seizure burden was associated with higher resource utilization, costs and poorer HRQoL. The burden of DS on patients, caregivers, the healthcare system, and society is profound, reflecting the severe nature of the syndrome. Future studies will be able to assess the impact that newly approved therapies have on reducing the burden of DS.
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Affiliation(s)
- Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine‐Main, Center of Neurology and NeurosurgeryGoethe‐University and University Hospital FrankfurtFrankfurt am MainGermany
- LOEWE Center for Personalized and Translational Epilepsy Research (CePTER)Goethe‐University FrankfurtFrankfurt am MainGermany
| | - Lieven Lagae
- Department of Development and RegenerationUniversity Hospitals KU LeuvenLeuvenBelgium
| | - Jo M Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - Andreas Brunklaus
- Paediatric Neurosciences Research GroupRoyal Hospital for ChildrenGlasgowUK
- School of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Pasquale Striano
- IRCCS ‘G. Gaslini’ InstituteGenovaItaly
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child HealthUniversity of GenoaGenovaItaly
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine‐Main, Center of Neurology and NeurosurgeryGoethe‐University and University Hospital FrankfurtFrankfurt am MainGermany
- LOEWE Center for Personalized and Translational Epilepsy Research (CePTER)Goethe‐University FrankfurtFrankfurt am MainGermany
| | - Susanne Schubert‐Bast
- Epilepsy Center Frankfurt Rhine‐Main, Center of Neurology and NeurosurgeryGoethe‐University and University Hospital FrankfurtFrankfurt am MainGermany
- LOEWE Center for Personalized and Translational Epilepsy Research (CePTER)Goethe‐University FrankfurtFrankfurt am MainGermany
- Department of NeuropediatricsGoethe‐University and University Hospital FrankfurtFrankfurt am MainGermany
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Jain S, Panda S, Garg M. Sociodemographic determinants of epilepsy and treatment-seeking behavior among patients with epilepsy - A hospital-based study from western India. Epilepsy Behav 2023; 145:109340. [PMID: 37422936 DOI: 10.1016/j.yebeh.2023.109340] [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: 03/23/2023] [Revised: 06/05/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Epilepsy ranks among the major noncommunicable diseases that confer significant morbidity and mortality. A lack of knowledge about epilepsy, coupled with negative attitude and false practices, has been shown to be influenced by sociodemographic parameters and in turn impacts healthcare-seeking behavior. METHODS An observational single-center study was conducted at a tertiary care center in western India. Data on sociodemographic parameters, clinical and healthcare-seeking patterns were recorded from all patients above 18 years with a diagnosis of epilepsy. A pre-validated questionnaire was then administered to assess the knowledge, attitude, and practices related to epilepsy. Data collected were evaluated. RESULTS A total of 320 patients with epilepsy were recruited for the study. Majority of the study subjects were young Hindu males from urban and semi-urban areas. Idiopathic generalized epilepsy was the most common diagnosis with significant number of patients showing poor seizure control. The knowledge, attitude, and practice (KAP) responses showed serious gaps in various aspects. Prevalent misconceptions were that epilepsy is a mental problem (40%), is a hereditary disorder (24.1%), is contagious (13.4%), and is a result of previous life sin (38.8%). With respect to discrimination in epilepsy using KAP questionnaire, most of the respondents (>80%) did not object to sitting or playing with a child with epilepsy. A significant proportion of patients (78.8%) feared from the side effects of long-term antiepileptic drug treatment. Almost one-third persons (31.6%) did not know the correct response in terms of first aid measures. The mean KAP score was 14.33 (±3.017 SD), significantly higher in better educated people from urban areas (p < 0.001 for both). Healthcare-seeking behavior with preference for early allopathic care had a positive correlation with various sociodemographic characteristics as well as with higher mean KAP scores. CONCLUSION Despite improved literacy and urbanization, knowledge regarding epilepsy still remains poor with wide prevalence of traditional wisdom and practices. Though better education, employment, and awareness may partially overcome the impediments resulting in delay in seeking early appropriate healthcare after first seizure, the issue is more complex and multifactorial, and a multipronged approach is need of the hour.
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Affiliation(s)
- Saksham Jain
- Departments of Neurology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Samhita Panda
- Departments of Neurology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Mayank Garg
- Departments of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
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de Lima Leite M, Toporcov TN, Pai JD, da Silva JC. Socio-demographic profiles and obstetrics outcomes of pregnant women with epilepsy in a vulnerability State, Brazil. PLoS One 2022; 17:e0271328. [PMID: 35857720 PMCID: PMC9299315 DOI: 10.1371/journal.pone.0271328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/28/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The socio-demographic profile of pregnant women in low- and middle- income countries is characterized by low educational attainment and unemployment, leading to social and economic morbidity. characterized by limited opportunities for education, employment, and marriage, which are strongly related to the stigmatization of the disease. The study of the socio- profile and obstetric outcomes of pregnant women with epilepsy in Alagoas, Brazil, may help understand this scenario and facilitate the development of public policy strategies to reduce local morbidity. OBJECTIVES We aimed to describe the sociodemographic profile of pregnant women with epilepsy and obstetric outcomes in Alagoas, Brazil. METHODS This cohort study was based on medical records of pregnant women with epilepsy in Brazilian high-risk maternity hospitals from 2008 to 2020. The following data were collected: age, race, education, marital status, occupation, number of pregnancies, delivery, and abortion. The inclusion criteria were pregnant women with and without epilepsy (control group) aged < 40 years. RESULTS The prevalence of PWWE was 0.49% (n = 224/44,917). Cesarean delivery was more frequent in PWWE than in pregnant women without epilepsy (adjusted odds ratio [OR] = 22.0; 95% confidence interval [CI] = 14.35-33.73; p<0,01). Abortion was associated with PWWE (OR adjusted = 1.72; 95% CI = 1.13-2.61; p = 0.01). Pregnant women in the countryside were more likely to develop epilepsy than those born in the capital (OR = 1.55; 95% CI = 1.12-2.14; p <0.01). CONCLUSION The PWWE socio-demographic profile of the Alagoas had a predominance of brown- colored skin, single status, homemakers, and illiteracy with a high proportion residing in the interior of the state. The obstetrics data show a higher incidence of cesarean deliveries and miscarriages.
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Affiliation(s)
- Magnúcia de Lima Leite
- Universidade Estadual de Ciências da Saúde Alagoas (UNCISAL), Maceió, AL, Brazil
- Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | - Janise Dal Pai
- Universidade Pontifícia Católica do Rio Grande do Sul (PUCRS), Rio Grande do Sul, RS, Brazil
| | - José Claudio da Silva
- Universidade Estadual de Ciências da Saúde Alagoas (UNCISAL), Maceió, AL, Brazil
- Faculdade de Medicina do Centro Universitário (CESMAC), Maceió, AL, Brazil
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Gwedela MNV, Terai H, Lampiao F, Matsunami K, Aizawa H. Anti-seizure effects of medicinal plants in Malawi on pentylenetetrazole-induced seizures in zebrafish larvae. JOURNAL OF ETHNOPHARMACOLOGY 2022; 284:114763. [PMID: 34688800 DOI: 10.1016/j.jep.2021.114763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 06/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Medicinal plants are used to manage and treat epilepsy in Malawi because of traditional beliefs and barriers to conventional anti-seizure drugs. Among the plants prescribed by traditional medical practitioners are Margaritaria discoidea, Dalbergia boehmii, Dalbergia nitidula, Catunaregam spinosa, and Lannea discolor. Despite the wide use of these plants, there is a lack of scientific evidence to support their anti-seizure efficacy. AIM OF THE STUDY This study used the pentylenetetrazole (PTZ)-induced larval zebrafish seizure model to screen for anti-seizure effects of a collection of medicinal plants traditionally used in Malawi. MATERIALS AND METHODS Zebrafish larvae were incubated in decoctions at maximum tolerated concentrations for 18 h and exposed to PTZ. As a primary screen, the effects of the decoctions on seizure-induced locomotor activity were determined. Decoctions that significantly reduced total distance traveled were further checked for effects on seizure latency and frequency, brain activity, immediate early gene expression, and c-fos protein expression. RESULTS M. discoidea male leaves, D. boehmii roots, and D. nitidula leaves showed significant anti-seizure effects in the primary screen and were selected for further study. Electrophysiological and immediate early gene analyses corroborated anti-seizure effect of D. boehmii and D. nitidula. The results of c-fos protein expression further suggested that the anti-seizure effects in the larval brain may be mediated by the suppression of neurons localized in midbrain regions. CONCLUSIONS These findings provide pioneering scientific evidence of the presence of anti-seizure activity in M. discoidea, D. boehmii, and D. nitidula, prescribed by traditional Malawian medical practitioners. Further studies are needed to identify and isolate compounds responsible for such biological activities and elucidate the possible mechanisms of action.
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Affiliation(s)
- Mayeso Naomi Victoria Gwedela
- Department of Neurobiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8553, Japan
| | - Haruhi Terai
- Department of Neurobiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8553, Japan
| | - Fanuel Lampiao
- Africa Centre of Excellence in Public Health and Herbal Medicine, Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi
| | - Katsuyoshi Matsunami
- Department of Pharmacognosy, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8553, Japan
| | - Hidenori Aizawa
- Department of Neurobiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8553, Japan.
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Dedeken P, Muhumuza SN, Sebera F, Umwiringirwa J, Bitunguhari L, Tierens H, Teuwen DE, Boon PAJM. Long-Term Impact of Single Epilepsy Training on Knowledge, Attitude and Practices: Comparison of Trained and Untrained Rwandan Community Health Workers. Int J Public Health 2021; 66:645598. [PMID: 34867136 PMCID: PMC8636829 DOI: 10.3389/ijph.2021.645598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 10/20/2021] [Indexed: 01/26/2023] Open
Abstract
Objectives: To close the epilepsy treatment gap and reduce related stigma, eradication of misconceptions is importantIn 2014, Community Health Workers (CHWs) from Musanze (Northern Rwanda) were trained on different aspects of epilepsy. This study compared knowledge, attitude and practices (KAPs) towards epilepsy of trained CHWs 3 years after training, to untrained CHWs from Rwamagana (Eastern Rwanda). Methods: An epilepsy KAP questionnaire was administered to 96 trained and 103 untrained CHWs. Demographic and intergroup KAP differences were analysed by response frequencies. A multivariate analyses was performed based on desired and undesired response categories. Results: Epilepsy awareness was high in both groups, with better knowledge levels in trained CHWs. Negative attitudes were lowest in trained CHWs, yet 17% still reported misconceptions. Multivariate analysis demonstrated the impact of the training, irrespective of age, gender and educational level. Knowing someone with epilepsy significantly induced more desired attitudes. Conclusion: Despite demographic differences between trained and untrained CHWs, a single epilepsy training resulted in significant improvement of desired KAPs after 3 years. Nation-wide CHW training programs with focus on training-resistant items, e.g., attitudes, are recommended.
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Affiliation(s)
- Peter Dedeken
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
- Department of Neurology, Heilig Hart Ziekenhuis, Lier, Belgium
- UCB Pharma, Brussels, Belgium
| | - Stephen N. Muhumuza
- School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
- Kabgayi District Hospital, Kabgayi, Rwanda
| | - Fidele Sebera
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
- CARAES Neuro-psychiatric Hospital, Brothers of Charity, Department of Neurology, Kigali, Rwanda
- Centre Hospitalier Universitaire (CHU-K), Kigali, Rwanda
| | - Josiane Umwiringirwa
- CARAES Neuro-psychiatric Hospital, Brothers of Charity, Department of Neurology, Kigali, Rwanda
| | | | | | - Dirk E. Teuwen
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
- UCB Pharma, Brussels, Belgium
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Zertuche-Ortuño L, Oropeza-Bustos N, Crail-Meléndez D, Bribiesca-Contreras E, Sebastián-Díaz MA, Martínez-Bustos V, Santos-Peyret A, Martínez-Medina S, Ochoa A, Jara-Prado A, Martínez-Juárez IE. Increased non-attendance at epilepsy clinic in patients with neuropsychiatric comorbidities: A prospective study. Epilepsy Behav 2021; 122:108202. [PMID: 34325158 DOI: 10.1016/j.yebeh.2021.108202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In patients with epilepsy, regular follow-up is vital for adequate seizure control, antiseizure drugs' (ASDs) side effects, psychiatric comorbidities, and planning for epilepsy surgery. Non-attendance creates barriers to adequate patient care, inefficient allocation of resources, loss of income, and unnecessary emergency department visits due to lack of seizure control. This study aimed to determine the causes and sociodemographic characteristics of the non-attendant population at the Epilepsy Clinic. METHODS A prospective and observational study was carried out on patients treated at the Epilepsy Clinic of the National Institute of Neurology and Neurosurgery (NINN) in Mexico from August 2015 to June 2016. A phone interview was made with all those patients who did not attend the epilepsy consultation. This call incorporated ad hoc questions to meet the objectives of this study. RESULTS During the study period, 1299 patients had an appointment at the epilepsy clinic, where 233 (17.9%) patients missed their consultation, 123 (52.8%) were male, mean age was 35.9 ± 14.42 years. The most frequent cause of non-attendance was forgetfulness of the appointment in 62 patients (26.6%). Two patients died; no patient was reported to have experienced SUDEP. Non-attendant patients showed statistically significant overall prevalence of psychiatric comorbidities (41.6%), particularly depression, anxiety, and interictal psychosis. CONCLUSION Information on non-attendance at various specialist consultations is scarce, and to our knowledge, this is the first study to address non-attendance in patients with epilepsy in Latin America. Improving hospital protocols to reduce non-attendance can increase patient adherence to follow-up, ultimately improving the quality of care in the epilepsy clinic.
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Affiliation(s)
| | - Nayeli Oropeza-Bustos
- Epilepsy Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Daniel Crail-Meléndez
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - Mario A Sebastián-Díaz
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - Andrea Santos-Peyret
- Neurology Residency Program, National Institute of Neurology and Neurosurgery, Mexico
| | - Salvador Martínez-Medina
- Epilepsy Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico; Posgraduate Program, Anáhuac Norte University, Estado de México, Mexico
| | - Adriana Ochoa
- Internal Medicine Residency Program, Medica Sur Hospital, Mexico City, Mexico
| | - Aurelio Jara-Prado
- Internal Medicine Residency Program, Medica Sur Hospital, Mexico City, Mexico
| | - Iris E Martínez-Juárez
- Epilepsy Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico; Neurogenetics Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
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Ogwang R, Ningwa A, Akun P, Bangirana P, Anguzu R, Mazumder R, Salamon N, Henning OJ, Newton CR, Abbo C, Mwaka AD, Marsh K, Idro R. Epilepsy in Onchocerca volvulus Sero-Positive Patients From Northern Uganda-Clinical, EEG and Brain Imaging Features. Front Neurol 2021; 12:687281. [PMID: 34149607 PMCID: PMC8209377 DOI: 10.3389/fneur.2021.687281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/12/2021] [Indexed: 01/08/2023] Open
Abstract
Globally, epilepsy is the most common chronic neurological disorder. The incidence in sub-Saharan Africa is 2-3 times higher than that in high income countries. Infection by Onchocerca volvulus may be an underlying risk factor for the high burden and based upon epidemiological associations, has been proposed to cause a group of disorders—Onchocerca associated epilepsies (OAE) like nodding syndrome (NS). To improve our understanding of the disease spectrum, we described the clinical, electroencephalographic (EEG) and magnetic resonance imaging (MRI) features of children with epilepsy and sero-positive for Onchocerca volvulus (possible OAEs other than nodding syndrome). Twenty-nine children and adolescents with non-nodding syndrome OAE in northern Uganda were enrolled. A diagnosis of OAE was made in patients with epilepsy and seizure onset after age 3 years, no reported exposure to perinatal severe febrile illness or traumatic brain injury, no syndromic epilepsy diagnosis and a positive Ov-16 ELISA test. Detailed clinical evaluation including psychiatric, diagnostic EEG, a diagnostic brain MRI (in 10 patients) and laboratory testing were performed. Twenty participants (69%) were male. The mean age was 15.9 (standard deviation [SD] 1.9) years while the mean age at seizure onset was 9.8 (SD 2.9) years. All reported normal early childhood development. The most common clinical presentation was a tonic-clonic seizure. The median number of seizures was 2 (IQR 1–4) in the previous month. No specific musculoskeletal changes, or cranial nerve palsies were reported, neither were any vision, hearing and speech difficulties observed. The interictal EEG was abnormal in the majority with slow wave background activity in 52% (15/29) while 41% (12/29) had focal epileptiform activity. The brain MRI showed mild to moderate cerebellar atrophy and varying degrees of atrophy of the frontal, parietal and occipital lobes. The clinical spectrum of epilepsies associated with Onchocerca may be broader than previously described. In addition, focal onset tonic-clonic seizures, cortical and cerebellar atrophy may be important brain imaging and clinical features.
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Affiliation(s)
- Rodney Ogwang
- College of Health Sciences, Makerere University, Kampala, Uganda.,KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Coast, Kilifi, Kenya.,Centre of Tropical Neuroscience, Kitgum, Uganda
| | - Albert Ningwa
- College of Health Sciences, Makerere University, Kampala, Uganda.,Centre of Tropical Neuroscience, Kitgum, Uganda
| | - Pamela Akun
- College of Health Sciences, Makerere University, Kampala, Uganda.,Centre of Tropical Neuroscience, Kitgum, Uganda
| | - Paul Bangirana
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ronald Anguzu
- College of Health Sciences, Makerere University, Kampala, Uganda.,Centre of Tropical Neuroscience, Kitgum, Uganda.,Division of Epidemiology, Medical College of Wisconsin, Institute for Health and Equity, Milwaukee, WI, United States
| | - Rajarshi Mazumder
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Noriko Salamon
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Oliver Johannes Henning
- Division of Clinical Neuroscience, The National Centre for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - Charles R Newton
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Coast, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Catherine Abbo
- College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Kevin Marsh
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Richard Idro
- College of Health Sciences, Makerere University, Kampala, Uganda.,Centre of Tropical Neuroscience, Kitgum, Uganda.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
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Zhuang C, Wu H, Lin B, An X. The effect of Omaha System-based continuous nursing care on the psychological status, self-esteem, and quality of life in epileptic children. Am J Transl Res 2021; 13:3435-3442. [PMID: 34017519 PMCID: PMC8129271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This study explored and analyzed the effect of Omaha System-based continual nursing care on the psychological status, self-esteem and quality of life in epileptic children. METHODS 127 epileptic children hospitalized from March 2018 to September 2019 were recruited as the study cohort and stochastically divided into an observation group (n=65) and a control group (n=62). The control group children were given regular out-of-hospital guidance after discharge, and the observation-group were treated with Omaha System-based continuous nursing intervention in addition to the routine out-of-hospital guidance the control group underwent. The two groups' psychological statuses, self-esteem, sense of defect, and quality of life were compared both pre- and post-intervention. RESULTS The SAS and SDS scores in the two groups after the intervention were significantly lower than their pre-intervention scores (P<0.05), and the scores in the observation group after the intervention were evidently lower than the scores in the control group (P<0.05). The two groups' post-intervention SES and FIS scores were significantly higher than their pre-intervention scores (P<0.05), and the scores in the observation group were notably lower than the scores in the control group (P<0.05). The post-intervention quality of life scores in the two groups were dramatically higher than the pre-intervention scores (P<0.05), and the quality of life scores in the observation group were notably higher than the quality of life scores in the control group (P<0.05). CONCLUSION The Omaha System-based continual nursing care can efficaciously elevate the psychological status of children with epilepsy, improve their self-esteem, reduce their sense of self-defect, and contribute to the improvement of their quality of life, so it is worthy of clinical promotion and application.
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Affiliation(s)
- Cong Zhuang
- Department of Nursing, Haikou Hospital Affiliated to Xiangya Medical College of Central South UniversityHaikou 570208, Hainan, China
| | - Haiyan Wu
- Department of Neurology, Haikou Hospital Affiliated to Xiangya Medical College of Central South UniversityHaikou 570208, Hainan, China
| | - Bailang Lin
- Department of Nursing, Haikou Hospital of The Maternal and Child HealthHaikou 570208, Hainan, China
| | - Xuefang An
- Department of Nursing, Haikou Hospital Affiliated to Xiangya Medical College of Central South UniversityHaikou 570208, Hainan, China
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Michaelis IA, Nielsen M, Carty C, Wolff M, Sabin CA, Lambert JS. Late diagnosis of human immunodeficiency virus infection is linked to higher rates of epilepsy in children in the Eastern Cape of South Africa. South Afr J HIV Med 2020; 21:1047. [PMID: 32670626 PMCID: PMC7343945 DOI: 10.4102/sajhivmed.v21i1.1047] [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: 11/23/2019] [Accepted: 01/07/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-positive children may present with a wide range of neurological disorders. Among these, epilepsy is of key concern because of its lifelong impact and potential for damage to the central nervous system (CNS). Few studies in developing regions have investigated the prevalence and aetiology of epilepsy in HIV-infected children as a key population. OBJECTIVES We describe the prevalence of epilepsy, associated neurological disabilities, immunological status, clinical stage and history of CNS infection at epilepsy diagnosis in a cohort of HIV-infected children receiving antiretroviral therapy (ART) in the Eastern Cape of South Africa. METHODS We conducted a retrospective study (2004-2014) at two major referral sites for HIV-infected children diagnosed with epilepsy aged 0-16 years. Eligible subjects were extracted from the electronic medicine bridging access to care in excellence (EMBRACE) Paediatric Cohort using the Paediatric ART Data Management Tool (PADMT). Fixed data fields were interrogated for exposures to antiepileptic drugs. Unstructured 'comments' fields were searched for the terms: epilepsy, seizures, fits and szs, as well as abbreviated versions of common antiepileptic drug names. Eligible subject folders were then retrieved to validate the digital data. RESULTS From 2139 children enrolled in the two sites, 53 children were diagnosed with epilepsy (2.48%). In these, the median CD4 count was 591 cells/mm3, and the mean viral load was 4.9 log copies/mL, with undetectable viral loads in only seven children (14.0%). World Health Organization (WHO) clinical HIV stage was available for 46 patients of the sample, with 3, 6, 26 and 11 children graded at stages 1, 2, 3 and 4, respectively. Forty percent children had a history of CNS infection prior to the epilepsy diagnosis, and 55% children were reported to have school problems. CONCLUSIONS In this descriptive study, the prevalence of epilepsy among children with HIV was 2.48%, mostly diagnosed in advanced HIV-disease stages. Our findings support the usefulness of early detection and initiation of ART in HIV-infected children in order to reduce the risk of epilepsy. In addition, our study demonstrates that novel techniques are effective in accessing cohort-level data that allow interrogation of both structured and unstructured clinical data.
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Affiliation(s)
- Isabel A Michaelis
- Department of Health, Faculty of Paediatrics, Walter Sisulu University, Mthatha, South Africa
| | - Maryke Nielsen
- Department of Paediatrics and Child Health, Faculty of Infectious Disease, Malawi-Liverpool-Wellcome Clinical Research Facility, Blantyre, Malawi
- Institute of Infection and Global Health, Faculty of Clinical Infection, Immunology and Microbiology, University of Liverpool, Liverpool, United Kingdom
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Craig Carty
- Department of Evidence-Based Social Intervention, Faculty of Sociology, University of Oxford, Oxford, United Kingdom
| | - Markus Wolff
- Department of Neuropaediatrics and Social Paediatrics, Faculty of Paediatrics, Vivantes Klinikum Neukolln, Berlin, Germany
| | - Caroline A Sabin
- Department of Medical Statistics and Epidemiology, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - John S Lambert
- Department of Infectious Diseases, Faculty of Infectious Diseases and Genitourinary Medicine, UCD School of Medicine, Dublin, Ireland
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Clinico-etiological Profile and Developmental Status of Infants Aged 1-24 months with Epilepsy. Indian J Pediatr 2019; 86:681-685. [PMID: 30976964 DOI: 10.1007/s12098-019-02943-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To study the clinico-etiological profile of epilepsy in children aged 1-24 mo attending a tertiary-care public hospital. METHODS All infants aged 1-24 mo with epilepsy (as per International League Against Epilepsy, 2014) presenting between April 2016 and March 2017 were enrolled. Detailed history and examination were done in all children, and developmental assessment was done using Developmental Assessment Scale for Indian Infants (DASII). Electroencephalography and neuroimaging (CT/MRI) were done for all subjects. RESULTS Sixty children (39 males) were consecutively enrolled after informed written consent. The mean (SD) age at seizure onset was 4.3 (4.14) mo. Perinatal asphyxia (45%) and malformations of cortical development (18.3%) were the commonest etiologies. Neurological examination was abnormal in 68.3%, and a neuroimaging abnormality was present in 76% of children. Fifteen patients (25%) had West syndrome, which was symptomatic in the majority (73.3%). Developmental delay (DQ < 70) was the commonest co-morbidity (81.7%); 28.3% had profound delay. Odds of having developmental delay were 13-times higher in those with an abnormal neurological examination [OR 13.5 (2.82-64.67), P = 0.001], and nearly 9-times higher with abnormal neuroimaging [OR 8.9 (2.11-37.9), P = 0.003]. CONCLUSIONS Epilepsy in children <2 y is symptomatic in the majority, with sequelae of birth asphyxia as the commonest etiology. High prevalence of co-morbid developmental delay underscores the need for routine evaluation and early intervention in all high-risk infants.
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Aliyu MH, Abdullahi AT, Iliyasu Z, Salihu AS, Adamu H, Sabo U, Garcia JP, Abdullahi SU, Mande A, Xian H, Yakasai HM, Schootman M, Ingles DJ, Patel AA, Yakasai A, Curry-Johnson S, Wudil UJ, DeBaun MR, Trevathan E. Bridging the childhood epilepsy treatment gap in northern Nigeria (BRIDGE): Rationale and design of pre-clinical trial studies. Contemp Clin Trials Commun 2019; 15:100362. [PMID: 31049462 PMCID: PMC6484289 DOI: 10.1016/j.conctc.2019.100362] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/07/2019] [Accepted: 04/10/2019] [Indexed: 01/26/2023] Open
Abstract
Epilepsy is the most common serious childhood neurological disorder. In the low- and middle-income countries (LMICs) of Africa, children with epilepsy suffer increased morbidity and mortality compared to their counterparts in high-income countries, and the majority do not receive treatment - the childhood epilepsy treatment gap. Reports of the childhood epilepsy treatment gap in Africa are likely underestimates; most surveys do not include several common childhood seizure types, including most types of non-convulsive epilepsy. Efforts to scale up childhood epilepsy care services in the LMICs of Africa must contend with a shortage of physicians and diagnostic technology [e.g., electroencephalograms (EEGs)]. One pragmatic solution is to integrate epilepsy care into primary care by task-shifting to community health extension workers. The aims of this project (BRIDGE) are to: 1) train, develop, and pilot task-shifted epilepsy care teams; 2) develop and pilot innovative childhood epilepsy screening and diagnostic paradigms adapted to the local Hausa language/culture in Kano, northern Nigeria; and, 3) quantify and map the childhood epilepsy treatment gap, using geographic information systems (GIS), to target limited resources to areas of greatest need. Task-shifted teams will diagnose and manage childhood epilepsy using an innovative epilepsy screening tools and diagnostic and management paradigms in environments with limited EEG access. If validated and demonstrated efficacious in clinical trials, this project can be taken to scale across broader areas of west Africa's LMICs that share language and culture. BRIDGE has the potential to enhance access to basic childhood epilepsy care and establish the foundation for childhood epilepsy clinical trials in west Africa.
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Affiliation(s)
- Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Health Policy, Vanderbilt University, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aminu T Abdullahi
- Department of Psychiatry, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Zubairu Iliyasu
- Department of Community Medicine, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Auwal S Salihu
- Department of Psychiatry, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Halima Adamu
- Department of Pediatrics, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Umar Sabo
- Department of Pediatrics, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Juanita Prieto Garcia
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shehu U Abdullahi
- Department of Pediatrics, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Aliyu Mande
- Department of Community Medicine, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Hong Xian
- Department of Epidemiology & Biostatistics, College for Public Health and Social Justice, Saint Louis University St. Louis, MO, USA
| | - Hafizu M Yakasai
- Centre for Nigerian Languages and Folklore, Bayero University, Kano, Nigeria
| | - Mario Schootman
- Department of Epidemiology & Biostatistics, College for Public Health and Social Justice, Saint Louis University St. Louis, MO, USA
| | - Donna J Ingles
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Archana A Patel
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Abubakar Yakasai
- Department of Psychiatry, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Stacy Curry-Johnson
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Eskind Biomedical Library, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Usman J Wudil
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael R DeBaun
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Edwin Trevathan
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurology, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN, USA
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Mbelesso P, Luna J, Yangatimbi E, Mboukou C, Preux PM. Sociocultural representations of epilepsy in the Central African Republic: A door-to-door survey. Seizure 2019; 67:23-26. [DOI: 10.1016/j.seizure.2019.02.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/10/2019] [Accepted: 02/26/2019] [Indexed: 01/01/2023] Open
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Dessie G, Mulugeta H, Leshargie CT, Wagnew F, Burrowes S. Depression among epileptic patients and its association with drug therapy in sub-Saharan Africa: A systematic review and meta-analysis. PLoS One 2019; 14:e0202613. [PMID: 30870423 PMCID: PMC6417665 DOI: 10.1371/journal.pone.0202613] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 02/12/2019] [Indexed: 12/14/2022] Open
Abstract
Background Despite the high prevalence of epilepsy in sub-Saharan Africa and the established relationship between depression and epilepsy, the extent of comorbid epilepsy and depression in the region is still poorly understood. The objective of this systematic review and meta-analysis is to address this gap in the literature by determining the pooled prevalence of depression among epileptic patients in sub-Saharan Africa. Methods A systematic desk review and electronic web-based search of PubMed, Google Scholar, EMBASE, PsycINFO and the World Health Organization’s Hinari portal (which includes the SCOPUS, African Index Medicus, and African Journals Online databases) conducted from December 2, 2017 to February 30, 2018, identified peer-reviewed, original research articles and doctoral dissertations using pre-defined quality and inclusion criteria. Relevant data were extracted and descriptive summaries of the studies presented in tabular form. The I2 statistic was used to assess heterogeneity across studies. Funnel plot asymmetry and Egger’s tests were used to check for publication bias and the methodological quality of the included studies were assessed using the scale developed by Hoy and colleagues. The pooled prevalence of comorbidity at a 95% confidence interval (CI) was determined by applying a trim and fill analysis in a random-effects model. Results Our search identified 167 studies, of which 14 original research articles and two doctoral dissertations reporting on case-control and cross-sectional studies were eligible for inclusion in the final analysis. The pooled estimate of prevalence of depression among patients with epilepsy was 32.71% (95% CI: 25.50–39.91%). Regional sub-group analysis found that the pooled prevalence in East Africa was 34.52% (95% CI: 23.53–45.51%) and 29.69% (95% CI: 22.7–36.68%) in Southern and West Africa. The odds of depression among epileptic patients receiving polytherapy were 2.65 higher than in those receiving monotherapy (95% CI: 1.49–4.71, I2 = 79.1%, p < 0.05). Conclusion Our findings indicate high comorbidity in sub-Saharan Africa and suggest that it may be more prevalent there than elsewhere. Comorbidity is statistically associated with polytherapy in the studies reviewed. Given the high levels of comorbidity in the region, more attention should be paid to incorporating depression screening and treatment into existing epilepsy programs and to revising treatment guidelines on comorbid depression to reduce polytherapy.
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Affiliation(s)
- Getenet Dessie
- Department of Nursing, school of health science, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
- * E-mail:
| | - Henok Mulugeta
- Department of Nursing, school of health science, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Cheru Tesema Leshargie
- Department of Environmental Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Fasil Wagnew
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Sahai Burrowes
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, United States of America
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Van Steenkiste F, Fidèle S, Nsanzabaganwa W, Uwacu B, Dedeken P, Teuwen DE, Boon P. An ambispective cohort study on treatment outcomes of patients with epilepsy in a tertiary epilepsy center in Rwanda and recommendations for improved epilepsy care. Epilepsia Open 2019; 4:123-132. [PMID: 30868122 PMCID: PMC6398151 DOI: 10.1002/epi4.12304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/17/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Because outcome data inform and drive healthcare decisions and improvement of patient care, this study aimed to gain a deep understanding of sociodemographic profiles and treatment outcomes of newly presenting and recently diagnosed persons living with epilepsy (PwE) at a tertiary epilepsy center in Rwanda. METHODS In June 2016 (T1), as a first stage of this single-center cohort study, an ambispective chart review was conducted on baseline sociodemographic and disease characteristics of PwE using a structured questionnaire. Missing data were obtained by phone interview. In 2017, follow-up data were collected by phone interview on treatment outcomes after 15-months (T2). RESULTS Of 406 PwE screened, 235 were included at T1 and outcomes on 166 PwE were obtained at T2. More than 70% were <20 years of age, with a male preponderance. A high number of patients were aged ≥20 years, were single (67.4%), unemployed (41.5%), and had no formal education or primary level education (53.9%), possibly reflecting stigma. A mean delay in diagnosis since first seizure increased with age at first seizure, amounting to 3 years for patients aged ≥20 years. At T2, 69.6% of 166 patients who could be contacted reported no seizures in the previous month. Valproate monotherapy was the most frequently prescribed treatment. At T2, 47% had discontinued treatment, which was often not recommended by a physician, despite medical insurance coverage in >90% of patients. Only 19% reported an adverse event. Marked and partial improvement in quality of life (QoL) was reported by, respectively, 50.9% and 32.7% of patients. SIGNIFICANCE Encouraging results on improved seizure control and QoL were observed at follow-up. The treatment gap remains high due to loss to follow-up and treatment discontinuation. In this article, we discuss needs and recommendations for improving patient care, requiring concerted efforts of stakeholders at all levels of the healthcare system.
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Affiliation(s)
| | | | | | - Beni Uwacu
- CARAES Neuro‐Psychiatric HospitalKigaliRwanda
| | | | | | - Paul Boon
- Reference Center for Refractory EpilepsyGhent University HospitalGhentBelgium
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Romo ML, Nash D. Onchocerciasis and epilepsy: a causal relationship? THE LANCET. INFECTIOUS DISEASES 2018; 18:1172-1174. [PMID: 30268644 DOI: 10.1016/s1473-3099(18)30488-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Matthew L Romo
- CUNY Institute for Implementation Science in Population Health & Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY 10027, USA.
| | - Denis Nash
- CUNY Institute for Implementation Science in Population Health & Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY 10027, USA
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Bajaj J, Tripathi M, Dwivedi R, Sapra S, Gulati S, Garg A, Tripathi M, Bal CS, Chandra SP. Does surgery help in reducing stigma associated with drug refractory epilepsy in children? Epilepsy Behav 2018; 80:197-201. [PMID: 29414552 DOI: 10.1016/j.yebeh.2018.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/07/2018] [Accepted: 01/08/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Epilepsy has several comorbidities and associated stigma. Stigma associated with epilepsy is well known and prevalent worldwide. Surgical treatment is an established treatment for drug refractory epilepsy. Following surgery in children, it is possible that the stigma may reduce, but such an effect has not been studied earlier. MATERIALS AND METHODS Analysis of prospectively collected data was performed for pediatric patients at a single tertiary center for treating epilepsy. Child stigma scale, as described by Austin et al., was used to evaluate stigma both pre- and postoperatively. Analysis was done using Paired t test. RESULTS In this study, following surgery, there was significant reduction of stigma (P<0.001). This was proportional to the reduction in seizures, though there were 9 (30%) patients, who due to persistent neurodisability did not have any reduction of stigma despite having good seizure outcome. CONCLUSION Surgery in drug-resistant epilepsy helps in reducing stigma. Seizure reduction is probably not the only factor responsible for a change in stigma outcome.
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Affiliation(s)
- Jitin Bajaj
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rekha Dwivedi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Savita Sapra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sheffali Gulati
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Madhavi Tripathi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chandra S Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sarat P Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
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Espinosa-Jovel C, Toledano R, Aledo-Serrano Á, García-Morales I, Gil-Nagel A. Epidemiological profile of epilepsy in low income populations. Seizure 2018; 56:67-72. [PMID: 29453113 DOI: 10.1016/j.seizure.2018.02.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 12/26/2017] [Accepted: 02/06/2018] [Indexed: 11/28/2022] Open
Abstract
Epilepsy is a global disease with an unequal distribution. About 80% of the affected individuals reside in low and middle income countries. The incidence and prevalence of epilepsy in low income populations is higher than in the rest of the world, this is partly explained by some risk factors such as head trauma, perinatal injury and CNS infections, which are more common in poor regions, especially in rural areas. Epilepsy is considered a treatable condition with high rates of therapeutic response. About three fourths of patients achieve control of the disease with the use of antiepileptic drugs, however, despite this benign prognosis, over 75% of patients from low income populations do not receive treatment at all. The cultural beliefs, the inequity in the distribution of public health services, the inadequate supply of antiepileptic drugs, the low number of neurologists involved in the attention of epilepsy, and the social stigma, are the main reasons that increase the treatment gap and the burden of disease in low income populations with epilepsy. We conducted a narrative review regarding the epidemiology of epilepsy in low income populations by searching PubMed, EMBASE, Google Scholar and thoroughly examining relevant bibliographies. This review aims to summarize the main epidemiological aspects of epilepsy in LMIC, emphasizing on incidence, prevalence, socio-demographic profile, TG, social stigma and QoL.
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Affiliation(s)
- Camilo Espinosa-Jovel
- Hospital Occidente de Kennedy, Servicio de Neurología, Bogotá, Colombia; Hospital Ruber Internacional, Servicio de Neurología, Programa de Epilepsia, Madrid, Spain.
| | - Rafael Toledano
- Hospital Ruber Internacional, Servicio de Neurología, Programa de Epilepsia, Madrid, Spain; Hospital Universitario Ramón y Cajal, Servicio de Neurología, Madrid, Spain
| | - Ángel Aledo-Serrano
- Hospital Ruber Internacional, Servicio de Neurología, Programa de Epilepsia, Madrid, Spain
| | - Irene García-Morales
- Hospital Ruber Internacional, Servicio de Neurología, Programa de Epilepsia, Madrid, Spain; Hospital Universitario Clínico San Carlos, Servicio de Neurología, Madrid, Spain
| | - Antonio Gil-Nagel
- Hospital Ruber Internacional, Servicio de Neurología, Programa de Epilepsia, Madrid, Spain
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Patterson V, Samant S, Singh MB, Jain P, Agavane V, Jain Y. Diagnosis of epileptic seizures by community health workers using a mobile app: A comparison with physicians and a neurologist. Seizure 2017; 55:4-8. [PMID: 29291457 DOI: 10.1016/j.seizure.2017.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 12/17/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The World Health Organisation (WHO) strategy for non-physician health workers (NPHWs) to diagnose and manage people with untreated epilepsy depends on them having access to suitable tools. We have devised and validated an app on a tablet computer to diagnose epileptic episodes and now examine how its use by NPHWs compares with diagnosis by local physicians and a neurologist. METHODS Fifteen NPHWs at Jan Swasthya Sahyog (JSS) a hospital with community outreach in Chhattisgarh, India were trained in the use of an epilepsy diagnosis app on a tablet computer. They were asked to determine the app scores on patients in their communities with possible epilepsy and then refer them first to their local JSS doctors and then to a visiting neurologist. With the neurologist's opinion as the "gold standard", the misdiagnosis rate from the NPHWs was compared with that of the local physicians. RESULTS There were 96 patients evaluated completely. The NPHWs misdiagnosed eight and the physicians seven. There were more uncertain diagnoses by the NPHWs. In the 22 patients who presented for the first time during the study, the NPHWs misdiagnosed three and the physicians five. CONCLUSIONS NPHWs using an app achieved similar misdiagnosis rates to local physicians. Both these rates were well within the range of misdiagnosis in the published literature. These results suggest that task-shifting epilepsy diagnosis and management from physicians to NPHWs, who are enabled with appropriate technology, can be an effective and safe way of reducing the epilepsy treatment gap.
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Affiliation(s)
- Victor Patterson
- Jan Swasthya Sahyog, Bilaspur, Chhattisgarh, India; Department of Clinical and Experimental Epilepsy, University College, London, UK.
| | | | - Mamta Bhushan Singh
- Jan Swasthya Sahyog, Bilaspur, Chhattisgarh, India; Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Jain
- Jan Swasthya Sahyog, Bilaspur, Chhattisgarh, India
| | | | - Yogesh Jain
- Jan Swasthya Sahyog, Bilaspur, Chhattisgarh, India
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Abstract
The characteristics of neurological, psychiatric, developmental and substance-use disorders in low- and middle-income countries are unique and the burden that they have will be different from country to country. Many of the differences are explained by the wide variation in population demographics and size, poverty, conflict, culture, land area and quality, and genetics. Neurological, psychiatric, developmental and substance-use disorders that result from, or are worsened by, a lack of adequate nutrition and infectious disease still afflict much of sub-Saharan Africa, although disorders related to increasing longevity, such as stroke, are on the rise. In the Middle East and North Africa, major depressive disorders and post-traumatic stress disorder are a primary concern because of the conflict-ridden environment. Consanguinity is a serious concern that leads to the high prevalence of recessive disorders in the Middle East and North Africa and possibly other regions. The burden of these disorders in Latin American and Asian countries largely surrounds stroke and vascular disease, dementia and lifestyle factors that are influenced by genetics. Although much knowledge has been gained over the past 10 years, the epidemiology of the conditions in low- and middle-income countries still needs more research. Prevention and treatments could be better informed with more longitudinal studies of risk factors. Challenges and opportunities for ameliorating nervous-system disorders can benefit from both local and regional research collaborations. The lack of resources and infrastructure for health-care and related research, both in terms of personnel and equipment, along with the stigma associated with the physical or behavioural manifestations of some disorders have hampered progress in understanding the disease burden and improving brain health. Individual countries, and regions within countries, have specific needs in terms of research priorities.
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