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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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Ashraf Mahmoud M, El Rashidi O, Halim G, Amgad Elkholy M, Aglan O, Rahman El Sabbagh A, Kamel Basha A, Hamdi H, El Sayed AM, Amin Saleh D, Shatla R, Abdel Ghany W. The dual effect of vagus nerve stimulation in pediatric patients with drug-resistant epilepsy: Is there more than seizure control? Epilepsy Behav Rep 2024; 27:100653. [PMID: 38841319 PMCID: PMC11150965 DOI: 10.1016/j.ebr.2024.100653] [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: 12/23/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 06/07/2024] Open
Abstract
This is a retrospective and comparative pilot study to investigate the role of vagus nerve stimulation (VNS) in improving cognitive functions in the pediatric age group with drug resistant epilepsy (DRE). It was conducted from January 2018 to February 2023. Children between the ages of 4 and 18 years were divided into two groups, the "VNS group" and the "best medical treatment (BMT) group". Follow up period was 12 months. Demographic, clinical, etiological and investigational data were recorded. Cognitive assessment using the Modified Mini-Mental State Examination for children (MMSE) was recorded at baseline and 12 months later for each group. 76.4 % of patients were classified as epilepsy secondary to cerebral palsy. 75 % of patients showed ≥ 50 % seizure frequency reduction among the VNS group as compared to 12.5 % in the BMT group. None of both groups achieved seizure freedom. At 12 months, both BMT and VNS groups showed statistically significantly improved overall cognitive score from baseline records (p = 0.027) and (p = 0.012), respectively, with a significantly higher improvement in VNS group. Also, statistical sub-analysis of cognitive subscales in cerebral palsy patients in both groups was conducted and revealed a significant improvement (p = 0.02) in the VNS group. We concluded that there is a potential role of VNS in improving cognitive functions which was shown by using a cost-effective screening tool. A significant effect was observed specially in cerebral palsy patients. This is very beneficial in limited-resources countries since VNS has good safety profile, high seizure control, and added value to cognitive functions.
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Affiliation(s)
| | | | - George Halim
- Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | | | - Osama Aglan
- Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | | | | | - Hussein Hamdi
- Neurosurgery Department, Tanta University, Tanta, Egypt
| | | | - Dina Amin Saleh
- Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | - R.H. Shatla
- Department of Pediatrics, Ain Shams University, Cairo, Egypt
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Todaro V, Giuliano L, Cicero CE, Spina L, Colli C, Cuellar S, Cosmi F, Vilte E, Bartoloni A, Crespo Gómez EB, Nicoletti A. Prevalence of epilepsy in the rural area of the Bolivian Gran Chaco: Usefulness of telemedicine and impact of awareness campaigns. Epilepsia Open 2023; 8:125-133. [PMID: 36461651 PMCID: PMC9977747 DOI: 10.1002/epi4.12677] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE The objective of this study is to estimate the prevalence of epilepsy with Tonic-Clonic (TC) seizures in rural areas of the Bolivian Gran Chaco and to evaluate the usefulness of telemedicine in this context. METHODS The study was carried out in the Isozo Area, southern-eastern Bolivia. Twenty-five rural communities with a population of 8258 inhabitants were included in the survey. Trained community-health workers administered a validated single screening question to the householders (stage I). A second face-to-face questionnaire was administered to each positive subject (stage II). At stage II subjects were also screened using the smartphone app "Epilepsy Diagnosis Aid". Subjects screened positive at stage II underwent a complete neurological examination to confirm the diagnosis (stage III). Due to the COVID-19 lockdown, some subjects have been evaluated through a digital platform (Zoom®). RESULTS One-thousand two-hundred and thirteen interviews were performed at stage I, corresponding to a total screened population of 6692 inhabitants. Thirty-eight screened positive were identified at stage I and II and of these, 28 people with epilepsy were identified, giving an overall prevalence of 4.2/1000 (95% CI 2.6-5.7). Prevalence rate steeply increased with age reaching a peak of 7.9/1000 in the population aged 20-29 years without significant differences between women and men. For almost 50% of the screened positive subjects, confirmation of epilepsy by a neurologist at stage III was achieved through simple videoconsultation. After a simultaneous awareness campaign, 22 self-reported PWE requested a consultation and, among them, 11 had a diagnosis of epilepsy confirmed. SIGNIFICANCE This study shows a prevalence estimate close to those reported for LMIC. Simple videoconsultation and specific apps may be valuable tools in epidemiological research. Awareness campaigns are important allies for a full case identification, particularly in contexts where higher rates of stigma are recorded.
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Affiliation(s)
- Valeria Todaro
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Loretta Giuliano
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Calogero Edoardo Cicero
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Ludovica Spina
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Chiara Colli
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Senovia Cuellar
- Center of Anthropological Research of the Teko Guaraní, Gutierrez, Bolivia
| | - Francesco Cosmi
- Center of Anthropological Research of the Teko Guaraní, Gutierrez, Bolivia
| | - Estela Vilte
- Center of Anthropological Research of the Teko Guaraní, Gutierrez, Bolivia
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, Infectious and Tropical Diseases Unit, University of Florence, Florence, Italy
| | | | - Alessandra Nicoletti
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
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Langat NK, Kariuki SM, Kamuyu G, Kakooza-Mwesige A, Owusu-Agyei S, Ae-Ngibise K, Wang'ombe A, Ngugi AK, Masaja H, Wagner RG, Newton CR. Exposure to parasitic infections determines features and phenotypes of active convulsive epilepsy in Africa. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17049.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Epilepsy affects 70 million people worldwide, 80% of whom are in low-and-middle income countries (LMICs). Parasitic infections contribute considerably to the burden of epilepsy in LMICs, but the nature and presentation of epilepsy following these infections is not fully understood. We examined if epilepsy outcomes are associated with the exposure to parasitic infections. Methods: This was a case-comparison study nested in a cross-sectional survey of people with active convulsive epilepsy, with cases as those exposed to parasitic infections, and comparison as those unexposed. Associations of exposure to parasites with clinical and electroencephalographic features of epilepsy were done using a modified mixed effects Poisson regression model across five sites in Africa. Multiplicative and additive scale (RERI) interactions were explored to determine the effect of co-infections on epilepsy features. Population attributable fractions (PAF) were calculated to determine the proportion of severe clinical and electroencephalographic features of epilepsy attributable to parasitic infections. Results: A total of 997 participants with active convulsive epilepsy from the five African sites were analyzed, 51% of whom were males. Exposure to parasitic infections was associated with more frequent seizures in adult epilepsy (relative risk (RR)=2.58, 95% confidence interval (95%CI):1.71-3.89). In children, exposure to any parasite was associated with convulsive status epilepticus (RR=4.68, (95%CI: 3.79-5.78), intellectual disabilities (RR=2.13, 95%CI: 1.35-3.34) and neurological deficits (RR=1.92, 95%CI: 1.42-2.61). Toxoplasma gondii and Onchocerca volvulus interacted synergistically to increase the risk of status epilepticus (RERI=0.91, 95%CI=0.48-1.35) in the data pooled across the sites. Exposure to parasitic infections contributed to 30% of severe features of epilepsy as shown by PAF. Conclusions: Parasitic infections may determine features and phenotypes of epilepsy through synergistic or antagonistic interactions, which can be different in children and adults. Interventions to control or manage infections may reduce complications and improve prognosis in people with epilepsy.
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Vergonjeanne M, Auditeau E, Thébaut C, Boumediene F, Preux PM. Instruments for investigation of epilepsy in low- and middle-income countries: a systematic review. Epilepsy Res 2022; 180:106865. [DOI: 10.1016/j.eplepsyres.2022.106865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/13/2021] [Accepted: 01/17/2022] [Indexed: 01/07/2023]
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Langat NK, Kariuki SM, Kamuyu G, Kakooza-Mwesige A, Owusu-Agyei S, Ae-Ngibise K, Wang'ombe A, Ngugi AK, Masaja H, Wagner RG, Newton CR. Exposure to parasitic infections determines features and phenotypes of active convulsive epilepsy in Africa. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.17049.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Epilepsy affects 70 million people worldwide, 80% of whom are in low-and-middle income countries (LMICs). Infections of the central nervous system (CNS) contribute considerably to the burden of epilepsy in LMICs, but the nature and presentation of epilepsy following these infections is not fully understood. We examined if epilepsy foutcomes are associated with the exposure to parasitic infections. Methods: This was a case-comparison study nested in a cross-sectional survey of people with active convulsive epilepsy, with cases as those exposed to parasitic infections, and comparison as those unexposed. Associations of exposure to parasites with clinical and electroencephalographic features of epilepsy were done using a modified mixed effects Poisson regression model across five sites in Africa. Multiplicative and additive scale (RERI) interactions were explored to determine the effect of co-infections on epilepsy features. Population attributable fractions (PAF) were calculated to determine the proportion of severe clinical and electroencephalographic features of epilepsy attributable to CNS infections. Results: A total of 997 participants with active convulsive epilepsy from the five African sites were analyzed, 51% of whom were males. Exposure to parasitic infections was associated with more frequent seizures in adult epilepsy (relative risk (RR)=2.58, 95% confidence interval (95%CI):1.71-3.89). In children, exposure to any parasite was associated with convulsive status epilepticus (RR=4.68, (95%CI: 3.79-5.78), intellectual disabilities (RR=2.13, 95%CI: 1.35-3.34) and neurological deficits (RR=1.92, 95%CI: 1.42-2.61). Toxoplasma gondii and Onchocerca volvulus interacted synergistically to increase the risk of status epilepticus (RERI=0.91, 95%CI=0.48-1.35) in the data pooled across the sites. Exposure to parasitic infections contributed to 30% of severe features of epilepsy as shown by PAF. Conclusions: Parasitic infections may determine features and phenotypes of epilepsy through synergistic or antagonistic interactions, which can be different in children and adults. Interventions to control or manage infections may reduce complications and improve prognosis in epilepsy.
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Angwafor SA, Bell GS, Ngarka L, Otte W, Tabah EN, Nfor LN, Njamnshi TN, Njamnshi AK, Sander JW. Incidence and prevalence of epilepsy and associated factors in a health district in North-West Cameroon: A population survey. Epilepsy Behav 2021; 121:108048. [PMID: 34083120 DOI: 10.1016/j.yebeh.2021.108048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/28/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
This population-based cross-sectional survey with a follow-up case-control study assessed the prevalence, incidence, and risk factors for epilepsy in a rural health district in the North-West Region of Cameroon. Community-based epilepsy screening targeted all inhabitants, six years and older, in all 16 health areas in the Batibo Health District. During door-to-door visits, trained fieldworkers used a validated questionnaire to interview consenting household heads to screen for epilepsy in eligible residents. Trained physicians subsequently assessed people with suspected seizures. After clinical assessment, they confirmed or refuted the diagnosis and estimated the date of epilepsy onset. A trained nurse interviewed people with epilepsy and randomly selected healthy individuals, obtaining relevant demographic details and information on exposure to risk factors for epilepsy. Out of 36,282 residents screened, 524 had active epilepsy. The age-standardized prevalence of active epilepsy was 33.9/1,000 (95% CI: 31.0-37.1/1,000). We estimated the one-year age-standardized epilepsy incidence at 171/100,000 (95%CI: 114.0-254.6). Active epilepsy prevalence varied widely between health areas, ranging between 12 and 75 per 1,000. The peak age-specific prevalence was in the 25-34 age group. In adults, multivariate analysis showed that having a relative with epilepsy was positively associated with epilepsy. Epilepsy characteristics in this population, geographical heterogeneity, and the age-specific prevalence pattern suggest that endemic neurocysticercosis and onchocerciasis may be implicated. Further investigations are warranted to establish the full range of risk factors for epilepsy in this population.
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Affiliation(s)
- Samuel A Angwafor
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG and Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks SL9 0RJ, United Kingdom; Faculty of Health Sciences, University of Bamenda, Cameroon
| | - Gail S Bell
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG and Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks SL9 0RJ, United Kingdom
| | - Leonard Ngarka
- Neurology Department, Central Hospital Yaoundé/Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé I, Yaoundé, Cameroon; Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon/Geneva, Switzerland
| | - Willem Otte
- Department of Pediatric Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Earnest N Tabah
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University Of Dschang, Cameroon & Department of Disease Control, Ministry of Public Health, Yaounde, Cameroon
| | - Leonard N Nfor
- Neurology Department, Central Hospital Yaoundé/Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé I, Yaoundé, Cameroon; Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon/Geneva, Switzerland
| | - Theophilus N Njamnshi
- Department of Medical Laboratory Science, School of Health and Medical Science, Kumbo, Catholic University of Cameroon, Bamenda, Cameroon
| | - Alfred K Njamnshi
- Neurology Department, Central Hospital Yaoundé/Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé I, Yaoundé, Cameroon; Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon/Geneva, Switzerland.
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG and Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks SL9 0RJ, United Kingdom; Stichting Epilepsie Instelligen Nederland (SEIN), Heemstede, Netherlands
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Vergonjeanne M, Auditeau E, Erazo D, Luna J, Gelle T, Gbessemehlan A, Boumediene F, Preux PM. Epidemiology of Epilepsy in Low- and Middle-Income Countries: Experience of a Standardized Questionnaire over the Past Two Decades. Neuroepidemiology 2021; 55:369-380. [PMID: 34315167 DOI: 10.1159/000517065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/04/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Epilepsy affects >50 million people worldwide, with 80% of them living in low- and middle-income countries (LMICs). Studies with a standardized methodology are required to obtain comparable data on epilepsy and implement health policies in order to reduce the treatment gap and improve the diagnosis and management of epilepsy. In 2000, following the guidelines of the International League Against Epilepsy (ILAE), the "questionnaire for investigation of epilepsy in tropical countries" (IENT questionnaire) was developed to promote epidemiological surveys on epilepsy using a standard methodology. This study aims to describe how, when, where, and why the IENT questionnaire has been used through epidemiological studies on epilepsy over the last 2 decades and to acquire users' opinions about the tool. METHODS Studies that used the IENT questionnaire were searched through international and local bibliographic databases, including the gray literature. An online survey was carried out, including a snowball effect. Original research studies were included. Characteristics of the studies and populations and general information on the instrument and its use were collected. RESULTS Eighty-two documents were selected referring to 61 studies that were mostly carried out on the African continent (n = 54). Most of them aimed to determine the prevalence (n = 31) and associated factors (n = 28) of epilepsy in LMICs. Among the 61 studies, 35 were population-based, and 30 included both adults and children. A methodological heterogeneity was found between studies, and in cases where the IENT questionnaire alone did not ensure complete data collection, other tools were used concomitantly (n = 40). DISCUSSION/CONCLUSION Over the last 2 decades, the IENT questionnaire has been continuously used in different LMICs. This result favors its promotion and updating, with the inclusion of new topics related to epilepsy (e.g., comorbidities, quality of life, and stigma), current ILAE guidelines, and digital versions.
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Affiliation(s)
- Marion Vergonjeanne
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France,
| | - Emilie Auditeau
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Daniells Erazo
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Jaime Luna
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Thibaut Gelle
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Antoine Gbessemehlan
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Farid Boumediene
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Pierre-Marie Preux
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
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Prevalence and mortality of epilepsies with convulsive and non-convulsive seizures in Kilifi, Kenya. Seizure 2021; 89:51-55. [PMID: 34000517 PMCID: PMC7611274 DOI: 10.1016/j.seizure.2021.04.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives The prevalence of all epilepsies (both convulsive and non-convulsive seizures) in Low- and Middle-Income Countries (LMIC), particularly sub-Saharan Africa is unknown. Under estimation of non-convulsive epilepsies in data from these countries may lead to inadequate and sub-optimal allocation of resources to control and prevent epilepsy. We determined the prevalence of all types of epilepsies and compared the mortality between convulsive seizures and non-convulsive seizures in a resource limited rural area in Kenya. Methods Trained clinicians identified cases of epilepsy in a randomly selected sample of 4,441 residents in the Kilifi Health and Demographic Surveillance System site using a cross-sectional survey design. Seizure types were classified by epileptologists using the current guidelines of the International League Against Epilepsy (ILAE). We estimated prevalence for epilepsy with convulsive seizures and non-convulsive seizures and for epilepsy with non-convulsive seizures only and compared premature mortality between these groups of seizures. Results Of the 4441 people visited, 141 had lifetime epilepsy and 96 active epilepsy, which is a crude prevalence of 31.7/1,000 persons (95% CI: 26.6-36.9) and 21.6/1,000 (95% CI: 17.3-25.9), respectively. Both convulsive and non-convulsive seizures occurred in 7% people with epilepsy (PWE), only convulsive seizures in 52% and only non-convulsive seizures in 35% PWE; there was insufficient information to classify epilepsy in the remainder 6%. The age- and sex-adjusted prevalence of lifetime people was 23.5/1,000 (95% CI: 11.0-36.0), with the adjusted prevalence of epilepsy with non-convulsive seizures only estimated at 8.2/1,000 (95%CI:3.9-12.6). The mortality rate in PWE was 6.3/1,000 (95%CI: 3.4-11.8), compared to 2.8/1,000 (2.3-3.3) in those without epilepsy; hazard ratio (HR) =2.31 (1.22-4.39; p=0.011). The annual mortality rate was 11.2/1,000 (95%CI: 5.3-23.4) in PWE with convulsive and non-convulsive seizures and none died in PWE with non-convulsive seizures alone. Conclusions Our study shows that epilepsy with non-convulsive seizures is common and adds to the prevalence of previously reported estimates of active convulsive epilepsy. Both epilepsy with convulsive seizures and that with non-convulsive seizures should be identified for optimising treatment and for planning resource allocation.
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Torres AR, Camayd-Muñoz C, Alvarado MC, Perez B, Pou J, Hereen T, Jonas R, Douglass LM. A Novel Parent Questionnaire for the Detection of Seizures in Children of Spanish-Speaking Families. J Child Neurol 2021; 36:461-467. [PMID: 33336600 DOI: 10.1177/0883073820978001] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND We developed and validated a Spanish seizure screen for children based on a previously validated English seizure screen that could be administered by a trained research assistant in a 2-step process, approximating the clinical diagnostic process of a pediatric epilepsy specialist. This questionnaire was designed to study seizure prevalence in a research population of children at risk for epilepsy. METHODS Spanish-speaking parents of children 6 months to 17 years old were recruited from the pediatric neurology clinics at Boston Medical Center and interviewed using a computerized questionnaire. A computerized algorithm of parent responses rendered a seizure classification of positive or negative. Blinded to questionnaire results, pediatric neurologists served as the diagnostic gold standard, ranking each patient event using a 4-level scale based on clinical history and examination: (1) not likely, (2) indeterminate, (3) probable, and (4) almost certain where rankings of 3 or 4 lead to a diagnosis of seizure. RESULTS The questionnaire was completed by 163 enrolled parents. The seizure screen demonstrated a 94.2% sensitivity and 93.7% specificity for identifying seizures. The positive predictive value was 87.5%, and the negative predictive value was 97.2%. CONCLUSIONS This pediatric seizure questionnaire was both sensitive and specific for detecting clinically confirmed seizures. This tool may be useful to clinicians and researchers in screening large populations of children, decreasing the time and cost of added neurologic assessments.
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Affiliation(s)
- Alcy R Torres
- 12259Boston University School of Medicine, Boston, MA, USA
| | | | | | - Brandon Perez
- 12259Boston University School of Medicine, Boston, MA, USA
| | - Jonathan Pou
- 12259Boston University School of Medicine, Boston, MA, USA
| | - Timothy Hereen
- 12259Boston University School of Medicine, Boston, MA, USA
| | - Rinat Jonas
- 12259Boston University School of Medicine, Boston, MA, USA
| | - Laurie M Douglass
- 1836Boston Medical Center, One Boston Medical Center Pl, Boston, MA, USA
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Usefulness of a smartphone application for the diagnosis of epilepsy: Validation study in high-income and rural low-income countries. Epilepsy Behav 2021; 115:107680. [PMID: 33348193 DOI: 10.1016/j.yebeh.2020.107680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/28/2020] [Accepted: 11/28/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION In low- and middle-income countries (LMIC), the diagnosis of epilepsy should be made by Non-Physician Health Workers (NPHW) who are widely available in these settings. Recently a smartphone app (Epilepsy Diagnosis Aid) has been developed and validated to be used by NPHW, in order to confirm the diagnosis of epilepsy. The aim of our study was to perform a validation of the app in two different contexts: a hospital-based setting of a high-income country (HIC) and a population-based setting of the rural communities of a LMIC. MATERIAL AND METHODS For the hospital-based setting, the app was administered to a sample of patients with epilepsy (PWE) and to a sample of subjects affected by syncope attending the epilepsy center of the University of Catania. For the population-based setting, performed in the rural communities of the Gran Chaco region in Bolivia,the app was administered by NPHW to a sample of PWE previously identified. Sensitivity and specificity were calculated for the diagnosis of epilepsy. RESULTS In the hospital-setting, the app was administered to 100 PWE and 20 syncopes. A probability score > 80 showed a sensitivity of 76% (95%CI 66.4-84) and a specificity of 100% (95%CI 83.2-100) for the diagnosis of epilepsy; higher values were found for active epilepsy with tonic-clonic seizures. In the rural-setting, the app was administered to 38 PWE, giving a sensitivity of 92.1% (95%CI 78.6-98.3). CONCLUSION The app for epilepsy could represent a valuable instrument, which can be easily employed by trained NPHW to diagnose epilepsy in primary health-care settings of LMIC.
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Watila MM, Balarabe SA, Komolafe M, Igwe SC, Bimbo Fawale M, van Diessen E, Nyandaiti YW, Singh G, Winkler AS, Sander JW. Translation and validation of an epilepsy-screening questionnaire in three Nigerian languages. Epilepsy Behav 2021; 114:107604. [PMID: 33268016 DOI: 10.1016/j.yebeh.2020.107604] [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: 09/01/2020] [Revised: 10/22/2020] [Accepted: 10/24/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVE We describe the development, translation and validation of epilepsy-screening questionnaires in the three most popular Nigerian languages: Hausa, Igbo and Yoruba. METHODS A 9-item epilepsy-screening questionnaire was developed by modifying previously validated English language questionnaires. Separate multilingual experts forward- and back-translated them to the three target languages. Translations were discussed with fieldworkers and community members for ethnolinguistic acceptability and comprehension. We used an unmatched affected-case versus unaffected-control design for the pilot study. Cases were people with epilepsy attending the tertiary hospitals where these languages are spoken. The controls were relatives of cases or people attending for other medical conditions. An affirmative response to any of the nine questions amounted to a positive screen for epilepsy. RESULTS We recruited 153 (75 cases and 78 controls) people for the Hausa version, 106 (45 cases and 61 controls) for Igbo and 153 (66 cases and 87 controls) for the Yoruba. The sensitivity and specificity of the questionnaire were: Hausa (97.3% and 88.5%), Igbo (91.1% and 88.5%) and Yoruba (93.9% and 86.7%). The three versions reliably indicated epilepsy with positive predictive values of 85.9% (Hausa), 85.4% (Igbo) and 87.3% (Yoruba) and reliably excluded epilepsy with negative predictive values of 97.1% (Hausa), 93.1% (Igbo) and 95.1% (Yoruba). Positive likelihood ratios were all greater than one. CONCLUSIONS Validated epilepsy screening questionnaires are now available for the three languages to be used for community-based epilepsy survey in Nigeria. The translation and validation process are discussed to facilitate usage and development for other languages in sub-Saharan Africa.
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Affiliation(s)
- Musa M Watila
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom; Neurology Unit, Department of Medicine, University of Maiduguri Teaching Hospital. PMB 1414 Maiduguri, Borno State, Nigeria
| | - Salisu A Balarabe
- Neurology Unit, Department of Medicine, Usman Danfodiyo University Teaching Hospital, Sokoto, Sokoto State Nigeria
| | - Morenikeji Komolafe
- Department of Medicine, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria
| | - Stanley C Igwe
- Department of Psychiatry, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Michael Bimbo Fawale
- Department of Medicine, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria
| | - Eric van Diessen
- Department of Pediatric Neurology, Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Yakub W Nyandaiti
- Neurology Unit, Department of Medicine, University of Maiduguri Teaching Hospital. PMB 1414 Maiduguri, Borno State, Nigeria
| | - Gagandeep Singh
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom; Department of Neurology, Dayanand Medical College, Ludhiana, India; The Research & Development Unit, Dayanand Medical College, Ludhiana, India
| | - Andrea S Winkler
- Centre for Global Health, Institute of Health and Society, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; Center for Global Health, Department of Neurology, Technical University Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103 SW Heemstede, the Netherlands.
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Wagner RG, Kabudula CW, Forsgren L, Ibinda F, Lindholm L, Kahn K, Tollman S, Newton CR. Epilepsy care cascade, treatment gap and its determinants in rural South Africa. Seizure 2020; 80:175-180. [PMID: 32593141 PMCID: PMC7443697 DOI: 10.1016/j.seizure.2020.06.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/14/2020] [Accepted: 06/06/2020] [Indexed: 12/20/2022] Open
Abstract
Most people with active convulsive epilepsy in rural South Africa are diagnosed. Most individuals diagnosed have some blood level of anti-seizure medication. Most individuals do not have optimal levels of medication. The epilepsy treatment gap is high in rural South Africa, especially in children. Identifying the epilepsy care cascade may better allow for targeting of interventions.
Purpose The percentage of people who are diagnosed with epilepsy (diagnostic gap), access, receive and adhere (treatment gap) to anti-seizure medication (ASM) in low- and middle- income countries remains low. We explored the epilepsy care cascade, measured the diagnostic and treatment gaps, and examined socio-demographic factors associated with adherence to ASMs in rural South Africa. Methods Utilizing a population-based cohort of 311 people with active convulsive epilepsy (ACE) residing in rural northeastern South Africa, a questionnaire was administered to examine associations between demographic and socioeconomic factors and the epilepsy treatment gap. Blood was taken to measure levels of ASMs. Results Of the 311 individuals diagnosed, 93 % of individuals reported being previously told they had epilepsy and 94 % reported previously attending a health facility for their epilepsy. ASMs were detected in 138 individuals (76 %) and optimal levels were detected in 67 individuals, resulting in a treatment gap of 63 % (95 % confidence interval [95 %CI]: 56 %–70 %). Self-reported specificity of ASM use was 23 % (95 %CI: 12–39 %) and individuals ≥18 years were significantly more likely to report taking ASM than children and were significantly (p = 0.011) more likely to be adherent. Conclusion Most people with epilepsy in rural South Africa had been previously diagnosed with epilepsy and had accessed care for epilepsy, yet the level of ASM adherence remained low, significantly lower amongst children. Understanding ways of improving knowledge of and adherence to ASM in rural South Africa is necessary, especially amongst children. The epilepsy care cascade can be useful in identifying gaps in care and targeting interventions to reduce these gaps.
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Affiliation(s)
- Ryan G Wagner
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS) - INDEPTH Network, Accra, Ghana; MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden; Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden.
| | - Chodziwadziwa W Kabudula
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lars Forsgren
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Fredrick Ibinda
- KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research - Coast, Kilifi, Kenya
| | - Lars Lindholm
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Kathleen Kahn
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden; INDEPTH Network, Accra, Ghana
| | - Stephen Tollman
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden; INDEPTH Network, Accra, Ghana
| | - Charles R Newton
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS) - INDEPTH Network, Accra, Ghana; MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research - Coast, Kilifi, Kenya; Neurosciences Unit, UCL Institute of Child Health, London, United Kingdom; Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Kamgno J, Tchatchueng-Mbougua JB, Nana-Djeunga HC, Esso L, Zouré HG, Mackenzie CD, Boussinesq M. Community-based door to door census of suspected people living with epilepsy: empowering community drug distributors to improve the provision of care to rural communities in Cameroon. BMC Public Health 2020; 20:871. [PMID: 32503495 PMCID: PMC7275343 DOI: 10.1186/s12889-020-08997-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 05/27/2020] [Indexed: 11/12/2022] Open
Abstract
Background Epilepsy is a severe neurological disorder with huge psychological, social, and economic consequences, including premature deaths and loss of productivity. Sub-Saharan Africa carries the highest burden of epilepsy. The management of epilepsy in Cameroon remains unsatisfactory due to poor identification of cases and a limited knowledge of the distribution of the disease. The objective of this study was to determine whether community drug distributors (CDDs) - volunteers selected by their communities to distribute ivermectin against onchocerciasis and who have been proven efficient to deliver other health interventions such as insecticide-treated bed nets to prevent malaria, vitamin A tablets, and albendazole to treat soil transmitted helminthiasis - can be used to reliably identify people living with epilepsy to promote better management of cases. Methods This study was carried out in three health Districts in Cameroon. An exhaustive house to house census was carried out by trained CDDs under the supervision of local nurses. In each household, all suspected cases of epilepsy were identified. In each health district, five communities were randomly selected for a second census by trained health personnel (research team). The results of the two censuses were compared for verification purposes. Results A total of 53,005 people was registered in the 190 communities surveyed with 794 (1.4%) individuals identified as suspected cases of epilepsy (SCE) by the CDDs. In the 15 communities where the SCE census was verified, the average ratio between the number of suspected cases of epilepsy reported in a community by the research team and that reported by the CDDs was 1.1; this ratio was < 0.8 and > 1.2 in 6 communities. Conclusions The results of this study suggest that CDDs, who are present in about 200,000 communities in 31 Sub Saharan African countries where onchocerciasis is endemic, can be successfully used to assess epilepsy prevalence, and therefore map epilepsy in many African countries.
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Affiliation(s)
- Joseph Kamgno
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), P.O. Box 5797, Yaoundé, Cameroon. .,Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
| | - Jules B Tchatchueng-Mbougua
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), P.O. Box 5797, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Service d'épidémiologie, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroon
| | - Hugues C Nana-Djeunga
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), P.O. Box 5797, Yaoundé, Cameroon
| | - Lynda Esso
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), P.O. Box 5797, Yaoundé, Cameroon
| | - Honorat G Zouré
- Expanded Special Project for Elimination of NTDs (ESPEN), World Health Organization, African Regional Office, Brazzaville, Republic of Congo
| | - Charles D Mackenzie
- Filarial Programmes Support Unit (FPSU), Liverpool School of Tropical Medicine, Pembroke Place Liverpool, Liverpool, L3 5QA, UK
| | - Michel Boussinesq
- Institut de Recherche pour le Développement (IRD), UMI233/ INSERM U1175/ Université de Montpellier, 911 Avenue Agropolis, 34394, Montpellier Cedex 5, France
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Makurumidze R. Coronavirus-19 disease (COVID-19): A case series of early suspected cases reported and the implications towards the response to the pandemic in Zimbabwe. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2020; 53:493-498. [PMID: 32305269 PMCID: PMC7152921 DOI: 10.1016/j.jmii.2020.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/02/2020] [Accepted: 04/02/2020] [Indexed: 12/17/2022]
Abstract
Zimbabwe is among the countries that have been identified to be at risk of the COVID-19 pandemic. As of the 15th of March 2020, there was no confirmed case of the virus. Official reports of suspected cases were used to appraise the general screening, case management, and the emergency preparedness and response of the country towards the COVID-19 pandemic. In terms of the surveillance and capacity to screen at the ports of entry, the country seems to be faring well. The country might not be screening optimally, considering the number of COVID-19 tests conducted to date and the suspected cases who missed testing. Three of the suspected cases faced mental, social, and psychological consequences due to them being suspected cases of COVID-19. There is a need to enhance the screening process and infrastructure at all the ports of entry. More COVID-19 diagnostic tests should be procured to increase the testing capacity. Training and awareness on mental, social, and psychological consequences of COVID-19 should be offered to the health care workers and the general public. More financial resources should be sourced to enable the country control the pandemic.
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Affiliation(s)
- Richard Makurumidze
- Department of Community Medicine, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe; Institute of Tropical Medicine, Antwerp, Belgium; Faculty of Medicine & Pharmacy, Free University of Brussels (VUB), Brussels, Belgium.
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Magai DN, Newton CR, Mwangi P, Koot HM, Abubakar A. Patterns of neurobehavioral functioning in school-aged survivors of neonatal jaundice and hypoxic-ischemic encephalopathy in Kilifi, Kenya: A cross-sectional study. Wellcome Open Res 2020. [DOI: 10.12688/wellcomeopenres.15200.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Studies in high-income countries have reported that school-aged children who survive neonatal jaundice (NNJ) and hypoxic-ischemic encephalopathy (HIE) develop long-term neurocognitive problems. However, less is known about the patterns of functioning in school-aged survivors of NNJ and HIE in sub-Saharan Africa. This study examined patterns of functioning in school-aged children who survived NNJ and HIE in Kilifi, Kenya. Methods: This is a cross-sectional study that included 107 survivors of NNJ/HIE (64 with NNJ, 43 with HIE), aged 6-12 years, admitted to Kilifi County Hospital on the Kenyan Coast. The Gross Motor Function Classification System (GMFCS), Adapted Communication Profile, Raven’s Coloured Progressive Matrices (RCPM) and an epilepsy screening tool were used to assess gross motor function, communication function, intellectual functioning, and epilepsy, respectively. Results: Most of the survivors of NNJ (95.2%) and HIE (95.3%) had no impairments in gross motor functioning. A small percentage of the children in the NNJ and HIE groups had profound problems in their communication (4.7% and 4.7%); expressive communication function (4.7% and 4.7%); social functions (3.1% and 2.3%); receptive communication (4.7% and 2.3%); and communicative effectiveness (4.7% and 2.3%). Cognitive impairment was reported in 10.9% and 11.9% for NNJ and HIE survivors, respectively. Active epilepsy was detected in 1.6% of survivors of NNJ and 2.3% of survivors of HIE. All children had normal hearing and visual functioning except one participant who presented with mild visual acuity problems. Conclusions: Most school-aged children who survive with NNJ and HIE have normal motor and communication function; however, one in ten are likely to present with lowered intellectual functioning compared to the normative sample.
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Fong SL, Lim KS, Tan L, Aris T, Khalid RA, Ali RA, Muhamad M, Puvanarajah SD, Law WC. Validation of Malay brief screening instrument for ascertainment of epilepsy. Epilepsy Behav 2019; 97:206-211. [PMID: 31252280 DOI: 10.1016/j.yebeh.2019.05.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/20/2019] [Accepted: 05/20/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Prevalence studies of epilepsy in Asia revealed a prevalence ranging from 1.5 to 14.0 per 1000 among Asian populations. However, the prevalence of epilepsy in Malaysia is not available for comparison with other countries. This study aimed to translate and validate a Malay brief screening instruments for ascertainment of epilepsy. METHOD We translated into Malay a brief screening instrument for ascertainment of epilepsy designed and validated by Ottman et al., using the three-stage cross-cultural adaptation process developed by the International Quality of Life Assessment (IQOLA) project. We then administered the translated questionnaire via online survey to 162 cases (patients with epilepsy under follow-up care at the neurology clinic in University of Malaya Medical Centre, Kuala Lumpur) and 146 controls with no known history of epilepsy for validation. RESULTS Applying the most liberal definition for a positive screen, we obtained a sensitivity of 96.3% (95% confidence interval [CI]: 91.8-98.5%), with a specificity of 66.4% (95% CI: 58.1-73.0%) and positive predictive value (PPV) of 2.0%. The most stringent definition for a positive screen (only epilepsy) resulted in a sensitivity of 97.4% (95% CI: 62.0-72.6%), specificity of 98.6% (95% CI: 94.6-99.7%), and PPV of 26.6%. Narrowing the definition of a positive screen decreased sensitivity but improved PPVs. When compared to the original English questionnaire, the sensitivities were similar for all four definitions of a positive screen. CONCLUSION This is the first validated epilepsy screening questionnaire in the Malay language and represents a useful tool for the ascertainment of epilepsy in population-based studies.
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Affiliation(s)
- Si-Lei Fong
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia
| | - Kheng-Seang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia.
| | - LeeAnn Tan
- Institute for Public Health, National Institutes of Health, Ministry of Health, Malaysia
| | - Tahir Aris
- Institute for Public Health, National Institutes of Health, Ministry of Health, Malaysia
| | | | - Raymond Azman Ali
- Division of Neurology, Department of Medicine, Faculty of Medicine, National University of Malaysia, Malaysia
| | - Mashkur Muhamad
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia
| | | | - Wan-Chung Law
- Division of Neurology, Department of Medicine, Sarawak General Hospital, Malaysia
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Magai DN, Newton CR, Mwangi P, Koot HM, Abubakar A. Patterns of neurobehavioral functioning in school-aged survivors of neonatal jaundice and hypoxic-ischemic encephalopathy in Kilifi, Kenya: A cross-sectional study. Wellcome Open Res 2019. [DOI: 10.12688/wellcomeopenres.15200.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Studies in high-income countries have reported that school-aged children who survive neonatal jaundice (NNJ) and hypoxic-ischemic encephalopathy (HIE) develop long-term neurocognitive problems. However, less is known about the patterns of functioning in school-aged survivors of NNJ and HIE in sub-Saharan Africa. This study examined patterns of functioning in school-aged children who survived NNJ and HIE in Kilifi, Kenya. Methods: This is a cross-sectional study that included 107 survivors of NNJ/HIE (64 with NNJ, 43 with HIE), aged 6-12 years, admitted to Kilifi County Hospital on the Kenyan Coast. The Gross Motor Function Classification System (GMFCS), Adapted Communication Profile, Raven’s Coloured Progressive Matrices (RCPM) and an epilepsy screening tool were used to assess gross motor function, communication function, intellectual functioning, and epilepsy, respectively. Results: Most of the survivors of NNJ (95.2%) and HIE (95.3%) had no impairments in gross motor functioning. A small percentage of the children in the NNJ and HIE groups had profound problems in their communication (4.7% and 4.7%); expressive communication function (4.7% and 4.7%); social functions (3.1% and 2.3%); receptive communication (4.7% and 2.3%); and communicative effectiveness (4.7% and 2.3%). Cognitive impairment was reported in 10.9% and 11.9% for NNJ and HIE survivors, respectively. Active epilepsy was detected in 1.6% of survivors of NNJ and 2.3% of survivors of HIE. All children had normal hearing and visual functioning except one participant who presented with mild visual acuity problems. Conclusions: Most school-aged children who survive with NNJ and HIE have normal motor and communication function; however, one in ten are likely to present with lowered intellectual functioning compared to the normative sample.
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Giuliano L, Cicero CE, Crespo Gómez EB, Sofia V, Zappia M, Nicoletti A. A screening questionnaire for generalized tonic-clonic seizures: Hospital-based validation vs field-validation method. Epilepsia Open 2019; 4:339-343. [PMID: 31168502 PMCID: PMC6546018 DOI: 10.1002/epi4.12315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/28/2019] [Indexed: 11/15/2022] Open
Abstract
The majority of the screening questionnaires for epilepsy have been validated in hospital settings. We previously developed and used for field validation a screening tool to detect generalized tonic-clonic seizures (GTCS) in the rural communities of the Chaco region of Bolivia. The objective of the present study was to perform a hospital-based validation of the same questionnaire and to compare the levels of accuracy obtained when validated in the field or in a hospital-based context. We carried out a hospital-based validation in the Hospital Hernandez Vera of Santa Cruz, Bolivia, where we enrolled patients affected by epilepsy with GTCS and controls. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated. One hundred twenty questionnaires were administered to 59 patients (27 men [45.8%]; mean age ± SD = 32.4 ± 14.2 years) and 61 controls (27 men [44.3%]; mean age ± SD = 32.6 ± 14.3 years). We obtained levels of accuracy of 100%. Sensitivity and PPV were significantly higher than the estimates obtained in the field-validation study (sensitivity 100% vs 76.3%; PPV 100% vs 69.0%). Our screening questionnaire showed a significantly lower level of sensitivity when validated in the field, confirming that hospital-based validation can lead to an overestimation of sensitivity.
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Affiliation(s)
- Loretta Giuliano
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”Section of NeurosciencesUniversity of CataniaCataniaItaly
| | - Calogero Edoardo Cicero
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”Section of NeurosciencesUniversity of CataniaCataniaItaly
| | | | - Vito Sofia
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”Section of NeurosciencesUniversity of CataniaCataniaItaly
| | - Mario Zappia
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”Section of NeurosciencesUniversity of CataniaCataniaItaly
| | - Alessandra Nicoletti
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”Section of NeurosciencesUniversity of CataniaCataniaItaly
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Siewe Fodjo JN, Dekker MCJ, Idro R, Mandro MN, Preux PM, Njamnshi AK, Colebunders R. Comprehensive management of epilepsy in onchocerciasis-endemic areas: lessons learnt from community-based surveys. Infect Dis Poverty 2019; 8:11. [PMID: 30738437 PMCID: PMC6368958 DOI: 10.1186/s40249-019-0523-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 01/23/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Onchocerciasis-endemic regions are known to have a high epilepsy prevalence. Limited resources in these areas and poor access to healthcare by persons with epilepsy (PWE) result in a wide anti-epileptic treatment gap, poor seizure control and a high burden of seizure-related complications. Recent community-based surveys highlight the need for epilepsy management strategies suitable for remote onchocerciasis-endemic villages to ensure better health outcomes for PWE. In this paper, we propose a feasible approach to manage PWE in such settings. MAIN TEXT Improved management of PWE in onchocerciasis-endemic areas may be achieved by decentralizing epilepsy care. Simplified approaches for the diagnosis and treatment of epilepsy may be used by non-physicians, under the supervision of physicians or specialists. To reduce the treatment gap, a regular supply of subsidized anti-epileptic drugs (AED) appropriate for different types of onchocerciasis-associated epilepsy should be instituted. Setting up a community-based epilepsy surveillance system will enable early diagnosis and treatment of PWE thereby preventing complications. Community awareness programs on epilepsy must be implemented to reduce stigma and facilitate the social rehabilitation of PWE. Finally, strengthening onchocerciasis elimination programs by optimizing community-directed treatment with ivermectin (CDTI) and considering alternative treatment strategies might reduce the incidence of epilepsy. CONCLUSIONS A community-based approach with task-shifting of epilepsy care from specialists to non-physician health workers will reduce epilepsy-associated morbidity. Increased advocacy and collaboration with various stakeholders is needed to establish a sustainable, cost-effective chronic care model for epilepsy that will significantly improve the quality of life of PWE in onchocerciasis-endemic regions.
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Affiliation(s)
| | - Marieke C. J. Dekker
- Department of Internal Medicine and Pediatrics, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Richard Idro
- Department of Paediatrics and Child Health, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Michel Ndahura Mandro
- Global Health Institute, University of Antwerp, Antwerp, Belgium
- Provincial Health Division Ituri, Ministry of Health, Bunia, Democratic Republic of the Congo
| | - Pierre-Marie Preux
- INSERM, Univ. Limoges, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, GEIST, 87000, Limoges, CHU, UMR 1094 Limoges, France
| | - Alfred K. Njamnshi
- Department of Neurology, Yaoundé Central Hospital / FMBS, The University of Yaoundé 1, Yaoundé, Cameroon
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
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Community-based rehabilitation offers cost-effective epilepsy treatment in rural Guinea-Bissau. Epilepsy Behav 2018; 79:23-25. [PMID: 29245111 DOI: 10.1016/j.yebeh.2017.11.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/06/2017] [Accepted: 11/08/2017] [Indexed: 11/23/2022]
Abstract
Treatment of epilepsy in low-income countries is a challenge considering the lack of resources, availability of antiepileptic drugs, and cultural beliefs. We used a community-based rehabilitation (CBR) service for the detection, monitoring, and treatment of epilepsy. A local network of trained community volunteers provided education, good quality antiepileptic drugs, and clinical follow-up for people with epilepsy (PWE). In a period of 2years, approximately 22,500 people were screened in central Guinea-Bissau, and 112 PWE were identified and registered. Monthly check-ups were offered to monitor treatment effect and increase compliance. Retrospective analysis on 81 records of patients under treatment in June 2016 showed a decrease of seizure frequency in 88.8% after treatment initiation and was maintained throughout the clinical follow-up of 15months. A conservative estimation of the treatment and monitoring of a single person with epilepsy revealed a daily cost of $0.73. Despite acknowledging epilepsy as a neglected condition by the World Health Organization (WHO), most PWE still lack appropriate treatment. Although CBR service has been suggested as efficient strategy to reduce the treatment gap, little information is available on the efficacy of the programs. Our experiences show that CBR service is a cost-effective approach to monitor treatment and increase compliance in PWE. This experience may be of value for other resource-poor settings.
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Kakooza-Mwesige A, Andrews C, Peterson S, Wabwire Mangen F, Eliasson AC, Forssberg H. Prevalence of cerebral palsy in Uganda: a population-based study. LANCET GLOBAL HEALTH 2017; 5:e1275-e1282. [DOI: 10.1016/s2214-109x(17)30374-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 09/01/2017] [Accepted: 09/05/2017] [Indexed: 12/12/2022]
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Dan B, Paneth N. Making sense of cerebral palsy prevalence in low-income countries. LANCET GLOBAL HEALTH 2017; 5:e1174-e1175. [PMID: 29102351 DOI: 10.1016/s2214-109x(17)30420-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Bernard Dan
- Université libre de Bruxelles, Inkendaal Rehabilitation Hospital, Brussels 1602, Belgium.
| | - Nigel Paneth
- Michigan State University, East Lansing, MI, USA
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Ibinda F, Odermatt P, Kariuki SM, Kakooza-Mwesige A, Wagner RG, Owusu-Agyei S, Masanja H, Ngugi AK, Mbuba CK, Doku VCK, Neville BG, Sander JW, Newton CRJC. Magnitude and factors associated with nonadherence to antiepileptic drug treatment in Africa: A cross-sectional multisite study. Epilepsia Open 2017; 2:226-235. [PMID: 29588951 PMCID: PMC5719857 DOI: 10.1002/epi4.12052] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 12/30/2022] Open
Abstract
Objectives The epilepsy treatment gap is large in low‐ and middle‐income countries, but the reasons behind nonadherence to treatment with antiepileptic drugs (AEDs) across African countries remain unclear. We investigated the extent to which AEDs are not taken and associated factors in people with active convulsive epilepsy (ACE) identified in cross‐sectional studies conducted in five African countries. Methods We approached 2,192 people with a confirmed diagnosis of ACE for consent to give blood voluntarily. Participants were asked if they were taking AEDs, and plasma drug concentrations were measured using a fluorescence polarization immunoassay analyzer. Information about possible risk factors was collected using questionnaire‐based clinical interviews. We determined factors associated with nonadherence to AED treatment in children and adults, as measured by detectable and optimal levels, using multilevel logistic regression. Results In 1,303 samples assayed (43.7% were children), AEDs were detected in 482, but only 287 had optimal levels. Of the 1,303 samples, 532 (40.8%) were from people who had reported they were on AEDs. The overall prevalence of nonadherence to treatment was 63.1% (95% confidence interval [CI] 60.5–65.6%) as measured by detectable AED levels and 79.1% (95% CI 73.3–84.3%) as measured by optimal AED levels; self‐reported nonadherence was 65.1% (95% CI 45.0–79.5%). Nonadherence was significantly (p < 0.001) more common among the children than among adults for optimal and detectable levels of AEDs, as was the self‐reported nonadherence. In children, lack of previous hospitalization and learning difficulties were independently associated with nonadherence to treatment. In adults, history of delivery at home, absence of burn marks, and not seeking traditional medicine were independently associated with the nonadherence to AED treatment. Significance Only about 20% of people with epilepsy benefit fully from antiepileptic drugs in sub‐Saharan Africa, according to optimum AEDs levels. Children taking AEDs should be supervised to promote compliance.
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Affiliation(s)
- Fredrick Ibinda
- Centre for Geographic Medicine Research (Coast) Kenya Medical Research Institute Kilifi Kenya.,Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra Ghana
| | - Peter Odermatt
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra Ghana.,Department of Public Health and Epidemiology Swiss Tropical and Public Health Institute Basel Switzerland.,University of Basel Basel Switzerland
| | - Symon M Kariuki
- Centre for Geographic Medicine Research (Coast) Kenya Medical Research Institute Kilifi Kenya.,Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra Ghana
| | - Angelina Kakooza-Mwesige
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra Ghana.,Iganga-Mayuge Health and Demographic Surveillance System Kampala Uganda.,Department of Paediatrics and Child Health Makerere University College of Health Sciences Kampala Uganda
| | - Ryan G Wagner
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra Ghana.,MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt) School of Public Health Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa.,Department of Public Health and Clinical Medicine Epidemiology and Public Health Sciences Umeå University Umeå Sweden
| | - Seth Owusu-Agyei
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra Ghana.,Kintampo Health Research Centre Kintampo Ghana
| | - Honorati Masanja
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra Ghana.,Ifakara Health InstituteI fakara Tanzania
| | - Anthony K Ngugi
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra Ghana.,Research Support Unit Faculty of Health Sciences Aga Khan University-East Africa Nairobi Kenya
| | - Caroline K Mbuba
- Department of Public Health School of Medicine and Health Sciences Kenya Methodist University Meru Kenya
| | - Victor C K Doku
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra Ghana.,Institute of Psychiatry Kings College London London United Kingdom
| | - Brian G Neville
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra Ghana.,Neurosciences Unit Institute of Child Health University College London London United Kingdom
| | - Josemir W Sander
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra Ghana.,NIHR University College London Hospitals Biomedical Research Centre UCL Institute of Neurology Queen Square United Kingdom.,Epilepsy Society Chalfont St. Peter United Kingdom.,Stichting Epilepsie Instellingen Nederland (SEIN) SW Heemstede the Netherlands
| | - Charles R J C Newton
- Centre for Geographic Medicine Research (Coast) Kenya Medical Research Institute Kilifi Kenya.,Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra Ghana.,Neurosciences Unit Institute of Child Health University College London London United Kingdom.,Department of Psychiatry University of Oxford Oxford United Kingdom
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Giuliano L, Cicero CE, Crespo Gómez EB, Padilla S, Bruno E, Camargo M, Marin B, Sofia V, Preux PM, Strohmeyer M, Bartoloni A, Nicoletti A. A screening questionnaire for convulsive seizures: A three-stage field-validation in rural Bolivia. PLoS One 2017; 12:e0173945. [PMID: 28301557 PMCID: PMC5354446 DOI: 10.1371/journal.pone.0173945] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 03/01/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction Epilepsy is one of the most common neurological diseases in Latin American Countries (LAC) and epilepsy associated with convulsive seizures is the most frequent type. Therefore, the detection of convulsive seizures is a priority, but a validated Spanish-language screening tool to detect convulsive seizures is not available. We performed a field validation to evaluate the accuracy of a Spanish-language questionnaire to detect convulsive seizures in rural Bolivia using a three-stage design. The questionnaire was also administered face-to-face, using a two-stage design, to evaluate the difference in accuracy. Methods The study was carried out in the rural communities of the Gran Chaco region. The questionnaire consists of a single screening question directed toward the householders and a confirmatory section administered face-to-face to the index case. Positive subjects underwent a neurological examination to detect false positive and true positive subjects. To estimate the proportion of false negative, a random sample of about 20% of the screened negative underwent a neurological evaluation. Results 792 householders have been interviewed representing a population of 3,562 subjects (52.2% men; mean age 24.5 ± 19.7 years). We found a sensitivity of 76.3% (95% CI 59.8–88.6) with a specificity of 99.6% (95% CI 99.4–99.8). The two-stage design showed only a slightly higher sensitivity respect to the three-stage design. Conclusion Our screening tool shows a good accuracy and can be easily used by trained health workers to quickly screen the population of the rural communities of LAC through the householders using a three-stage design.
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Affiliation(s)
- Loretta Giuliano
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Calogero Edoardo Cicero
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | | | - Sandra Padilla
- Center of Anthropological Researches of the Teko Guaraní, Gutierrez, Bolivia
| | - Elisa Bruno
- Department of Neurology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Mario Camargo
- The Bolivian League Against Epilepsy, Santa Cruz, Bolivia
| | - Benoit Marin
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France
| | - Vito Sofia
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | | | - Marianne Strohmeyer
- Department of Experimental and Clinical Medicine, Infectious and Tropical Diseases Unit, University of Florence, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, Infectious and Tropical Diseases Unit, University of Florence, Florence, Italy
| | - Alessandra Nicoletti
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
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Kakooza-Mwesige A, Ndyomugyenyi D, Pariyo G, Peterson SS, Waiswa PM, Galiwango E, Chengo E, Odhiambo R, Ssewanyana D, Bottomley C, Ngugi AK, Newton CRJC. Adverse perinatal events, treatment gap, and positive family history linked to the high burden of active convulsive epilepsy in Uganda: A population-based study. Epilepsia Open 2017; 2:188-198. [PMID: 29588948 PMCID: PMC5719853 DOI: 10.1002/epi4.12048] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2017] [Indexed: 12/24/2022] Open
Abstract
Objective To determine the prevalence of active convulsive epilepsy (ACE) and describe the clinical characteristics and associated factors among a rural Ugandan population. Methods The entire population in Iganga/Mayuge Health Demographic Surveillance Site (IM-HDSS) was screened using two questions about seizures during a door-to-door census exercise. Those who screened positive were assessed by a clinician to confirm diagnosis of epilepsy. A case control study with the patients diagnosed with ACE as the cases and age/sex-matched controls in a ratio of 1:1 was conducted. Results A total of 64,172 (92.8%) IM-HDSS residents, with a median age of 15.0 years (interquartile range [IQR]: 8.0-29.0), were screened for epilepsy. There were 152 confirmed ACE cases, with a prevalence of 10.3/1,000 (95% confidence interval [CI]: 9.5-11.1) adjusted for nonresponse and screening sensitivity. Prevalence declined with age, with the highest prevalence in the 0-5 years age group. In an analysis of n = 241 that included cases not identified in the survey, nearly 70% were unaware of their diagnosis. Seizures were mostly of focal onset in 193 (80%), with poor electroencephalogram (EEG) agreement with seizure semiology. Antiepileptic drug use was rare, noted in 21.2% (95% CI: 16.5-25.8), and 119 (49.3%) reported using traditional medicines. History of an abnormal antenatal period (adjusted odds ratio [aOR] 10.28; 95%CI 1.26-83.45; p = 0.029) and difficulties in feeding, crying, breathing in the perinatal period (aOR 10.07; 95%CI 1.24-81.97; p = 0.031) were associated with ACE in children. In adults a family history of epilepsy (aOR 4.38 95%CI 1.77-10.81; p = 0.001) was the only factor associated with ACE. Significance There is a considerable burden of epilepsy, low awareness, and a large treatment gap in this population of rural sub-Saharan Africa. The identification of adverse perinatal events as a risk factor for developing epilepsy in children suggests that epilepsy burden may be decreased by improving obstetric and postnatal care.
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Affiliation(s)
- Angelina Kakooza-Mwesige
- Makerere University Centre for Health and Population Research Iganga-Mayuge Health and Demographic Surveillance Site Iganga Uganda.,Department of Paediatrics and Child Health Makerere University College of Health Sciences Kampala Uganda.,Astrid Lindgren Children's Hospital Neuropediatric Research Unit Karolinska Institutet Stockholm Sweden
| | - Donald Ndyomugyenyi
- Makerere University Centre for Health and Population Research Iganga-Mayuge Health and Demographic Surveillance Site Iganga Uganda
| | - George Pariyo
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland U.S.A
| | - Stefan Swartling Peterson
- International Maternal and Child Health Unit Department of Women's and Children's Health Uppsala University Uppsala Sweden.,Karolinska Institutet Stockholm Sweden.,UNICEF New York New York U.S.A
| | - Paul Michael Waiswa
- Makerere University Centre for Health and Population Research Iganga-Mayuge Health and Demographic Surveillance Site Iganga Uganda
| | - Edward Galiwango
- Makerere University Centre for Health and Population Research Iganga-Mayuge Health and Demographic Surveillance Site Iganga Uganda
| | - Eddie Chengo
- Centre for Geographic Medicine Research Coast Kenya Medical Research Institute Kilifi Kenya
| | - Rachael Odhiambo
- Centre for Geographic Medicine Research Coast Kenya Medical Research Institute Kilifi Kenya
| | - Derrick Ssewanyana
- Centre for Geographic Medicine Research Coast Kenya Medical Research Institute Kilifi Kenya
| | - Christian Bottomley
- Department of Infectious Disease Epidemiology Faculty of Epidemiology and Population Health London School of Hygiene and Tropical Medicine London United Kingdom
| | - Anthony K Ngugi
- Population Health Sciences Faculty of Health Sciences Aga Khan University (East Africa) Nairobi Kenya
| | - Charles R J C Newton
- Centre for Geographic Medicine Research Coast Kenya Medical Research Institute Kilifi Kenya.,Neurosciences Unit UCL Institute of Child Health London United Kingdom.,Clinical Research Unit London School of Hygiene and Tropical Medicine London United Kingdom.,Department of Psychiatry University of Oxford Oxford United Kingdom
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Colebunders R, Tepage F, Rood E, Mandro M, Abatih EN, Musinya G, Mambandu G, Kabeya J, Komba M, Levick B, Mokili JL, Laudisoit A. Prevalence of River Epilepsy in the Orientale Province in the Democratic Republic of the Congo. PLoS Negl Trop Dis 2016; 10:e0004478. [PMID: 27139245 PMCID: PMC4854481 DOI: 10.1371/journal.pntd.0004478] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 01/30/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND An increased prevalence of epilepsy has been reported in many onchocerciasis endemic areas. OBJECTIVE To determine the prevalence and distribution of epilepsy in an onchocerciasis endemic region in the Democratic Republic of the Congo (DRC). DESIGN/METHODS An epilepsy prevalence study was carried out in 2014, in two localities of the Bas-Uélé district, an onchocerciasis endemic region in the Orientale Province of the DRC. Risk factors for epilepsy were identified using a random effects logistic regression model and the distribution of epilepsy cases was investigated using the Moran's I statistic of spatial auto-correlation. RESULTS Among the 12,776 individuals of Dingila, 373 (2.9%) individuals with epilepsy were identified. In a house-to-house survey in Titule, 68 (2.3%) of the 2,908 people who participated in the survey were found to present episodes of epilepsy. Epilepsy showed a marked spatial pattern with clustering of cases occurring within and between adjacent households. Individual risk of epilepsy was found to be associated with living close to the nearest fast flowing river where blackflies (Diptera: Simuliidae)-the vector of Onchocerca volvulus-oviposit and breed. CONCLUSIONS The prevalence of epilepsy in villages in the Bas-Uélé district in the DRC was higher than in non-onchocerciasis endemic regions in Africa. Living close to a blackflies infested river was found to be a risk factor for epilepsy.
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Affiliation(s)
- Robert Colebunders
- Global Health Institute, University of Antwerp, Antwerp, Belgium
- * E-mail:
| | - Floribert Tepage
- National Onchocerciasis Control Program, Kisangani, Democratic Republic of the Congo
| | - Ente Rood
- Royal Tropical Institute, Amsterdam, The Netherlands
| | - Michel Mandro
- Provincial Health Division Ituri, Bunia, Democratic Republic of the Congo
| | - Emmanuel Nji Abatih
- Department of Biomedical Science, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Germain Mambandu
- Provincial Ministry of Public Health, Kisangani, Democratic Republic of the Congo
| | - José Kabeya
- Provincial Ministry of Public Health, Kisangani, Democratic Republic of the Congo
| | - Michel Komba
- Biodiversity Monitoring Centre (CSB), Faculty of Sciences, University of Kisangani, Kisangani, Democratic Republic of the Congo
| | - Bethany Levick
- Institute of Integrative Biology, School of Biological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - John L Mokili
- Biology Department, San Diego State University, San Diego, California, United States of America
| | - Anne Laudisoit
- Global Health Institute, University of Antwerp, Antwerp, Belgium
- Institute of Integrative Biology, School of Biological Sciences, University of Liverpool, Liverpool, United Kingdom
- Evolutionary Biology group, University of Antwerp, Antwerp, Belgium
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Douglass LM, Kuban K, Tarquinio D, Schraga L, Jonas R, Heeren T, DeBassio WA, Stafstrom CE, Heinrick RJ, Ferguson C, Blumberg L, Wong V. A Novel Parent Questionnaire for the Detection of Seizures in Children. Pediatr Neurol 2016; 54:64-69.e1. [PMID: 26552646 DOI: 10.1016/j.pediatrneurol.2015.09.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 09/14/2015] [Accepted: 09/16/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND We developed a seizure questionnaire that could be administered by a trained research assistant in a two-step process, approximating the clinical diagnostic process of a pediatric epileptologist. This questionnaire was designed to study seizure prevalence in a research population of 10-year-old children at risk for epilepsy. METHODS English-speaking parents of children 6 months to 12 years old were recruited from the pediatric neurology clinics at Boston Medical Center and interviewed using a computerized questionnaire. An algorithm of parent responses rendered a 4-level ranking scale of seizure probability for events: (1) not likely, (2) indeterminate, (3) probable, (4) almost certain. Blinded to questionnaire results, pediatric neurologists served as the diagnostic gold standard, ranking each patient event using the same four-level scale based on clinical history and examination. RESULTS The questionnaire was completed by 150 of 177 (84.7%) enrolled parents. Seizure prevalence among participants was 38.6%. The seizure questionnaire yielded a fitted receiver operating characteristic area of 0.93 (95% confidence interval [CI], 0.89-0.97). Based on optimal sensitivity and false-positive fraction, we dichotomized the questionnaire results as consistent with seizure (levels 3 and 4) or without seizure (levels 1 and 2). Overall, findings included a 91.4% sensitivity (95% CI, 84.2%-98.6%) and an 82.6% specificity (95% CI, 74.9%-90.4%). The positive predictive value was 76.8% (95% CI, 66.9%-86.8%) and the negative predictive value was 93.8% (95% CI, 88.6%-99.1%). CONCLUSIONS This pediatric seizure questionnaire was both sensitive and specific for detecting clinically confirmed seizures. This tool may be useful to researchers and clinicians in screening large populations of children, decreasing the time and cost of added neurological assessments.
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Affiliation(s)
- Laurie M Douglass
- Division of Pediatric Neurology, Boston Medical Center, Boston, Massachusetts; Boston University School of Medicine, Boston, Massachusetts.
| | - Karl Kuban
- Division of Pediatric Neurology, Boston Medical Center, Boston, Massachusetts; Boston University School of Medicine, Boston, Massachusetts
| | | | - Leah Schraga
- Division of Pediatric Neurology, Boston Medical Center, Boston, Massachusetts
| | - Rinat Jonas
- Division of Pediatric Neurology, Boston Medical Center, Boston, Massachusetts; Boston University School of Medicine, Boston, Massachusetts
| | - Timothy Heeren
- Boston University School of Public Health, Boston, Massachusetts
| | - William A DeBassio
- Division of Pediatric Neurology, Boston Medical Center, Boston, Massachusetts; Boston University School of Medicine, Boston, Massachusetts
| | - Carl E Stafstrom
- Division of Pediatric Neurology, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Chantal Ferguson
- Division of Pediatric Neurology, Boston Medical Center, Boston, Massachusetts
| | - Lauren Blumberg
- Division of Pediatric Neurology, Boston Medical Center, Boston, Massachusetts
| | - Vanessa Wong
- Division of Pediatric Neurology, Boston Medical Center, Boston, Massachusetts
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29
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Longford NT. Classification in two-stage screening. Stat Med 2015; 34:3281-97. [PMID: 26082302 DOI: 10.1002/sim.6554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 04/27/2015] [Accepted: 05/24/2015] [Indexed: 11/08/2022]
Abstract
Decision theory is applied to the problem of setting thresholds in medical screening when it is organised in two stages. In the first stage that involves a less expensive procedure that can be applied on a mass scale, an individual is classified as a negative or a likely positive. In the second stage, the likely positives are subjected to another test that classifies them as (definite) positives or negatives. The second-stage test is more accurate, but also more expensive and more involved, and so there are incentives to restrict its application. Robustness of the method with respect to the parameters, some of which have to be set by elicitation, is assessed by sensitivity analysis.
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Abstract
Of the 70 million persons with epilepsy (PWE) worldwide, nearly 12 million PWE are expected to reside in India; which contributes to nearly one-sixth of the global burden. This paper (first of the two part series) provides an in-depth understanding of the epidemiological aspects of epilepsy in India for developing effective public health prevention and control programs. The overall prevalence (3.0-11.9 per 1,000 population) and incidence (0.2-0.6 per 1,000 population per year) data from recent studies in India on general population are comparable to the rates of high-income countries (HICs) despite marked variations in population characteristics and study methodologies. There is a differential distribution of epilepsy among various sociodemographic and economic groups with higher rates reported for the male gender, rural population, and low socioeconomic status. A changing pattern in the age-specific occurrence of epilepsy with preponderance towards the older age group is noticed due to sociodemographic and epidemiological transition. Neuroinfections, neurocysticercosis (NCC), and neurotrauma along with birth injuries have emerged as major risk factors for secondary epilepsy. Despite its varied etiology (unknown and known), majority of the epilepsy are manageable in nature. This paper emphasizes the need for focused and targeted programs based on a life-course perspective and calls for a stronger public health approach based on equity for prevention, control, and management of epilepsy in India.
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Affiliation(s)
- Senthil Amudhan
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Gopalkrishna Gururaj
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Parthasarathy Satishchandra
- Director/Vice-chancellor and Professor of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Incidence, Remission and Mortality of Convulsive Epilepsy in Rural Northeast South Africa. PLoS One 2015; 10:e0129097. [PMID: 26053071 PMCID: PMC4459982 DOI: 10.1371/journal.pone.0129097] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 05/06/2015] [Indexed: 11/25/2022] Open
Abstract
Background Epilepsy is one of the most common neurological conditions globally, estimated to constitute 0.75% of the global burden of disease, with the majority of this burden found in low- and middle- income countries (LMICs). Few studies from LMICs, including much of sub-Saharan Africa, have described the incidence, remission or mortality rates due to epilepsy, which are needed to quantify the burden and inform policy. This study investigates the epidemiological parameters of convulsive epilepsy within a context of high HIV prevalence and an emerging burden of cardiovascular disease. Methods A cross-sectional population survey of 82,818 individuals, in the Agincourt Health and Socio-demographic Surveillance Site (HDSS) in rural northeast South Africa was conducted in 2008, from which 296 people were identified with active convulsive epilepsy. A follow-up survey was conducted in 2012. Incidence and mortality rates were estimated, with duration and remission rates calculated using the DISMOD II software package. Results The crude incidence for convulsive epilepsy was 17.4/100,000 per year (95%CI: 13.1-23.0). Remission was 4.6% and 3.9% per year for males and females, respectively. The standardized mortality ratio was 2.6 (95%CI: 1.7-3.5), with 33.3% of deaths directly related to epilepsy. Mortality was higher in men than women (adjusted rate ratio (aRR) 2.6 (95%CI: 1.2-5.4)), and was significantly associated with older ages (50+ years versus those 0-5 years old (RR 4.8 (95%CI: 0.6-36.4)). Conclusions The crude incidence was lower whilst mortality rates were similar to other African studies; however, this study found higher mortality amongst older males. Efforts aimed at further understanding what causes epilepsy in older people and developing interventions to reduce prolonged seizures are likely to reduce the overall burden of ACE in rural South Africa.
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Ae-Ngibise KA, Akpalu B, Ngugi A, Akpalu A, Agbokey F, Adjei P, Punguyire D, Bottomley C, Newton C, Owusu-Agyei S. Prevalence and risk factors for Active Convulsive Epilepsy in Kintampo, Ghana. Pan Afr Med J 2015; 21:29. [PMID: 26401223 PMCID: PMC4561141 DOI: 10.11604/pamj.2015.21.29.6084] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 04/22/2015] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Epilepsy is common in sub-Saharan Africa, but there is little data in West Africa, to develop public health measures for epilepsy in this region. METHODS We conducted a three-stage cross-sectional survey to determine the prevalence and risk factors for active convulsive epilepsy (ACE), and estimated the treatment gap in Kintampo situated in the middle of Ghana. RESULTS 249 people with ACE were identified in a study population of 113,796 individuals. After adjusting for attrition and the sensitivity of the screening method, the prevalence of ACE was 10.1/1000 (95% Confidence Interval (95% CI) 9.5-10.7). In children aged <18 years, risk factors for ACE were: family history of seizures (OR=3.31; 95% CI: 1.83-5.96), abnormal delivery (OR=2.99; 95% CI: 1.07-8.34), problems after birth (OR=3.51; 95% CI: 1.02-12.06), and exposure to Onchocerca volvulus (OR=2.32; 95% CI: 1.12-4.78). In adults, a family history of seizures (OR=1.83; 95% CI: 1.05-3.20), never attended school (OR=11.68; 95% CI: 4.80-28.40), cassava consumption (OR=3.92; 95% CI: 1.14-13.54), pork consumption (OR=1.68; 95% CI: 1.09-2.58), history of snoring at least 3 nights per week (OR=3.40: 95% CI: 1.56-7.41), exposure to Toxoplasma gondii (OR=1.99; 95% CI: 1.15-3.45) and Onchocerca volvulus (OR=2.09: 95% CI: 1.29-3.40) were significant risk factors for the development of ACE. The self-reported treatment gap was 86.9% (95% CI: 83.5%-90.3%). CONCLUSION ACE is common within the middle belt of Ghana and could be reduced with improved obstetric care and prevention of parasite infestations such as Onchocerca volvulus and Toxoplasma gondii.
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Affiliation(s)
- Kenneth Ayuurebobi Ae-Ngibise
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana ; Studies of the Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra, Ghana
| | - Bright Akpalu
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana ; Studies of the Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra, Ghana
| | - Anthony Ngugi
- Studies of the Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra, Ghana ; KEMRI/Wellcome Trust Research Programme, The Centre of Geographical Medicine Research- Coast, Kilifi, Kenya ; Population Health Sciences/Research Support Unit, Faculty of Health Sciences, Aga Khan University- East Africa, Nairobi, Kenya
| | - Albert Akpalu
- Department of Medicine, Korle Bu Teaching Hospital, Ghana
| | - Francis Agbokey
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana ; Studies of the Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra, Ghana
| | - Patrick Adjei
- Department of Medicine, Korle Bu Teaching Hospital, Ghana
| | | | - Christian Bottomley
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, UK
| | - Charles Newton
- Studies of the Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra, Ghana ; KEMRI/Wellcome Trust Research Programme, The Centre of Geographical Medicine Research- Coast, Kilifi, Kenya ; Department of Psychiatry, University of Oxford, United Kingdom
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana ; Studies of the Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra, Ghana
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Kariuki SM, Kakooza-Mwesige A, Wagner RG, Chengo E, White S, Kamuyu G, Ngugi AK, Sander JW, Neville BGR, Newton CRJ. Prevalence and factors associated with convulsive status epilepticus in Africans with epilepsy. Neurology 2015; 84:1838-45. [PMID: 25841025 PMCID: PMC4433462 DOI: 10.1212/wnl.0000000000001542] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 01/09/2015] [Indexed: 01/23/2023] Open
Abstract
Objective: We conducted a community survey to estimate the prevalence and describe the features, risk factors, and consequences of convulsive status epilepticus (CSE) among people with active convulsive epilepsy (ACE) identified in a multisite survey in Africa. Methods: We obtained clinical histories of CSE and neurologic examination data among 1,196 people with ACE identified from a population of 379,166 people in 3 sites: Agincourt, South Africa; Iganga-Mayuge, Uganda; and Kilifi, Kenya. We performed serologic assessment for the presence of antibodies to parasitic infections and HIV and determined adherence to antiepileptic drugs. Consequences of CSE were assessed using a questionnaire. Logistic regression was used to identify risk factors. Results: The adjusted prevalence of CSE in ACE among the general population across the 3 sites was 2.3 per 1,000, and differed with site (p < 0.0001). Over half (55%) of CSE occurred in febrile illnesses and focal seizures were present in 61%. Risk factors for CSE in ACE were neurologic impairments, acute encephalopathy, previous hospitalization, and presence of antibody titers to falciparum malaria and HIV; these differed across sites. Burns (15%), lack of education (49%), being single (77%), and unemployment (78%) were common in CSE; these differed across the 3 sites. Nine percent with and 10% without CSE died. Conclusions: CSE is common in people with ACE in Africa; most occurs with febrile illnesses, is untreated, and has focal features suggesting preventable risk factors. Effective prevention and the management of infections and neurologic impairments may reduce the burden of CSE in ACE.
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Affiliation(s)
- Symon M Kariuki
- From Kenya Medical Research Institute-Wellcome Trust Research Programme (S.M.K., E.C., G.K., A.K.N., C.R.J.N.), Kilifi, Kenya; Nuffield Department of Medicine (S.M.K.), University of Oxford, UK; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.-M., R.G.W., E.C., G.K., A.K.N., C.R.J.N.), Accra, Ghana; Iganga-Mayuge Health and Demographic Surveillance System (A.K.-M.), Iganga; the Department of Paediatrics and Child Health (A.K.-M.), Makerere University College of Health Sciences, Kampala, Uganda; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) (R.G.W.), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Global Health (R.G.W.), Department of Public Health and Clinical Medicine, Umeå University, Sweden; the Neurophysiology Department (S.W.), Great Ormond Street Hospital for Children, London; the Neurosciences Unit (B.G.R.N., C.R.J.N.), UCL Institute of Child Health, London, UK; Population Health Sciences/Research Support Unit (A.K.N.), Faculty of Health Sciences, Aga Khan University (East Africa), Nairobi, Kenya; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S.), Bucks, UK; Stichting Epilepsie Instellingen Nederland-SEIN (J.W.S.), Heemstede, Netherlands; Clinical Research Unit (C.R.J.N.), London School of Hygiene and Tropical Medicine; and the Department of Psychiatry (C.R.J.N.), University of Oxford, UK.
| | - Angelina Kakooza-Mwesige
- From Kenya Medical Research Institute-Wellcome Trust Research Programme (S.M.K., E.C., G.K., A.K.N., C.R.J.N.), Kilifi, Kenya; Nuffield Department of Medicine (S.M.K.), University of Oxford, UK; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.-M., R.G.W., E.C., G.K., A.K.N., C.R.J.N.), Accra, Ghana; Iganga-Mayuge Health and Demographic Surveillance System (A.K.-M.), Iganga; the Department of Paediatrics and Child Health (A.K.-M.), Makerere University College of Health Sciences, Kampala, Uganda; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) (R.G.W.), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Global Health (R.G.W.), Department of Public Health and Clinical Medicine, Umeå University, Sweden; the Neurophysiology Department (S.W.), Great Ormond Street Hospital for Children, London; the Neurosciences Unit (B.G.R.N., C.R.J.N.), UCL Institute of Child Health, London, UK; Population Health Sciences/Research Support Unit (A.K.N.), Faculty of Health Sciences, Aga Khan University (East Africa), Nairobi, Kenya; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S.), Bucks, UK; Stichting Epilepsie Instellingen Nederland-SEIN (J.W.S.), Heemstede, Netherlands; Clinical Research Unit (C.R.J.N.), London School of Hygiene and Tropical Medicine; and the Department of Psychiatry (C.R.J.N.), University of Oxford, UK
| | - Ryan G Wagner
- From Kenya Medical Research Institute-Wellcome Trust Research Programme (S.M.K., E.C., G.K., A.K.N., C.R.J.N.), Kilifi, Kenya; Nuffield Department of Medicine (S.M.K.), University of Oxford, UK; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.-M., R.G.W., E.C., G.K., A.K.N., C.R.J.N.), Accra, Ghana; Iganga-Mayuge Health and Demographic Surveillance System (A.K.-M.), Iganga; the Department of Paediatrics and Child Health (A.K.-M.), Makerere University College of Health Sciences, Kampala, Uganda; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) (R.G.W.), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Global Health (R.G.W.), Department of Public Health and Clinical Medicine, Umeå University, Sweden; the Neurophysiology Department (S.W.), Great Ormond Street Hospital for Children, London; the Neurosciences Unit (B.G.R.N., C.R.J.N.), UCL Institute of Child Health, London, UK; Population Health Sciences/Research Support Unit (A.K.N.), Faculty of Health Sciences, Aga Khan University (East Africa), Nairobi, Kenya; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S.), Bucks, UK; Stichting Epilepsie Instellingen Nederland-SEIN (J.W.S.), Heemstede, Netherlands; Clinical Research Unit (C.R.J.N.), London School of Hygiene and Tropical Medicine; and the Department of Psychiatry (C.R.J.N.), University of Oxford, UK
| | - Eddie Chengo
- From Kenya Medical Research Institute-Wellcome Trust Research Programme (S.M.K., E.C., G.K., A.K.N., C.R.J.N.), Kilifi, Kenya; Nuffield Department of Medicine (S.M.K.), University of Oxford, UK; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.-M., R.G.W., E.C., G.K., A.K.N., C.R.J.N.), Accra, Ghana; Iganga-Mayuge Health and Demographic Surveillance System (A.K.-M.), Iganga; the Department of Paediatrics and Child Health (A.K.-M.), Makerere University College of Health Sciences, Kampala, Uganda; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) (R.G.W.), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Global Health (R.G.W.), Department of Public Health and Clinical Medicine, Umeå University, Sweden; the Neurophysiology Department (S.W.), Great Ormond Street Hospital for Children, London; the Neurosciences Unit (B.G.R.N., C.R.J.N.), UCL Institute of Child Health, London, UK; Population Health Sciences/Research Support Unit (A.K.N.), Faculty of Health Sciences, Aga Khan University (East Africa), Nairobi, Kenya; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S.), Bucks, UK; Stichting Epilepsie Instellingen Nederland-SEIN (J.W.S.), Heemstede, Netherlands; Clinical Research Unit (C.R.J.N.), London School of Hygiene and Tropical Medicine; and the Department of Psychiatry (C.R.J.N.), University of Oxford, UK
| | - Steven White
- From Kenya Medical Research Institute-Wellcome Trust Research Programme (S.M.K., E.C., G.K., A.K.N., C.R.J.N.), Kilifi, Kenya; Nuffield Department of Medicine (S.M.K.), University of Oxford, UK; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.-M., R.G.W., E.C., G.K., A.K.N., C.R.J.N.), Accra, Ghana; Iganga-Mayuge Health and Demographic Surveillance System (A.K.-M.), Iganga; the Department of Paediatrics and Child Health (A.K.-M.), Makerere University College of Health Sciences, Kampala, Uganda; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) (R.G.W.), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Global Health (R.G.W.), Department of Public Health and Clinical Medicine, Umeå University, Sweden; the Neurophysiology Department (S.W.), Great Ormond Street Hospital for Children, London; the Neurosciences Unit (B.G.R.N., C.R.J.N.), UCL Institute of Child Health, London, UK; Population Health Sciences/Research Support Unit (A.K.N.), Faculty of Health Sciences, Aga Khan University (East Africa), Nairobi, Kenya; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S.), Bucks, UK; Stichting Epilepsie Instellingen Nederland-SEIN (J.W.S.), Heemstede, Netherlands; Clinical Research Unit (C.R.J.N.), London School of Hygiene and Tropical Medicine; and the Department of Psychiatry (C.R.J.N.), University of Oxford, UK
| | - Gathoni Kamuyu
- From Kenya Medical Research Institute-Wellcome Trust Research Programme (S.M.K., E.C., G.K., A.K.N., C.R.J.N.), Kilifi, Kenya; Nuffield Department of Medicine (S.M.K.), University of Oxford, UK; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.-M., R.G.W., E.C., G.K., A.K.N., C.R.J.N.), Accra, Ghana; Iganga-Mayuge Health and Demographic Surveillance System (A.K.-M.), Iganga; the Department of Paediatrics and Child Health (A.K.-M.), Makerere University College of Health Sciences, Kampala, Uganda; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) (R.G.W.), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Global Health (R.G.W.), Department of Public Health and Clinical Medicine, Umeå University, Sweden; the Neurophysiology Department (S.W.), Great Ormond Street Hospital for Children, London; the Neurosciences Unit (B.G.R.N., C.R.J.N.), UCL Institute of Child Health, London, UK; Population Health Sciences/Research Support Unit (A.K.N.), Faculty of Health Sciences, Aga Khan University (East Africa), Nairobi, Kenya; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S.), Bucks, UK; Stichting Epilepsie Instellingen Nederland-SEIN (J.W.S.), Heemstede, Netherlands; Clinical Research Unit (C.R.J.N.), London School of Hygiene and Tropical Medicine; and the Department of Psychiatry (C.R.J.N.), University of Oxford, UK
| | - Anthony K Ngugi
- From Kenya Medical Research Institute-Wellcome Trust Research Programme (S.M.K., E.C., G.K., A.K.N., C.R.J.N.), Kilifi, Kenya; Nuffield Department of Medicine (S.M.K.), University of Oxford, UK; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.-M., R.G.W., E.C., G.K., A.K.N., C.R.J.N.), Accra, Ghana; Iganga-Mayuge Health and Demographic Surveillance System (A.K.-M.), Iganga; the Department of Paediatrics and Child Health (A.K.-M.), Makerere University College of Health Sciences, Kampala, Uganda; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) (R.G.W.), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Global Health (R.G.W.), Department of Public Health and Clinical Medicine, Umeå University, Sweden; the Neurophysiology Department (S.W.), Great Ormond Street Hospital for Children, London; the Neurosciences Unit (B.G.R.N., C.R.J.N.), UCL Institute of Child Health, London, UK; Population Health Sciences/Research Support Unit (A.K.N.), Faculty of Health Sciences, Aga Khan University (East Africa), Nairobi, Kenya; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S.), Bucks, UK; Stichting Epilepsie Instellingen Nederland-SEIN (J.W.S.), Heemstede, Netherlands; Clinical Research Unit (C.R.J.N.), London School of Hygiene and Tropical Medicine; and the Department of Psychiatry (C.R.J.N.), University of Oxford, UK
| | - Josemir W Sander
- From Kenya Medical Research Institute-Wellcome Trust Research Programme (S.M.K., E.C., G.K., A.K.N., C.R.J.N.), Kilifi, Kenya; Nuffield Department of Medicine (S.M.K.), University of Oxford, UK; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.-M., R.G.W., E.C., G.K., A.K.N., C.R.J.N.), Accra, Ghana; Iganga-Mayuge Health and Demographic Surveillance System (A.K.-M.), Iganga; the Department of Paediatrics and Child Health (A.K.-M.), Makerere University College of Health Sciences, Kampala, Uganda; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) (R.G.W.), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Global Health (R.G.W.), Department of Public Health and Clinical Medicine, Umeå University, Sweden; the Neurophysiology Department (S.W.), Great Ormond Street Hospital for Children, London; the Neurosciences Unit (B.G.R.N., C.R.J.N.), UCL Institute of Child Health, London, UK; Population Health Sciences/Research Support Unit (A.K.N.), Faculty of Health Sciences, Aga Khan University (East Africa), Nairobi, Kenya; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S.), Bucks, UK; Stichting Epilepsie Instellingen Nederland-SEIN (J.W.S.), Heemstede, Netherlands; Clinical Research Unit (C.R.J.N.), London School of Hygiene and Tropical Medicine; and the Department of Psychiatry (C.R.J.N.), University of Oxford, UK
| | - Brian G R Neville
- From Kenya Medical Research Institute-Wellcome Trust Research Programme (S.M.K., E.C., G.K., A.K.N., C.R.J.N.), Kilifi, Kenya; Nuffield Department of Medicine (S.M.K.), University of Oxford, UK; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.-M., R.G.W., E.C., G.K., A.K.N., C.R.J.N.), Accra, Ghana; Iganga-Mayuge Health and Demographic Surveillance System (A.K.-M.), Iganga; the Department of Paediatrics and Child Health (A.K.-M.), Makerere University College of Health Sciences, Kampala, Uganda; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) (R.G.W.), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Global Health (R.G.W.), Department of Public Health and Clinical Medicine, Umeå University, Sweden; the Neurophysiology Department (S.W.), Great Ormond Street Hospital for Children, London; the Neurosciences Unit (B.G.R.N., C.R.J.N.), UCL Institute of Child Health, London, UK; Population Health Sciences/Research Support Unit (A.K.N.), Faculty of Health Sciences, Aga Khan University (East Africa), Nairobi, Kenya; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S.), Bucks, UK; Stichting Epilepsie Instellingen Nederland-SEIN (J.W.S.), Heemstede, Netherlands; Clinical Research Unit (C.R.J.N.), London School of Hygiene and Tropical Medicine; and the Department of Psychiatry (C.R.J.N.), University of Oxford, UK
| | - Charles R J Newton
- From Kenya Medical Research Institute-Wellcome Trust Research Programme (S.M.K., E.C., G.K., A.K.N., C.R.J.N.), Kilifi, Kenya; Nuffield Department of Medicine (S.M.K.), University of Oxford, UK; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.-M., R.G.W., E.C., G.K., A.K.N., C.R.J.N.), Accra, Ghana; Iganga-Mayuge Health and Demographic Surveillance System (A.K.-M.), Iganga; the Department of Paediatrics and Child Health (A.K.-M.), Makerere University College of Health Sciences, Kampala, Uganda; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) (R.G.W.), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Global Health (R.G.W.), Department of Public Health and Clinical Medicine, Umeå University, Sweden; the Neurophysiology Department (S.W.), Great Ormond Street Hospital for Children, London; the Neurosciences Unit (B.G.R.N., C.R.J.N.), UCL Institute of Child Health, London, UK; Population Health Sciences/Research Support Unit (A.K.N.), Faculty of Health Sciences, Aga Khan University (East Africa), Nairobi, Kenya; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S.), Bucks, UK; Stichting Epilepsie Instellingen Nederland-SEIN (J.W.S.), Heemstede, Netherlands; Clinical Research Unit (C.R.J.N.), London School of Hygiene and Tropical Medicine; and the Department of Psychiatry (C.R.J.N.), University of Oxford, UK
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Keezer MR, Bouma HK, Wolfson C. The diagnostic accuracy of screening questionnaires for the identification of adults with epilepsy: a systematic review. Epilepsia 2014; 55:1772-80. [PMID: 25377133 DOI: 10.1111/epi.12811] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the diagnostic accuracy of screening questionnaires to identify epilepsy in adults, we performed a systematic review of diagnostic studies that assessed the sensitivity and specificity of such screening questionnaires as compared to a physician's clinical assessment. METHODS We searched Ovid MEDLINE (1946 to present) and Ovid EMBASE (1947 to present) for studies that estimated the sensitivity and specificity of nonphysician administered screening questionnaires for adults with epilepsy. Both telephone and in-person administered questionnaires were included, whether applied to population or hospital/clinic-based cohorts. The risk of bias was assessed using the Quality Assessment of Diagnostic Studies-2 (QUADAS-2) tool. RESULTS Our initial search strategy resulted in 917 records. We found nine studies eligible for inclusion. The estimated sensitivity and specificity of the questionnaires used to identify persons with a lifetime history of epilepsy ranged from 81.5% to 100% and 65.6% to 99.2%, respectively. The sensitivity and specificity of these questionnaires in identifying persons with active epilepsy ranged from 48.6% to 100% and 73.9% to 99.9%, respectively. Overall we found a high risk of bias in patient selection and study flow in the majority of studies. SIGNIFICANCE We identified nine validation studies of epilepsy screening questionnaires, summarized their study characteristics, presented their results, and performed a rigorous quality assessment. This review serves as a basis for future studies by providing a systematic review of existing work. Future research addressing previous limitations will ultimately allow us to more accurately estimate the burden and risk of epilepsy in the general population.
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Affiliation(s)
- Mark R Keezer
- Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Keezer MR, Pelletier A, Stechysin B, Veilleux M, Jetté N, Wolfson C. The diagnostic test accuracy of a screening questionnaire and algorithm in the identification of adults with epilepsy. Epilepsia 2014; 55:1763-71. [DOI: 10.1111/epi.12805] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Mark R. Keezer
- Neuroepidemiology Research Unit; Research Institute of the McGill University Health Centre; Montreal Quebec Canada
- Department of Epidemiology; Biostatistics and Occupational Health; McGill University; Montreal Quebec Canada
| | - Amélie Pelletier
- Neuroepidemiology Research Unit; Research Institute of the McGill University Health Centre; Montreal Quebec Canada
| | - Barbara Stechysin
- Neuroepidemiology Research Unit; Research Institute of the McGill University Health Centre; Montreal Quebec Canada
| | - Martin Veilleux
- Department of Neurology and Neurosurgery; Montreal Neurological Institute and Hospital; Montreal Quebec Canada
| | - Nathalie Jetté
- Department of Clinical Neurosciences and Hotchkiss Brain Institute; University of Calgary; Calgary Alberta Canada
- Department of Community Health Sciences; Institute for Public Health; University of Calgary; Calgary Alberta Canada
| | - Christina Wolfson
- Neuroepidemiology Research Unit; Research Institute of the McGill University Health Centre; Montreal Quebec Canada
- Department of Epidemiology; Biostatistics and Occupational Health; McGill University; Montreal Quebec Canada
- Department of Medicine; McGill University; Montreal Quebec Canada
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Ibinda F, Wagner RG, Bertram MY, Ngugi AK, Bauni E, Vos T, Sander JW, Newton CR. Burden of epilepsy in rural Kenya measured in disability-adjusted life years. Epilepsia 2014; 55:1626-33. [PMID: 25131901 PMCID: PMC4238788 DOI: 10.1111/epi.12741] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The burden of epilepsy, in terms of both morbidity and mortality, is likely to vary depending on the etiology (primary [genetic/unknown] vs. secondary [structural/metabolic]) and with the use of antiepileptic drugs (AEDs). We estimated the disability-adjusted life years (DALYs) and modeled the remission rates of active convulsive epilepsy (ACE) using epidemiologic data collected over the last decade in rural Kilifi, Kenya. METHODS We used measures of prevalence, incidence, and mortality to model the remission of epilepsy using disease-modeling software (DisMod II). DALYs were calculated as the sum of Years Lost to Disability (YLD) and Years of Life Lost (YLL) due to premature death using the prevalence approach, with disability weights (DWs) from the 2010 Global Burden of Disease (GBD) study. DALYs were calculated with R statistical software with the associated uncertainty intervals (UIs) computed by bootstrapping. RESULTS A total of 1,005 (95% UI 797-1,213) DALYs were lost to ACE, which is 433 (95% UI 393-469) DALYs lost per 100,000 people. Twenty-six percent (113/100,000/year, 95% UI 106-117) of the DALYs were due to YLD and 74% (320/100,000/year, 95% UI 248-416) to YLL. Primary epilepsy accounted for fewer DALYs than secondary epilepsy (98 vs. 334 DALYs per 100,000 people). Those taking AEDs contributed fewer DALYs than those not taking AEDs (167 vs. 266 DALYs per 100,000 people). The proportion of people with ACE in remission per year was estimated at 11.0% in males and 12.0% in females, with highest rates in the 0-5 year age group. SIGNIFICANCE The DALYs for ACE are high in rural Kenya, but less than the estimates of 2010 GBD study. Three-fourths of DALYs resulted from secondary epilepsy. Use of AEDs was associated with 40% reduction of DALYs. Improving adherence to AEDs may reduce the burden of epilepsy in this area.
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Affiliation(s)
- Fredrick Ibinda
- KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research - Coast, Kilifi, Kenya
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Kamuyu G, Bottomley C, Mageto J, Lowe B, Wilkins PP, Noh JC, Nutman TB, Ngugi AK, Odhiambo R, Wagner RG, Kakooza-Mwesige A, Owusu-Agyei S, Ae-Ngibise K, Masanja H, Osier FHA, Odermatt P, Newton CR. Exposure to multiple parasites is associated with the prevalence of active convulsive epilepsy in sub-Saharan Africa. PLoS Negl Trop Dis 2014; 8:e2908. [PMID: 24875312 PMCID: PMC4038481 DOI: 10.1371/journal.pntd.0002908] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 04/16/2014] [Indexed: 11/21/2022] Open
Abstract
Background Epilepsy is common in developing countries, and it is often associated with parasitic infections. We investigated the relationship between exposure to parasitic infections, particularly multiple infections and active convulsive epilepsy (ACE), in five sites across sub-Saharan Africa. Methods and Findings A case-control design that matched on age and location was used. Blood samples were collected from 986 prevalent cases and 1,313 age-matched community controls and tested for presence of antibodies to Onchocerca volvulus, Toxocara canis, Toxoplasma gondii, Plasmodium falciparum, Taenia solium and HIV. Exposure (seropositivity) to Onchocerca volvulus (OR = 1.98; 95%CI: 1.52–2.58, p<0.001), Toxocara canis (OR = 1.52; 95%CI: 1.23–1.87, p<0.001), Toxoplasma gondii (OR = 1.28; 95%CI: 1.04–1.56, p = 0.018) and higher antibody levels (top tertile) to Toxocara canis (OR = 1.70; 95%CI: 1.30–2.24, p<0.001) were associated with an increased prevalence of ACE. Exposure to multiple infections was common (73.8% of cases and 65.5% of controls had been exposed to two or more infections), and for T. gondii and O. volvulus co-infection, their combined effect on the prevalence of ACE, as determined by the relative excess risk due to interaction (RERI), was more than additive (T. gondii and O. volvulus, RERI = 1.19). The prevalence of T. solium antibodies was low (2.8% of cases and 2.2% of controls) and was not associated with ACE in the study areas. Conclusion This study investigates how the degree of exposure to parasites and multiple parasitic infections are associated with ACE and may explain conflicting results obtained when only seropositivity is considered. The findings from this study should be further validated. The prevalence of epilepsy is greater in developing countries compared to developed countries, and parasitic infestations are thought to contribute to this increased burden. We conducted a case-control study across five sites in sub-Saharan Africa to investigate the relationship between epilepsy and exposure to parasitic infections, and the association between epilepsy and multiple co-incidental infections. Exposure to Onchocerca volvulus, Toxocara canis and Toxoplasma gondii as well as high antibody levels (top tertile) to Toxocara canis was positively associated with the prevalence of active convulsive epilepsy (ACE). Multiple co-incidental parasitic infections were common, and the combined effect of T. gondii and O. volvulus co-infection on ACE was greater than the sum of the individual effects. The contribution of each of these parasitic infections on the burden of epilepsy in sub-Saharan Africa should be explored.
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Affiliation(s)
- Gathoni Kamuyu
- KEMRI/Wellcome Trust Research Programme, The Centre of Geographical Medicine Research – Coast, Kilifi, Kenya
- Studies of the Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network, Accra, Ghana
- * E-mail:
| | - Christian Bottomley
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - James Mageto
- KEMRI/Wellcome Trust Research Programme, The Centre of Geographical Medicine Research – Coast, Kilifi, Kenya
- Egerton University, Nakuru, Kenya
| | - Brett Lowe
- KEMRI/Wellcome Trust Research Programme, The Centre of Geographical Medicine Research – Coast, Kilifi, Kenya
- Studies of the Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network, Accra, Ghana
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Patricia P. Wilkins
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - John C. Noh
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Thomas B. Nutman
- Laboratory of Parasitic Diseases. National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | - Anthony K. Ngugi
- KEMRI/Wellcome Trust Research Programme, The Centre of Geographical Medicine Research – Coast, Kilifi, Kenya
- Studies of the Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network, Accra, Ghana
- Research Support Unit, Faculty of Health Sciences, Aga Khan University (East Africa), Nairobi, Kenya
| | - Rachael Odhiambo
- KEMRI/Wellcome Trust Research Programme, The Centre of Geographical Medicine Research – Coast, Kilifi, Kenya
| | - Ryan G. Wagner
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Epidemiology and Public Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Angelina Kakooza-Mwesige
- Studies of the Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network, Accra, Ghana
- Iganga-Mayuge Health and Demographic Surveillance System, Iganga, Uganda
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | | | - Faith H. A. Osier
- KEMRI/Wellcome Trust Research Programme, The Centre of Geographical Medicine Research – Coast, Kilifi, Kenya
| | - Peter Odermatt
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Unversity of Basel, Basel, Switzerland
| | - Charles R. Newton
- KEMRI/Wellcome Trust Research Programme, The Centre of Geographical Medicine Research – Coast, Kilifi, Kenya
- Studies of the Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network, Accra, Ghana
- Neurosciences Unit, UCL Institute of Child Health, London, United Kingdom
- Clinical Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Wagner RG, Ngugi AK, Twine R, Bottomley C, Kamuyu G, Gómez-Olivé FX, Connor MD, Collinson MA, Kahn K, Tollman S, Newton CR. Prevalence and risk factors for active convulsive epilepsy in rural northeast South Africa. Epilepsy Res 2014; 108:782-91. [PMID: 24582322 PMCID: PMC4000269 DOI: 10.1016/j.eplepsyres.2014.01.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 11/21/2013] [Accepted: 01/14/2014] [Indexed: 11/21/2022]
Abstract
Epilepsy is prevalent in rural South Africa, but less than other parts of Africa. Most epilepsy starts in childhood. Poor obstetric history and snoring were associated with active convulsive epilepsy. HIV and parasitic infection were not associated with active convulsive epilepsy.
Rationale Epilepsy is among the most common neurological disorders worldwide. However, there are few large, population-based studies of the prevalence and risk factors for epilepsy in southern Africa. Methods From August 2008 to February 2009, as part of a multi-site study, we undertook a three-stage, population-based study, embedded within the Agincourt health and socio-demographic surveillance system, to estimate the prevalence and identify risk factors of active convulsive epilepsy (ACE) in a rural South African population. Results The crude prevalence of ACE, after adjusting for non-response and the sensitivity of the screening method, was 7.0/1,000 individuals (95%CI 6.4–7.6) with significant geographic heterogeneity across the study area. Being male (OR = 2.3; 95%CI 1.6–3.2), family history of seizures (OR = 4.0; 95%CI 2.0–8.1), a sibling with seizures (OR = 7.0; 95%CI 1.6–31.7), problems after delivery (OR = 5.9; 95%CI 1.2–24.6), and history of snoring (OR = 6.5; 95%CI 4.5–9.5) were significantly associated with ACE. For children, their mother's exposure to some formal schooling was protective (OR = 0.30; 95%CI 0.11–0.84) after controlling for age and sex. Human immunodeficiency virus was not found to be associated with ACE. Conclusions ACE is less frequent in this part of rural South Africa than other parts of sub-Saharan Africa. Improving obstetric services could prevent epilepsy. The relationship between snoring and ACE requires further investigation, as does the relative contribution of genetic and environmental factors to examine the increased risk in those with a family history of epilepsy.
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Affiliation(s)
- Ryan G Wagner
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network, Accra, Ghana; MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | - Anthony K Ngugi
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network, Accra, Ghana; KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya; Research Support Unit, Faculty of Health Sciences, Aga Khan University- East Africa, Nairobi, Kenya
| | - Rhian Twine
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network, Accra, Ghana
| | - Christian Bottomley
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gathoni Kamuyu
- KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Myles D Connor
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Borders General Hospital, Melrose, United Kingdom
| | - Mark A Collinson
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kathleen Kahn
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network, Accra, Ghana; MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Stephen Tollman
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network, Accra, Ghana; MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Charles R Newton
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network, Accra, Ghana; MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya; Neurosciences Unit, UCL Institute of Child Health, London, United Kingdom; Clinical Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Ngugi AK, Bottomley C, Fegan G, Chengo E, Odhiambo R, Bauni E, Neville B, Kleinschmidt I, Sander JW, Newton CR. Premature mortality in active convulsive epilepsy in rural Kenya: causes and associated factors. Neurology 2014; 82:582-9. [PMID: 24443454 PMCID: PMC3963418 DOI: 10.1212/wnl.0000000000000123] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective: We estimated premature mortality and identified causes of death and associated factors in people with active convulsive epilepsy (ACE) in rural Kenya. Methods: In this prospective population-based study, people with ACE were identified in a cross-sectional survey and followed up regularly for 3 years, during which information on deaths and associated factors was collected. We used a validated verbal autopsy tool to establish putative causes of death. Age-specific rate ratios and standardized mortality ratios were estimated. Poisson regression was used to identify mortality risk factors. Results: There were 61 deaths among 754 people with ACE, yielding a rate of 33.3/1,000 persons/year. Overall standardized mortality ratio was 6.5. Mortality was higher across all ACE age groups. Nonadherence to antiepileptic drugs (adjusted rate ratio [aRR] 3.37), cognitive impairment (aRR 4.55), and age (50+ years) (rate ratio 4.56) were risk factors for premature mortality. Most deaths (56%) were directly related to epilepsy, with prolonged seizures/possible status epilepticus (38%) most frequently associated with death; some of these may have been due to sudden unexpected death in epilepsy (SUDEP). Possible SUDEP was the likely cause in another 7%. Conclusion: Mortality in people with ACE was more than 6-fold greater than expected. This may be reduced by improving treatment adherence and prompt management of prolonged seizures and supporting those with cognitive impairment.
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Affiliation(s)
- Anthony K Ngugi
- From the KEMRI/Wellcome Trust Research Programme (A.K.N., G.F., E.C., R.O., E.B., C.R.N.), Centre for Geographic Medicine Research-Coast, Kilifi, Kenya; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health (A.K.N., C.B., I.K.), London School of Hygiene and Tropical Medicine, United Kingdom; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.N., E.B., C.R.N.), Accra, Ghana; Research Support Unit, Faculty of Health Sciences (A.K.N.), Aga Khan University (East Africa), Nairobi, Kenya; MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health (C.B., I.K.), London School of Hygiene and Tropical Medicine, United Kingdom; Nuffield Department of Medicine (G.F.), Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, United Kingdom; Neurosciences Unit (B.N., C.R.N.), UCL Institute of Child Health, London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy (J.W.S.), UCL Institute of Neurology, London, United Kingdom; Epilepsy Society (J.W.S.), Chalfont St Peter, United Kingdom; SEIN - Stichting Epilepsie Instellingen Nederland (J.W.S.), Heemstede, the Netherlands; Clinical Research Unit (C.R.N.), London School of Hygiene and Tropical Medicine, United Kingdom; and Department of Psychiatry (C.R.N.), University of Oxford, United Kingdom
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40
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Kariuki SM, Matuja W, Akpalu A, Kakooza-Mwesige A, Chabi M, Wagner RG, Connor M, Chengo E, Ngugi AK, Odhiambo R, Bottomley C, White S, Sander JW, Neville BGR, Newton CRJC, Twine R, Gómez Olivé FX, Collinson M, Kahn K, Tollman S, Masanja H, Mathew A, Pariyo G, Peterson S, Ndyomughenyi D, Bauni E, Kamuyu G, Odera VM, Mageto JO, Ae-Ngibise K, Akpalu B, Agbokey F, Adjei P, Owusu-Agyei S, Kleinschmidt I, Doku VCK, Odermatt P, Nutman T, Wilkins P, Noh J. Clinical features, proximate causes, and consequences of active convulsive epilepsy in Africa. Epilepsia 2013; 55:76-85. [PMID: 24116877 PMCID: PMC4074306 DOI: 10.1111/epi.12392] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE Epilepsy is common in sub-Saharan Africa (SSA), but the clinical features and consequences are poorly characterized. Most studies are hospital-based, and few studies have compared different ecological sites in SSA. We described active convulsive epilepsy (ACE) identified in cross-sectional community-based surveys in SSA, to understand the proximate causes, features, and consequences. METHODS We performed a detailed clinical and neurophysiologic description of ACE cases identified from a community survey of 584,586 people using medical history, neurologic examination, and electroencephalography (EEG) data from five sites in Africa: South Africa; Tanzania; Uganda; Kenya; and Ghana. The cases were examined by clinicians to discover risk factors, clinical features, and consequences of epilepsy. We used logistic regression to determine the epilepsy factors associated with medical comorbidities. KEY FINDINGS Half (51%) of the 2,170 people with ACE were children and 69% of seizures began in childhood. Focal features (EEG, seizure types, and neurologic deficits) were present in 58% of ACE cases, and these varied significantly with site. Status epilepticus occurred in 25% of people with ACE. Only 36% received antiepileptic drugs (phenobarbital was the most common drug [95%]), and the proportion varied significantly with the site. Proximate causes of ACE were adverse perinatal events (11%) for onset of seizures before 18 years; and acute encephalopathy (10%) and head injury prior to seizure onset (3%). Important comorbidities were malnutrition (15%), cognitive impairment (23%), and neurologic deficits (15%). The consequences of ACE were burns (16%), head injuries (postseizure) (1%), lack of education (43%), and being unmarried (67%) or unemployed (57%) in adults, all significantly more common than in those without epilepsy. SIGNIFICANCE There were significant differences in the comorbidities across sites. Focal features are common in ACE, suggesting identifiable and preventable causes. Malnutrition and cognitive and neurologic deficits are common in people with ACE and should be integrated into the management of epilepsy in this region. Consequences of epilepsy such as burns, lack of education, poor marriage prospects, and unemployment need to be addressed.
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Affiliation(s)
- Symon M Kariuki
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute, Kilifi, Kenya; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network, Accra, Ghana; Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Ngugi AK, Bottomley C, Scott JAG, Mung'ala-Odera V, Bauni E, Sander JW, Kleinschmidt I, Newton CR. Incidence of convulsive epilepsy in a rural area in Kenya. Epilepsia 2013; 54:1352-9. [PMID: 23750825 PMCID: PMC4114531 DOI: 10.1111/epi.12236] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2013] [Indexed: 11/27/2022]
Abstract
Purpose There are only a few studies of incidence of epilepsy in low and middle income countries (LMICs). These are often small and conducted in specific age groups or areas where the prevalence of risk factors is high; therefore, these studies are not representative of the wider populations. We determined the incidence of convulsive epilepsy (CE) in a large rural population in Kenya. Methods We conducted two cross‐sectional surveys 5 years apart within a health and demographic surveillance system. Initially we identified residents without epilepsy who were then reexamined in the follow‐up survey to determine incidence. We estimated the overall incidence of CE and incidence by age‐group, sex, and by administrative location. Estimates were adjusted for attrition during case identification and for the sensitivity of the screening method. Key Findings In a cohort of 151,408 people, 194 developed CE over the 5 years. The minimum crude incidence rate was 37.6/100,000 persons per year (95% confidence interval (CI) 32.7–43.3) and adjusted for loss to follow‐up, and the sensitivity of the survey methodology was 77.0/100,000 persons per year (95% CI 67.7–87.4). Incidence was highest in children 6–12 years (96.1/100,000 persons per year; 95% CI 78.4–117.9), and was lowest in the 29–49 year age group (37.4/100,000 persons per year; 95% CI 25.7–54.7). Significance We estimated a high incidence of convulsive epilepsy in this population. Incidence was highest early and late in life, suggesting that preventive interventions should target exposures that occur in these age groups. Incidence of focal epilepsy was more than twice that of generalized epilepsy, suggesting that etiologies that are amenable to intervention were most important in this population. It is likely that incidence is underestimated because of the early mortality of incident cases.
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Affiliation(s)
- Anthony K Ngugi
- KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya.
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Ngugi AK, Bottomley C, Kleinschmidt I, Wagner RG, Kakooza-Mwesige A, Ae-Ngibise K, Owusu-Agyei S, Masanja H, Kamuyu G, Odhiambo R, Chengo E, Sander JW, Newton CR. Prevalence of active convulsive epilepsy in sub-Saharan Africa and associated risk factors: cross-sectional and case-control studies. Lancet Neurol 2013; 12:253-63. [PMID: 23375964 PMCID: PMC3581814 DOI: 10.1016/s1474-4422(13)70003-6] [Citation(s) in RCA: 218] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The prevalence of epilepsy in sub-Saharan Africa seems to be higher than in other parts of the world, but estimates vary substantially for unknown reasons. We assessed the prevalence and risk factors of active convulsive epilepsy across five centres in this region. METHODS We did large population-based cross-sectional and case-control studies in five Health and Demographic Surveillance System centres: Kilifi, Kenya (Dec 3, 2007-July 31, 2008); Agincourt, South Africa (Aug 4, 2008-Feb 27, 2009); Iganga-Mayuge, Uganda (Feb 2, 2009-Oct 30, 2009); Ifakara, Tanzania (May 4, 2009-Dec 31, 2009); and Kintampo, Ghana (Aug 2, 2010-April 29, 2011). We used a three-stage screening process to identify people with active convulsive epilepsy. Prevalence was estimated as the ratio of confirmed cases to the population screened and was adjusted for sensitivity and attrition between stages. For each case, an age-matched control individual was randomly selected from the relevant centre's census database. Fieldworkers masked to the status of the person they were interviewing administered questionnaires to individuals with active convulsive epilepsy and control individuals to assess sociodemographic variables and historical risk factors (perinatal events, head injuries, and diet). Blood samples were taken from a randomly selected subgroup of 300 participants with epilepsy and 300 control individuals from each centre and were screened for antibodies to Toxocara canis, Toxoplasma gondii, Onchocerca volvulus, Plasmodium falciparum, Taenia solium, and HIV. We estimated odds ratios (ORs) with logistic regression, adjusted for age, sex, education, employment, and marital status. RESULTS 586,607 residents in the study areas were screened in stage one, of whom 1711 were diagnosed as having active convulsive epilepsy. Prevalence adjusted for attrition and sensitivity varied between sites: 7·8 per 1000 people (95% CI 7·5-8·2) in Kilifi, 7·0 (6·2-7·4) in Agincourt, 10·3 (9·5-11·1) in Iganga-Mayuge, 14·8 (13·8-15·4) in Ifakara, and 10·1 (9·5-10·7) in Kintampo. The 1711 individuals with the disorder and 2032 control individuals were given questionnaires. In children (aged <18 years), the greatest relative increases in prevalence were associated with difficulties feeding, crying, or breathing after birth (OR 10·23, 95% CI 5·85-17·88; p<0·0001); abnormal antenatal periods (2·15, 1·53-3·02; p<0·0001); and head injury (1·97, 1·28-3·03; p=0·002). In adults (aged ≥18 years), the disorder was significantly associated with admission to hospital with malaria or fever (2·28, 1·06-4·92; p=0·036), exposure to T canis (1·74, 1·27-2·40; p=0·0006), exposure to T gondii (1·39, 1·05-1·84; p=0·021), and exposure to O volvulus (2·23, 1·56-3·19; p<0·0001). Hypertension (2·13, 1·08-4·20; p=0·029) and exposure to T solium (7·03, 2·06-24·00; p=0·002) were risk factors for adult-onset disease. INTERPRETATION The prevalence of active convulsive epilepsy varies in sub-Saharan Africa and that the variation is probably a result of differences in risk factors. Programmes to control parasitic diseases and interventions to improve antenatal and perinatal care could substantially reduce the prevalence of epilepsy in this region.
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Affiliation(s)
- Anthony K Ngugi
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems, International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH), Accra, Ghana.
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