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Anaje OD, Nwani PO, Nwosu MC, Asomugha LA, Anaje CC, Amaechi IA, Ebeogu OG, Oriji SO, Ndukwe CC, Eze LI, Morah NJ, Omaga IC, Ogunniyi A. Prevalence and Patterns of Seizure-related Injuries: A Study of People Living with Epilepsy Found in a Community-based Door-to-door Survey in Southeast Nigeria. Ann Afr Med 2024; 23:628-634. [PMID: 39138960 DOI: 10.4103/aam.aam_39_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/11/2024] [Indexed: 08/15/2024] Open
Abstract
CONTEXT Epileptic seizures and the unpredictable falls resulting from epileptic seizures predispose the people living with epilepsy (PLWE) to various physical injuries as well as postictal cognitive and behavioral changes. AIMS The aim of the study was to determine the frequency and patterns of seizure-related physical injuries, postictal cognitive impairments, and behavioral changes. SETTINGS AND DESIGN This was a cross-sectional descriptive study in a Southeast Nigeria local government area. SUBJECTS AND METHODS PLWE identified during a two-phase door-to-door survey and their caregivers were interviewed using a semi-structured questionnaire. STATISTICAL ANALYSIS USED The Statistical Package for the Social Sciences version 22.0 was used. RESULTS There were 56 cases of active convulsive seizures comprising 33 (58.9%) males and 23 (41.1%) females, with a mean age of 32.9 ± 14.2. The lifetime prevalence of seizure-related physical injuries, postictal behavioral changes, and postictal cognitive impairments was 9.8 per 1000 (95% confidence interval [CI]: 9.1-10.0), 8.4 per 1000 (95% CI: 7.2-9.2), and 6.3 per 1000 (95% CI: 4.9-7.5), respectively. Skin/soft-tissue injuries and tongue laceration were the most frequent physical injuries found in 66.1% ( n = 37/56) and 60.7% ( n = 34/56) of cases, respectively. The frequency of soft-tissue injuries was significantly higher (χ 2 = 5.038; P = 0.0248) in the females 78.3% ( n = 18/23) than the males 48.5% ( n = 16/33). About a third of the females 39.1% had burn injuries compared to 18.1% of the males. CONCLUSIONS Seizure-related injuries are common and have the tendency to increase the burden of epilepsy and epilepsy-related stigma from deformities and the chronic disfiguring scars resulting from such injuries.
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Affiliation(s)
- Obiora Daniel Anaje
- Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Paul Osemeke Nwani
- Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
- Department of Internal Medicine, Department of Mental Health, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Maduaburochukwu Cosmas Nwosu
- Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
- Department of Internal Medicine, Department of Mental Health, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Lasbrey Azuoma Asomugha
- Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
- Department of Internal Medicine, Department of Mental Health, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Chetanna Chioma Anaje
- Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Ifeoma Adaigwe Amaechi
- Department of Medical Rehabilitation, Department of Mental Health, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | | | - Sunday Onyemaechi Oriji
- Department of Psychiatry, Department of Mental Health, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Chinwe Chioma Ndukwe
- Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Linda Ifunanya Eze
- Department of Internal Medicine, Neurology Unit, Enugu State University of Science and Technology Teaching Hospital Parklane, Enugu, Nigeria
| | | | - Imelda Chinenye Omaga
- Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Adesola Ogunniyi
- Department of Internal Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
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Garrez I, Teuwen DE, Sebera F, Kayirangwa J, Düll UE, Dedeken P, Boon PAJM. Converging evidence on the high prevalence of epilepsy in Rwanda: Response to the commentary 'High prevalence of epilepsy in Southern and Northern Rwanda: Myth or reality?'. Trop Med Int Health 2024; 29:844-847. [PMID: 39044349 DOI: 10.1111/tmi.14039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Affiliation(s)
- Ieme Garrez
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
- 4Brain, Department of Neurology, Institute of Neuroscience, Ghent University, Ghent, Belgium
| | - Dirk E Teuwen
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
- 4Brain, Department of Neurology, Institute of Neuroscience, Ghent University, Ghent, Belgium
| | - Fidèle Sebera
- Department of Neurology, Ndera Neuro-Psychiatric Teaching Hospital, Kigali, Rwanda
- Department of Internal Medicine, University Hospital Center - Kigali, Kigali, Rwanda
| | | | - Uta E Düll
- Medicalised Health Center, Gikonko, Rwanda
| | - Peter Dedeken
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
- Department of Neurology, Heilig Hart Ziekenhuis, Lier, Belgium
| | - Paul A J M Boon
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
- 4Brain, Department of Neurology, Institute of Neuroscience, Ghent University, Ghent, Belgium
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Angwafor SA, Watila MM, Njamnshi AK, Sander JW. High prevalence of epilepsy in Southern and Northern Rwanda: Myth or reality? Trop Med Int Health 2024; 29:842-843. [PMID: 38943256 DOI: 10.1111/tmi.14027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Affiliation(s)
- S A Angwafor
- Department of Clinical Sciences, Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
- Department of Neurology, Bamenda Regional Hospital, Bamenda, Cameroon
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
- Brain Research Africa Initiative (BRAIN), Geneva, Switzerland
| | - M M Watila
- Department of Neurology, Aberdeen Royal Infirmary, Foresterhill Health Campus, Aberdeen, UK
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter, UK
| | - A K Njamnshi
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
- Brain Research Africa Initiative (BRAIN), Geneva, Switzerland
- Neuroscience Lab, Faculty of Medicine & Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
- Department of Neurology, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - J W Sander
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter, UK
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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Ogunjimi L, Osalusi B, Fagbemi A, Oyenuga I, Ojini F, Collins S, Elegbede O, Oladele O, Fehintola F. Prescription patterns and therapeutic gaps among persons with epilepsy in Southwestern Nigeria. Front Pharmacol 2024; 15:1430716. [PMID: 39170699 PMCID: PMC11335482 DOI: 10.3389/fphar.2024.1430716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 06/25/2024] [Indexed: 08/23/2024] Open
Abstract
Introduction: Pharmacotherapy with antiseizure medications (ASMs) has been a cornerstone for achieving long-term remissions in persons with epilepsy (PWEs). This study aims to determine the prescription patterns and treatment gaps (TGs) among PWEs. Methods: Accordingly, a descriptive cross-sectional study was conducted with 940 PWEs aged ≥18 years having clinically confirmed diagnosis of epilepsy based on the International League Against Epilepsy (ILAE) criteria. At a scheduled interview with each participant, a previously established questionnaire was used to obtain clinical information relating to epilepsy in terms of the age of onset, etiology, duration of epilepsy, frequency, types, and number of ASMs used. Results: There were fewer male participants [445 (47.4%) vs. 495 (53.6%)] than females, with a higher mean age of onset [(35.19 ± 21.10 vs. 31.58 ± 20.82 years; p = 0.009]. The medication characteristics showed that 336 (35.7%) of the 940 PWEs recruited were not on any ASMs, whereas the remaining 604 (64.3%) patients were on ASMs, with 504 (83.4%) on monotherapy vs. 100 (16.6%) on polytherapy. The PWEs on ASM monotherapy had a higher mean age [40.92 ± 19.40 vs. 33.61 ± 16.51 years; p < 0.001] and higher mean age of onset [34.47 ± 21.80 vs. 25.39 ± 19.78 years; p < 0.001] than those on polytherapy. Furthermore, there were more persons on ASM monotherapy among the participants with seizure duration < 2 years [251 (87.5%) vs. 36 (12.5%)] and seizure duration > 2 years [253 (79.8%) vs 64 (20.2%)]. Conclusion: The majority of the participants receiving ASMs were on monotherapy, with carbamazepine being the most frequently prescribed medication. Furthermore, about a third of the participants had TGs; therefore, healthcare providers should focus on alleviating the TGs among PWEs.
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Affiliation(s)
- Luqman Ogunjimi
- Department of Pharmacology and Therapeutics, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Remo Campus, Ago Iwoye, Nigeria
| | - Bamidele Osalusi
- Department of Medicine, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Remo Campus, Ago Iwoye, Nigeria
| | - Ayotomiwa Fagbemi
- Department of Medicine, Federal Medical Centre Abeokuta, Abeokuta, Nigeria
| | - Ibironke Oyenuga
- Department of Pharmacology and Therapeutics, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Remo Campus, Ago Iwoye, Nigeria
| | - Fedora Ojini
- Department of Biochemistry, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Remo Campus, Ago Iwoye, Nigeria
| | - Samuel Collins
- Department of Pharmacology and Therapeutics, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Remo Campus, Ago Iwoye, Nigeria
| | - Oluwatosin Elegbede
- Stroke Investigative and Research Network Unit, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Olayinka Oladele
- Stroke Investigative and Research Network Unit, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Fatai Fehintola
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
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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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Peng L, Wang M, Zhang XF, Guo DY, Zhai BT, Zou JB, Shi YJ. Research on Pickering emulsification technology based on the concept of “combination of medicine and adjuvant” to improve the pH stability of volatile oil in solid preparations—taking Lingzhu Pulvis as an Example. AAPS OPEN 2023. [DOI: 10.1186/s41120-022-00068-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
AbstractLingzhu Pulvis are widely used in clinical practice because of their therapeutic effects, but their stability and efficacy are affected by the easy oxidation and volatility of Acorus calamus. In this study, we combined the idea of “combination of medicine and adjuvant” and introduced Pickering emulsion technology to use the ingredients of Lingzhu Pulvis as the stabilizer of Pickering emulsion. Pearl powder was selected as the stabilizer by the type of emulsion formation and the state of emulsion layer, and the optimal preparation method was 0.065 g·ml− 1 of pearl powder and 45% oil, prepared using high-pressure homogenization method (500 bar, three times). The malondialdehyde and peroxide contents in the crude oil and Pickering emulsion groups were analyzed under different pH environments, and it was clear that the Pickering emulsion group possessed higher antioxidant properties. The volatile oil of Acorus calamus in different groups was analyzed using GC-MS, and seven differential components were screened by processing the analytical data with R language, which were further determined that the differential components changed more slowly and had significantly improved stability in the Pickering emulsion group. This study provides a reference for the improvement of stability of other solid formulations containing oil in Chinese medicine.
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Patel AA, Birbeck GL. Nigerian Study Validates Wide Variations in Epilepsy Prevalence and Elucidates Potential Targets for Disease Prevention. Neurology 2021; 97:305-306. [PMID: 34253635 DOI: 10.1212/wnl.0000000000012418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Archana A Patel
- From the Division of Epilepsy and Clinical Neurophysiology (A.A.P.), Department of Neurology, Boston Children's Hospital, Harvard Medical School, MA; Epilepsy Division (G.L.B.), Department of Neurology, University of Rochester, NY; Chikankata Epilepsy Care Team (G.L.B.), Chikankata Hospital, Mazabuka; and School of Medicine (A.A.P., G.L.B.), University of Zambia, Lusaka
| | - Gretchen L Birbeck
- From the Division of Epilepsy and Clinical Neurophysiology (A.A.P.), Department of Neurology, Boston Children's Hospital, Harvard Medical School, MA; Epilepsy Division (G.L.B.), Department of Neurology, University of Rochester, NY; Chikankata Epilepsy Care Team (G.L.B.), Chikankata Hospital, Mazabuka; and School of Medicine (A.A.P., G.L.B.), University of Zambia, Lusaka
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