Building Capacity in Epilepsy Care

Ghana Fight Against Epilepsy Initiative

Albert Akpalu1, Cynthia Sottie2, Samuel Odonkor3, Patrick Adjei1, Kodwo Nkromah1, Sammy Ohene4, Edith Annan5, Akwasi Osei6, Tarun Dua7

1Korle Bu Teaching Hopsital, Accra, Ghana; 2Ghana Health Service, Accra, Ghana; 337 Military hospital, Accra, Ghana; 4Mental Health Authority, Accra, Ghana; 5WHO, Accra, Ghana; 6Mental Health Authority, Accra, Ghana; 7WHO, Geneva, Switzerland

Purpose:              The Ghana Fight Against Epilepsy Initiative (FAEI) is a Ministry of Health/WHO Pilot Programme funded by Sanofi Espoir Foundation 2012-2015. The goal is to improve access to care and services for people with epilepsy

Method:              Involved training and monitoring primary health care providers to diagnose, treat and follow up people with epilepsy. Strengthening the health system to improve supply of medicines, supervision, referrals and information systems. The pilot project was implemented in 10 districts of 5 regions (population of about 1.2 million people)

Results:                The project has formed a functional national and 10 district coordinating committees. Trained 14 trainers and supervisors to support 4 master consultant facilitators. Trained 690 primary health care providers and 730 community based volunteers in epilepsy management; 25 health professionals in quantification of medicines. Nearly 65,000 people have been educated on epilepsy as part of community awareness strategies. Religious, traditional/faith healers, family members and carers have been sensitized and involved in this process. A robust monitoring and evaluation strategy, health education materials (4 posters, 2 videos) and a draft National Model for Epilepsy Care have been developed. The project has recorded no seizures in 46 %, reduced seizure frequency in 49 % and a 20.5% reduction in treatment gap from 85% at the implementation sites

Conclusion:        The 4-year pilot project has ended successfully and Ghana is ready to scale up. The FAEI has demonstrated that there are simple, cost-effective ways to improve epilepsy care in resource-poor settings, which can significantly reduce treatment gaps

 

Cost Estimation in Management of Epileptics Followed in Neurology at Fann Teaching Hospital/Dakar

Adjaratou Dieynabou Sow1, Eric Gueumekane Bila Lamou1, Kamadore Toure2, Anna Modji Basse Faye1, Ngor Side Diagne1, Alassane Diop1, Soumaila Boubacar1, Moustapha Ndiaye1, Amadou Gallo Diop1, Mouhamadou Mansour Ndiaye1

1Neurological clinic, Fann teaching hospital, Dakar, Senegal; 2Health UFR, Thies University, Thies, Senegal

Purpose:              Epilepsy, major public health problem, in addition to its medical and social consequences, have a cost. This cost is difficult to evaluate in sub-Saharan Africa due to many contingencies.

Method:              We did a cross-sectional study over 3 months (January to March 2016) in Neurological unit concerning patients known epileptic followed regularly for more than a year. Data analysis made on the software Epi info version 3.5.

Results:                Sample of 59 patients predominance of men (sex ratio of 1.68) and a low education level (65% of primary level) and limited resources (+++ no profession and without pay). Overall average of 6.85-year follow-up. Seizures are mainly generalized and monthly recurring. The average direct cost was estimated at 4.225.946 Fcfa (6.451,86 Euros), the average indirect cost was estimated at 703.800 Fcfa (1.074 Euros), and 451.250 Fcfa (688,93 Euros) for the traditional treatment cost.

Conclusion:        In Senegal, epilepsy cost are too expensive according to the patient’s profile. Thus, the subsidy politics are necessary. A good knowledge of the direct and indirect costs of epilepsy would help in the optimization of real needs of people with epilepsy for a good public health planning to improve their support.

 

Evaluation of seven years decentralized epilepsy consultation by the Senegalese League Against Epilepsy in Pikine (Senegal)

Marieme Soda Diop-Sene, Makhtar Ba, Ousmane Cisse, Moustapha Ndiaye, Amadou Gallo Diop, Mouhamadou Mansour Ndiaye

Fann University Hospital, Dakar, Senegal

Purpose:              Epilepsy is the most common neurologic affection worldwide. In Senegal prevalence ranges from 8 to 14.2‰.With 1 neurologist for 600000 inhabitants and a unique center of reference in the capital, Dakar, access to care is very limited for people living with epilepsy in Senegal. In 2002 the SLAE initiated a weekly consultation of epilepsy in pikine, suburb of Dakar.

the Objectivewas to evaluate the impact on quality and access to care after 7 years of decentralized epilepsy consultation.

Method:              We conducted a retrospective study concerning 832 patients regularly followed for active epilepsy in the district of Pikine from May 2002 to June 2009.

Results:                Mean age was 22, and the mean number of consultations was 3. Antecedents was dominated by infections 24.1%, traumatic brain injuries 18.6%, anoxo-ischemia 15.2%. Seizusres were generalized in 89.3%. EEG was performed in 83.5% and was abnormal in 75.9%. Phenobarbitone was prescribed in 81%and it was a monotherapy in 90%. 100 patients were interrogated concerning access to care, quality of care, and satisfaction. 90% were satisfied and 99% wanted to continue the follow-up in pikine.

Conclusion:        Decentralization improves access to care and quality of life in in people living with epilepsy, and prove disposition of patients to follow a therapy if they are aware. The main limit remains difficult access to antiepileptic drugs. In Senegal, epilepsy rose from 6th to 2nd place in neurology consultation.

 

The role of associations in the management of epilepsy: a case study of the Epilepsy Support Foundation in Zimbabwe

Taurai Kadzviti1, Jacob Mugumbate2

1Epilepsy Support Foundation, Harare, Zimbabwe; 2Bindura Science and Technology, Harare, Zimbabwe

Purpose:              The fight against epilepsy involves the government, private sector and voluntary associations. In this article, the author looks at the role of the voluntary associations using a case study of the Epilepsy Support Foundation which was established in 1990 to provide support to people with epilepsy.

Method:              The article resulted from a review of historical documents at the Epilepsy Support Foundation. Documents included in the review were annual reports, program reports, newspaper articles and banners. In addition, a video documentary was reviewed. The initial report was given to workers who had been at the Epilepsy Support Foundation for more than 10 years so their input.

Results:                On 17 April 1990, a man named Nicholas Arthur George formed the first organisation dedicated to improvement of life of people with epilepsy in Zimbabwe, the Epilepsy Support Foundation (ESF). He was supported in this work by his doctor, the late Professor Laurence Levy a neurosurgeon and parents of children with epilepsy. Although the story of Nick, as he was passionately known, is now history, his story has now become a story of many. The ESF now has over 1600 active members. His charitable life left an indelible mark on all those who worked with him and came to know about the wonderful work he did. Nick passed on in Harare in 1999. Three years after his death, a center was found, named after him and today it is the center piece of epilepsy work in Zimbabwe. The founding of the center fulfilled the founder’s dream: Nicholas had dreamt to have a one stop center for epilepsy with epilepsy to get the best possible treatment, rehabilitation and support.

Conclusion:        By tracing the history and activities of the ESF, it has been concluded that voluntary associations play a vital role in epilepsy management and a recommendation is being made to promote new and existing epilepsy associations in Africa.

 

Nodding Syndrome in northern Uganda – social background and care for the patient community

Yayoi Takei1, Kikuko Sakai2, Taisuke Otsuki3, Takashi Saito4, Sato Yasuaki5, Kazuhiko Moji6, Itaru Ohta2

1Sophia University, Tokyo, Japan; 2Kyoto University, Kyoto, Japan; 3Epilepsy Hospital Bethel Japan, Sendai, Miyagi, Japan; 4National Center for Neurology and Psychiatry, Kodaira, Tokyo, Japan; 5Osaka Sangyo University, Daitoshi, Osaka, Japan; 6Nagasaki University, Nagasaki, Japan

Purpose:              Nodding Syndrome (NS) is an epileptic encephalopathy with unknown etiology causing endemic in northern Uganda. The government has officially reported no case in 2013. However, the effects of the disease are still haunting the families because of the poor access to health facility, resistance to anticonvulsants, progressive mental disability and accidental death. In ordr to empower the patients’ families, Community Based Organization (CBO) was formed in 2013. In order to determine how CBO may affect the community to enhance the families’ sustainable self-support capability, socio-economical background and demography of the village and the activities of CBO were asked to evaluate.

Method:              In September 2014, a household survey was conducted at Lakwela village, Gulu district, using a questionnaire. Activities of Daily Living (ADL) were examined using Barthel Index.

Results:                A survey of 97 households (565) revealed that epilepsy affected 10.3% children (35/339). Epilepsy prevalence was 6.2% (35/565). 26 households had patients, of which 16 households formed CBO. CBO contributed a common field and the labour to cultivate together. They harvested casaba or peanut, which was neither enough for the extra income nor for the young patients’ nutrition. However, they had more meetings than before. On neurological examinations, 24 patients showed nearly normal ADL, though they develped mental retardation.

Conclusion:        With the developing of CBO, their communication improved more than before, and CBO received new visitors from the outside who had left isolated. Hope was being brought about. Acknowledgement: This work was supported by JSPS KAKENHI #JP26570007

 

The first TeleEEG service for the diagnosis of epilepsy in Swaziland – a way forward for Africa?

Stephen Coates1, Mbusomuni Mahlalela1, Manquoba Nkambule1, Edward Shabangu2

1Swaziland Epilepsy Organization, Mbabane, Swaziland; 2Mbabane Hospital, Mbabane, , Swaziland

Purpose:              An estimated 65000 people in Swaziland have epilepsy.  Crucial in the management of epilepsy is in its correct diagnosis. However, there are no specialists in the diagnosis of epilepsy in Swaziland and no fully functioning EEG machines.

The use of TeleEEG offered a potential solution to help in the diagnosis of epilepsy in Swaziland as well as providing feedback on epilepsy management for individual patients.

The purpose of the study was to determine the efficacy of TeleEEG in the diagnosis of epilepsy in Swaziland.

Method:              Over a 3 month period TeleEEG was carried out on 73 patients.  Forty five patients had a provisional diagnosis of focal epilepsy. Twenty patients had a provisional diagnosis of primary generalised epilepsy.  Eight patients were of unknown provisional diagnosis.

The provisional diagnosis of epilepsy based on clinical history was compared to the findings on EEG.

Results:                Of the 45 patients with provisional focal epilepsy the EEG showed focal epileptiform features in 10.  However, three patients showed generalised epileptiform discharges.  Of the twenty patients with a provisional diagnosis of primary generalised epilepsy 2 patients showed generalised epileptiform discharges and five showed focal epileptiform discharges.  Two patients had typical attacks during their EEG recordings.  The EEG during this time was normal.

Management of patients was then adjusted according to the clinical history and EEG findings.

Conclusion:        TeleEEG proved a useful aid in the diagnosis and management of epilepsy in Swaziland and may offer a way forward for Africa.

 

Survey of Healthcare Workers on Psychogenic Non-Epileptic Seizures in Kenya

Dilraj Sokhi, Anthony Ngugi

The Aga Khan University Hospital, Nairobi, Kenya

Purpose:              There are very few studies about Psychogenic Non-epileptic Seizures (PNES) in Africa. PNES are not well diagnosed or managed globally, and PNES patients thus have a lower quality of life. Under the International League Against Epilepsy (ILAE) PNES Task Force, we surveyed PNES knowledge and services in Kenya.

Method:              We carried out a cross-sectional study of healthcare workers identified through regional health centres, medical associations, epilepsy societies and online directories. We included specialist and non-specialist doctors, clinical officers, nurses, and psychologists who managed people with epilepsy. All potential participants were emailed the pre-set survey questionnaire at 0, 8 and 16 months. Results were collated and analysed using SurveyMonkey™.

Results:                We had 79/310 responders (80.6% medical clinical officers; 73.6% hospital-based). 58% saw 5-10 PNES cases annually. 62.8% could not confidently differentiate PNES from epilepsy. Perceived contributing factors were: childhood abuse/trauma (19.8%); personality disorders (42%); HIV-related stigma (43.1%); alcohol (46.8%); and depression (58.8%). 24.6% did not know the psychological basis for PNES. 31.6% told patients PNES was a mental health problem. 51.1%, 16.3% and 2.1% had access to inter-ictal electroencephalography (EEG), electrocardiography, and video-EEG respectively, but the majority felt <10% of patients had access to these investigations. For treatment, 43.5% referred to another specialist but only 18.9% specifically for psychotherapy. 42.3% stated no psychotherapy was available locally. 20.3% prescribed drugs including anti-epileptics. Only 36.8% of patients were followed up.

Conclusion:        Knowledge and capacity for management of PNES amongst healthcare workers in Kenya is poor, and calls for a national approach to improve PNES care pathways.

 

Building Capacity for Epilepsy Care at the Primary Healthcare Level in Fontem, South West Region, Cameroon

Nkouonlack Cyrille1, Tatah Godwin2, Njamnshi Alfred3

1Buea Regional Hospital, Buea, South West Region, Cameroon; 2Yaounde Central Hospital, Yaounde, Central Region, Cameroon; 3Faculty of Medicine and Biomedical Sciences, The University of Yaounde 1, Yaounde, Central Region, Cameroon

Purpose:              Epilepsy is a common neurological disorder with a very high prevalence in Cameroon. Within the framework of task-shifting to improve epilepsy care, a training programme for non-physicians had been embarked since 2000, highlighting the need of clarification of roles and responsibilities in the setting. (Njamnshi et al, Epilepsia, 2009, 50(9):2167–2173). The objectives of this training were; to improve the epilepsy diagnosis and management skills of non-specialist health care workers, to educate community health workers on psychosocial aspects of epilepsy, and to promote collaboration.

Method:              Participants were invited from health centers in Fontem.  The training was done by a Neurologist using slide presentations developed from the WHO Information kit on epilepsy and the mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings. Practical sessions included videos presentations and direct patient assessments, with discussions on diagnosis and choice of antiepileptic drug. Collaboration was maintained between the health centers and the Neurologist in view of future evaluation of outcomes.

Results:                Nine participants were trained, including 2 Physicians, 5 Nurses and 2 Community-Health Workers. 24 patients were assessed clinically during the practical sessions with clarification of diagnostic and management challenges. The training was successful as participants` feedback was very positive and collaboration has been maintained with the Neurologists for referrals and   evaluation of outcomes.

Conclusion:        This training aimed at enhancing the capacity of health care workers and promoting collaboration in epilepsy care, with the hope of f reducing stigma and treatment gap in this setting.

 

Epilepsy in Primary Care: a pilot experience of online education in Latin America

Jaime Carrizosa1, Patricia Braga2

1University of Antioquia, Medellín, Antioquia, Colombia; 2University of Uruguay, Montevideo, Uruguay

Purpose:              The aim was to decrease the diagnostic and therapeutic gap in epilepsy, through a virtual course, language and cost-friendly, devoted to primary care physicians in Latin America.

Method:              The project was designed by the ILAE Education Commission and submitted to evaluation by ILAE. It included 8 topic specific modules of 1-week duration each, including epidemiology, clinics, diagnostic procedures, drug treatment, social and legal aspects. A 16 member Latin American teaching team (Spanish and Portuguese) developed the contents. Virtual platform and formal accreditation were obtained through international University collaboration. Repositories and discussion forums were developed. Approval and certification required passing the final exam.

Results:                38 professionals from 9 countries started the course: 22 of them worked in primary care. 33 participants completed the course and 32 approved the final exam. Students ranked the course as of low/intermediate difficulty; mean duration time was 4 to 6 hours/week. 95% qualified the interactive experience as good/very good. 97% would recommend this course to other colleagues. 20% felt confident on epilepsy patients´ management before the course, increasing up to 65% after the course. The total cost of the course was 4000 USD with a revenue of 1250 USD.

Conclusion:        Our experience showed positive results on all predefined specific aims of the project: attendance, feasibility and achievement of learning goals. Current challenges can be summarized as consolidating the initiative and optimizing the inclusion of the targeted population, particularly developing a bilingual platform (Spanish-Portuguese). Long term challenges would include continuous update of the contents, balance between stability and renewal of teaching staff, financial sustainability and adaptation to emerging technologies.

 

Drug Therapeutics

Metabolics variations, haptoglobine’s place in epileptics followed in Fann Teaching Hospital; Dakar – Senegal

Adjaratou Dieynabou SOW1, Anna Modji Basse Faye1, Mamadou Moustapha Sarr2, Moustapha Ndiaye1, Amadou Gallo Diop1, Mouhamadou Mansour Ndiaye1, Pape Madièye Guèye3

1Neurological Clinic, Fann Teaching Hospital, Dakar, Senegal; 2Health UFR, Thies University, Thies, Senegal; 3Pharamaceutical Biochemy, Medical and Pharmaceutic Faculty, Cheikh Anta Diop University, Dakar, Senegal

Purpose:              Global public health problem, epilepsy is a chronic condition requiring medication long term, likely of adverse reactions and/or biological and metabolic disturbances. We tried to check changes in lipid parameters that may arise during antiepileptic treatment (AET), and to study the influence of the haptoglobine (Hp)’s polymorphism on the development of epilepsy.

Method:              Longitudinal prospective study (October 2012-December 2013) with epileptics followed at least 2 years, under treatment, well-monitored, effective dose, without prejudging of epilepsy types. Patients were matched with controls healthy, similar in age and sex. Blood samples were taken at rest, fasting. Analysis by Mann-Whitney test to compare patients and witnesses (significant p<0.05).

Results:                38 epileptics and 38 witnesses: majority of women and 20-39 years. Epilepsy evolved since 2-30 years, treated by monotherapy (52.6%), mainly phenobarbital (71%) and Carbamazepine (44,73%) from 2-28 years. No significant difference between patients and witnesses for the blood glucose and HDL cholesterol, but significant rise in the epilepsy of total cholesterol, LDL, triglycerides, urea and increased. Significantly greater frequency of seizures with profile Hp2.2.

Conclusion:        The significant increase in lipid and renal parameters in epileptics during treatment would suggest exposure to cardiovascular complications. This phenomenon could be mediated by the 2.2 haptoglobine more frequent in our epileptics, where increasing their seizures. Another explanation is the blood homocysteine increase by associated with folic acid reduction in long term epilepsy treatment. Susceptibility’s differences among epileptics could be linked to functional polymorphism of genes coding for enzymes/proteins including the haptoglobine.

 

Therapeutic follow-up of persons with epilepsy by plasmatic dosage of anti-epileptic drugs at Centre National et Universitaire Hubert K. Maga of Cotonou

Constant Adjien, Dieu Donné Gnonlonfoun, Nadège Avode, Dismand Houinato

Neurologie,Centre National et Universitaire Hubert K. Maga, Cotonou, Benin

Purpose:              The main objective is to study the therapeutic follow-up of people with epilepsy (PWE) by plasmatic dosage of medication antiepileptic drugs (AED) at the CNHU-HKM of  Cotonou (Benin).

Method:              The cross-sectional and descriptive study looked at a sample of 70 (PWE). This study took place between March and December 2012 at the Centre National Hospitalier et Universitaire Hubert K Maga (CNHU-HKM) of  Cotonou (Benin).

. The dosage was done by the CMIA method (dosage immunological microparticular by chemiluminescence). Data was analyzed by the software Epi info.

Results:                The PWE 70 were divided into 36 patients of male and 34 female patients, is a sex-ratio of 1.1. The average age was 26.1 years ± 17.8 years. Generalized seizures tonico-cloniques were the most predominant with 74.3%. The study showed that the average plasma concentration after the assays carried out by CMIA 15,77 µg/ml ± 11.32 µg/ml for phenobarbital with 14 subjects of 48 who had a therapeutic concentration; 4.73 µg/ml ± 3.66 µg/ml for carbamazepine including 10 topics on 21 had a therapeutic concentration. and 60,35 ± 25,55 µg/ml µg/ml for acid valproic and 5 topics on 11 had a therapeutic concentration. Sex, age and the regularity of the medication, the frequency of seizures and side effects were the factors influencing plasma levels.

Conclusion:        This study to know the clinical, therapeutic and biological PWS studied characteristics and especially to control their adherence

 

Epidemiology

Epilepsy in schools of a rural community in Niger: a teacher-based survey

BOUBACAR Soumaila1, Djibrilla Ben Adji2, Youssoufa Maiga3, Moumini Hrouna4, Kamadore Touré5, Moustapha Ndiaye5, Eric Adéhossi6

1Integrated Health Center of Sakoira, Sakoira, Tillabéri, Niger; 2Department of Medicine and medical specialties, Niamey, Niger; 3Department of Neurology, University hospital of Gabriel Touré, Bamako, Mali; 4District hospital, Tillabéri, Niger; 5Department of Neurology , Fann National hospital, Dakar, Senegal; 6Department of Medicine and medical specialties, Niamey, Niger

Purpose:              Epilepsy is a common disorder amongst school aged children. There is no study targeting epilepsy in a school environment in Niger. The objective of this work is to determine the knowledge and attitudes of teachers about epilepsy in a rural area of Niger.

Method:              This was a cross-sectional, descriptive and analytic study, carried out from March 2014, to September 2014 in Sakoira, Niger. Teachers of this community, who gave their verbal consent were asked to fill a pre-tested questionnaire on their knowledge and attitudes towards epilepsy.

Results:                We included 52 teachers. The majority were females (70%). Mean age of participants was 32 years. Twelve percent declared have never heard about epilepsy and 27% had no idea about the possible causes of epilepsy. Witchcraft was cited as a cause of epilepsy by 8% of teachers. Up to 42% of teachers claimed epilepsy was a contagious disease, and 27% of them acknowledged that children with epilepsy were marginalized. Seizure frequency was the main explanation of absenteeism for 75% of teachers. One half of participants believe that epilepsy could lower academic achievements, and for 37%, epilepsy is incurable. For 21% of teachers, traditional treatment was the best option for epilepsy.

Conclusion:        Many wrong believes about epilepsy still exist amongst teachers in this rural area of Niger. Yet, there is a need to organize educational campaigns about epilepsy in school environment in rural areas of Niger.

 

Prevalence of Active Convulsive Epilepsy in Bombali District Sierra Leone

Durodami Radcliffe Lisk1, Francis Moses2, Virginia George2

1College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; 2Ministry of Health and Sanitation, Freetown, Sierra Leone

Purpose:              To determine the prevalence and determinants of active convulsive epilepsy in the Bombali district of Sierra Leone using a one stage screening methodology.

Method:              We designed a simple questionnaire to identify people with active convulsive epilepsy in a rural district in Sierra Leone.  Case definition of ACE was determined by the following 4 questions all of which should be answered in the affirmative: 1. Was there convulsion? 2. Was there loss of consciousness? 3. Was there more than one attack? 4. No associated fever with attacks? At least one attack should have occurred in the past year.

Other information collected were demographic details of the patient, relevant medical history related to possible aetiology such as birth injury, delayed development, history of meningitis, cerebral malaria and family history of epilepsy.  We also collected information related to use of traditional treatment, faith healing and social issues such as smoking and drinking.

Eight out of the 13 chiefdoms in the rural Bombali district were randomly selected for the study and a door to door survey of every household in the selected chiefdoms was done by Community Health Workers trained for the exercise.

Results:                We identified 820 people with ACE out of a population of 300662 in the area surveyed giving a crude prevalence rate of 2.7/1000. The mean age was 22 years (95% CI = 21 – 22). 52.6% were males and 47.4% females. The age group of peak prevalence was 15-24 years.  80% of patients had used traditional treatment while 27.7% had sought faith healing.  73% had taken anti-epileptic medication.  25% gave a history of either birth difficulties such as prolonged labour or delayed developmental milestones.  33.9% of respondents had severe malaria requiring hospital admission as a child and 21.8% gave a history of epilepsy affecting first degree relatives.

Conclusion:        The crude prevalence of epilepsy in this rural population as determined by this one stage method is lower than expected. This is likely due to stigma related concealment . This appears to be a major problem in Sierra Leone. In the recently concluded National Census in December 2015, only 2271 self reported cases of epilepsy out of a population of 7 million were identified.

More robust methods such as the three stage screening methodology may give more accurate results.

 

Medical care of epilepsy in a semi-urban area in Burkina-Faso: challenges and prospects. Example of the Hospital Regional Center of Ouahigouya. About 110 patients

Alassane Drave1, Christian Napon2, Anselme Dabiligou2, Marie Julie Kyelem2, Raphael Kabore3, Labodi Djingri Lompo3, Ousseni Diallo1, Desire Sankara4, Hamadou Kabore2, B. Jean Kabore2

1University Hospital Center of Ouahigouya, Ouahigouya, Yatenga, Burkina-Faso; 2National University Hospital Center Yalgado Ouedraogo, Ouagadougou, Kadiogo, Burkina-Faso; 3University Hospital Blaise Compaoré Tengandogo, Ouagadougou, Kadiogo, Burkina-Faso; 4Medical Imaging Center of Ouagadougou, Ouagadougou, Kadiogo, Burkina-Faso

Purpose:              Epilepsy is a chronic brain disease, affecting 2.4 million people annually in the world. Its diagnosis is not always easy. It can be easily treat. We propose to describe the clinical profile, electro clinical, imaging and treatment of our patients.

Method:              Prospective descriptive study on the period of September 2015 to December 2016, about 110 epileptic patients in General Medicine at the Hospital Regional Center of Ouahigouya.

Results:                The average age of the patients was 18 years with extremes of 7 months and 60 years. The sex ratio was 1.8. Academic problems were objectified in 65 patients. The seizures were immediately widespread in 46 patients and on driving and focal seizures in 64 patients. History were more represented by suffering fetal acute. Neurological examination found abnormalities in 32 patients. The magnetic resonance imaging performed in 8 patients was pathological in 5 patients of which 2 cases of bilateral hippocampal sclerosis and 3 cases of unilateral hippocampal sclerosis. The brain scan noted 16 anoxo-ischemic lesion cases. 62 patients responded favorably to monotherapy treatment and 10 in the therapy combination. 38 cases of therapeutic window.

Conclusion:        The diagnosis of epilepsy, sometimes difficult, requires a thorough investigation of the crises, physical examination, electroencephalography, tomodensitométric and magnetic resonance imaging. Treatment is easy, but the molecules are unavailable or inaccessible.

 

Seizure‐related injuries and associated factors among persons with epilepsy at regular seizure follow up clinics in Ethiopia

Yared Yifru

Addis Ababa University, Addis Ababa, 14, Ethiopia

Purpose:              Patients with epilepsy (PWE) can sustain different injuries. Severity of seizure related injuries (SRI) differ in type and their determinants. This study was conducted to assess prevalence of SRI and associated factors.

Method:              Cross‐sectional retrospective survey was conducted July 1 to September 1, 2013, in seizure follow-up clinics of two hospitals in Addis Ababa. A total of 298 epilepsy patients, > 15 years of age, with unequivocal clinical and/or EEG diagnosis of epilepsy were included

Results:                Overall SRI was 38.25%; multiple-injuries (8.8%); lacerations (54.2%), burn (19.8%) and dental loss (15.8%). SRI was negatively associated with educational status (OR 0.11; 0.01-0.84). Age, sex, religion, marital status, occupation, and living situations were not associated. PWE diagnosed 6-10 years (OR 0.51; 0.27, 0.96) and 1-5 years ago (OR 0.29; 0.14, 0.58) had less chance of SRI. Last seizure within last 1 month had more SRI than seizures > 2 years ago. Last seizure 6 months to 2 years ago had less SRI (OR = 0.42 (0.20, 0.86) than seizures within last 6 months. No association obtained between SRI and onset of treatment

Conclusion:        The study documented significant levels of SRI with varied levels of severity, most commonly soft tissue and burn injuries. Associated factors were less educational status, long-standing epilepsy, and day-time attacks. We recommend increases awareness for epilepsy patients, care-givers and professionals on SRI; set up surveillance and monitoring for SRI; design interventions to reduce SRI at home, workplace and public spaces and continued advocacy on behalf of epilepsy patients.

 

Epilepsy de novo in adults at the Teaching Hospital Hubert K. Maga of Cotonou

Constant Adjien, Dieu Donné Gnonlonfoun, Brandon Ekanmian, Dismand Houinato

Clinique Universitaire de Neurologie, Centre National Hospitalier et Universitaire Hubert K. Maga, Cotonou, Bénin, Bénin

Purpose:              The objective of this work is to study the epidemiological and  clinical aspects of epilepsy de novo in adults at the Neurological Clinic of Teaching Hospital  Hubert K. Maga of Cotonou

Method:              This was a retrospective, descriptive and analytical study that cover a period of 5 years from 1st January 2011 to 31th December 2015 and involved 203 cases of patients aged over 18 years selected according to an extensive recruitment. Data were entered into the Microsoft ACESS software and analysed in SPSS version 21 software.

Results:                The hospital prevalence of epilepsy de novo in adults  was 67%, 95% CI [60.5% – 73.5%]. This prevalence was 76.7% among males versus 69% among females (p = 0.03). It also increased significantly with age until reaching 97.9% among subjects over 50 years (p <10-6). The mean age of people with epilepsy was 36.4 years and the sex ratio was 1.03. Generalized tonico-clonic epilepsy crisis were the most frequent (72.8%) and 94.9% of subjects were taking medication. Epilepsy de novo in adults was strongly associated with hypertension (p = 0.00) and stroke (p = 0.010). It was symptomatic in 58.8% of cases and vascular aetiologies (23.5%) and traumatic ones (15.4%) were most common.

Conclusion:        These results suggest that epilepsy de novo in adults is a reality fact at Teaching  Hospital of Cotonou.

 

Clinical and epidemiological aspects of epilepsy associated with onchocerciasis in the Democratic Republic of Congo

Daniel Okitundu Luwa E-Andjafono1, Jean-Marie Kashama wa Kashama1, Béatrice Bora Koba2, Nicole Mashukano3, Billy Kunyu Shako4, Tommy Nseka4, Guy Bumoko Makila-Mabe1, Jean-Pierre Banea-Mayambu3, Dieudonné Mumba Ngoy4, Désiré Tshala-Katumbay5

1Centre Neuro-Psycho-Pathologique, Université de Kinshasa, Kinshasa, DR Congo; 2Faculté de Médecine, Université de Lubumbashi, Lubumbashi, DR Congo; 3PRONANUT, Kinshasa, DR Congo; 4Département de Médecine Tropicale, Université de Kinshasa, Kinshasa, DR Congo; 5Institut National de Recherche Biomédicale, RDC; and Department of Neurology & Oregon Institute of Occupational Health Sciences, Kinshasa, DR Congo

Purpose:              To elucidate the risk factors as well as the biological markers of epilepsy in onchocerciasis-endemic areas.

Method:              In the Kasangulu health district in DRC, September 2014, a team of trained physicians had face-to-face interviews with 91 epileptic (aged 8-50 years) and 35 non epileptic (aged 9-55years) consenting subjects and close relatives to confirm the diagnosis of epilepsy using the International League Against Epilepsy guidelines.  Anthropometric measurements were used for nutritional assessment. Snip skin biopsies were performed to confirm OV (onchocerca volvulus)-infection. Plasma cytokines were measured using the Human cytokine magnetic 30-plex (Life Technologies, CA).

Results:                Stunted growth was found in 59.5 % (95%CI: 54.3-64.5) in children aged 5 – 18 years. Skin biopsies showed evidence of OV infestation in 79.1% of epileptic subjects. The median (± IQR) age for the onset of epilepsy was 13 (10-16) years. Familial history of epilepsy was reported in 68/88 of epileptic subjects vs. 14/28 in non-epileptic subjects (50%) (OR 3.4; CI 95%: 1.4-8.3; p=0.006). Most subjects (71.6%) reported generalized tonico-clonic seizures, with head nodding preceding the generalization of seizures in 3/88 cases (3.4%). Logistic regression indicated that epilepsy was associated with onchocerciasis [OR=: 5.3 CI 95%1.7 – 14), p =0.004], low levels of growth factor EGF (ß= – 0.012; OR 0.99, CI 95% 0.98-0.99; p=0.019), IL-8 (ß= – 006, CI 95% 0.99-1.00; p= 0.047), and high levels of IFN-α (ß= 0.93, CI 95% 1.098-1.19; p= 0.027).

Conclusion:        Poor nutrition, inflammation, and changes in EGF may be implicated in the pathogenesis of epilepsy associated with onchocerciasis.

 

A 3 year audit of adult epilepsy care in a Nigerian tertiary hospital (2011-2013)

Wemimo Alaofin

General Hospital, Ilorin, Kwara, Nigeria

Purpose:              The study was carried out to evaluate care given to people with epilepsy over a 3 year period with the aim of determining potentials for improvement.

Method:              Medical records of patients with uncomplicated epilepsy who have attended the neurology clinic at the University of Ilorin Teaching Hospital for not less 12 months between years 2011and 2013 were reviewed

Results:                A total of 125 patients were as evaluated; of which 64 (51%) were males and 61 (49%) were females. Their median age was 26 (21-40) years and median seizure duration of 9 (4-15) years. Close to 65% of the patients were below 30 years of age. Most patients (68%) were referred by general practitioners/family physicians. Generalized epilepsy was the predominant seizure type seen in 73 (58%) patients. Majority of patients (76%) were on antiepileptic drug (AED) monotherapy, and 28 (22%) were on two AEDs combination. Eighty-one patients (64%) used carbamazepine either singly (63%) or in combination (18%) at an average dose of 600 mg/day. The two other common AEDs used were: Sodium valproate (45%) and phenobarbitone (9%). Fifty-one patients (41%) had good seizure control (no seizure in preceding 1 year), 34 (27%) had partial control (<12 attacks/year) and 41 (36%) had poor control (>1 attack/month). Overall, 66 patients (48%) had their medication changed between 2 and 3 times in the course of treatment, and the most common reason was poor seizure control. Twenty-one (21%) did not comply with the use of given AED.

Conclusion:        Less than half of our patients had good epilepsy control. To improve on drug compliance attending physicians need to prescribe more of the relatively cheaper AED like the phenobarbitone and to optimize drug dosage before switching to another

 

Epileptology of first seizure and risk of seizure recurrence

Michail Koutroumanidis, Elisa Bruno

Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom

Purpose:              To assess whether prediction of a second seizure depends on the early epilepsy type diagnosis.

Method:              Incident cohort of 150 consecutive patients (99 men) with first generalized convulsive seizure (GCS). All had brain imaging and video EEG (sleep deprived in 116 patients). Mean follow-up 1,121.5±757.7 days; min 365 days

Results:                53 patients (35.3%) had idiopathic and 97 (64.7%) symptomatic (57) / probably symptomatic (40) epilepsies. Of the non-idiopathic, 40 (46.5%) had temporal lobe (TLE), 17 (19.8%) had frontal lobe (FLE), 29 (33.7) had focal of undetermined lobar origin, and 11 (7.3%) unclassified epilepsy. EEG epileptic discharges (ED) occurred in 103 patients (68.7%), generalized in 42 and focal in 61. 100 patients (66.7%) (33 with and 67 with non-idiopathic) had a second GCS after mean times of 306.8 and 226.6 days respectively. The risk was highest within the first year (52.7%, 95% CI 44.9-60.8) and in particular in the first six months (38.0%, 95% CI 30.8-46.3). The risk at 6 months was significantly lower in idiopathic (26.4%) than in the non-idiopathic (44.3%). Diagnosis of TLE or FLE bears higher risk (p=0.000) compared to undetermined onset. Modulators / triggers and early treatment reduce the risk (p=0.05 and 0.02 respectively).  In non-idiopathic, focal ED (p=0.05), focal imaging changes (p=0.06) and age <60 (p=0.01) were independent risk factors.

Conclusion:        Early epilepsy diagnosis is possible in the majority of patients with a first GCS, enabling appropriate treatment. Recognition of seizure precipitants and patient education can prevent a second GCS recurrence as much as early treatment.

 

Pattern of presentation of epilepsy and its educational impact in Nigerian children with newly diagnosed epilepsy

Oluwatosin Olorunmoteni, Saheed Oseni, Jerome Elusiyan, Jide Joriah

Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun, Nigeria

Purpose:              Epilepsy is a highly prevalent neurologic condition in children. In developing countries, it is characterized by delayed presentation with resultant adverse effect on physical well-being and educational opportunities. We therefore sought to determine the pattern of presentation of children with epilepsy and its impact on their education.

Method:              Consecutive children with newly diagnosed epilepsy were recruited prospectively at the Paediatric Neurology clinic of OAUTHC, Ile-Ife, Nigeria. Demographic data, seizure variables and seizure-related injuries were obtained. Impact of epilepsy on education at diagnosis was classified into whether patients had never attended school, stopped schooling, repeated classes or doing well in school since onset of epilepsy.

Results:                Fifty patients were studied with a mean±SD age of 6.4 ± 4.5 years and a male to female ratio of 2.3:1. About half of the subjects were from low socioeconomic class (44.0%). The mean age of seizure onset and mean duration of seizures prior to presentation were 4.7years and 22.2 months respectively. Epilepsy was generalized in 41 (82.0%), and localization-related in 9 (18.0%). Seizure related injuries were found in 12 (24.0%) of the subjects with majority having lacerations (14.0%). Majority of the patients had never attended school while 16% had stopped schooling due seizures and 20.0 % had poor academic performance. Duration of seizure before presentation was significantly associated with seizure-related injuries at diagnosis and poor educational impact (p=0.014 and 0.044 respectively).

Conclusion:        Early presentation should be encouraged in children with epilepsy in order to reduce risk of seizure related injuries and poor educational impact.

 

Epilepsy in onchocerciasis endemic regions in the Democratic Republic of the Congo (DRC)

Robert Colebunders1, Deby Mukendi2, Michel Mandro3, Alliance Tagoto4, Housseini Dolo5, Floribert Tepage6, Gisele Musinya6, Anne Laudisoit1, Jean Marie Kashama7, Patrick Suykerbuyk1

1University of Antwerp, Antwerp, Belgium; 2University of Kinshasa, Kinshasa, DR Congo; 3Provincial Health Division Ituri, Bunia, DR Congo; 4UNIKIS, Kisangani, DR Congo; 5International Center of Excellence in Research, Bamako, Mali; 6National Onchocercosis Control Program, Kisangani, DR Congo; 7UNIKIN-CNPP, Kinshasa, DR Congo

Purpose:              To document the prevalence of epilepsy in onchocerciasis endemic regions in the DRC and to describe the clinical characteristics of onchocerciasis associated epilepsy.

Method:              Between 2014 and 2016, we conducted epilepsy prevalence surveys in 61 villages in onchocerciasis endemic areas in the DRC. Case control studies were performed in Bas-Uélé, Tshopo and Ituri Province, respectively. Cases were patients with active convulsive epilepsy and controls were age matched controls randomly selected from the same village.

Results:                A high prevalence of epilepsy was observed in villages located closely to Simulidae (blackfly) infested rivers: 2.3-6.4% in Bas-Uélé, 1.5-6.0% in Tshopo, and 3.0-5.6% in Ituri. Peak onset of epilepsy was around the age of 11 (SD=7.64). Most persons with epilepsy reported bilateral tonic-clonic seizures, nodding syndrome was not observed but adolescent with epilepsy with severe stunting and without secondary external signs of sexual development were observed. Phenobarbital was the anti-epileptic drug most frequently used but rarely continuously. In areas where Ivermectin was never distributed, Onchocerca volvulus microfilaria were observed in skin snips of 55.9% (33/59) epilepsy cases compared to 24.6% (17/69) of controls (p = 0.002); mean density of microfilaria (Mf) in skin snips of cases was 33.6 parasites/mg skin compared to 3.8 parasites/mg skin in controls (p = 0.002); and 45.8 % (27/59) of cases had OV16 antibodies compared to 26.1% (18/69) of controls (p = 0.002).

Conclusion:        The prevalence of epilepsy in villages in onchocerciasis endemic areas in the DRC was 2-10 times higher than in non-onchocerciasis endemic regions in Africa. Our study confirms that OV infestation is associated with epilepsy.

 

Neuropsychology

Clinical assessment of sleep profile in an epileptic patient’s series

Lala Bouna Seck1, Aicha Yaborko Kodio2, Anna Basse2, Fatoumata Ba1, Moustapha Ndiaye2, Amadou Gallo Diop2, Mouhamadou Mansour Ndiaye2

1Gaston Berger University, Saint Louis, Senegal; 2Fann teaching hospital, Dakar, Senegal

Purpose:              We aimed to describe the clinical profile of sleep in a series of epileptic patients

Method:              We collected personal and clinical data on 100 patients followed-up for epilepsy in the neurological department of Fann teaching hospital in Dakar through a cross-sectional study during 4 months. We used a questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS) and the Hospital Anxiety and Depression Scale (HAD)

Results:                Patients were 16 to 65 years old with 47% aged from 16 to 25 years. 54% were male. 69% suffered from generalized seizures and 31% from partial seizures. 58% had idiopathic epilepsy, while 16% had symptomatic one. For 61% of patients, seizures occurred most often during wakefulness. Anxiety symptoms were more frequent than depression ones. 51% were good sleepers and 49% poor sleepers, with 86% of heavy sleepers. According to PSQI, most patients (not far from 100%) had a good efficiency of sleep, were in good shape during daytime, had almost no sleep disorders, and a few (20%) were complaining of daytime sleepiness.  However, 60% of patients were complaining of a poor quality of sleep.

Conclusion:        We notice that epileptic patients may have a good quality of sleep, but a subjective perception of this later. Further studies of factors interfering with sleep in such patients should allow to better understand this process.

 

Psychiatry

Psychiatric comorbidity in African patients with epilepsy – Experience from Sierra Leone

Tenema Mbayo1, Michal Tomek2

1College of Medicine, University of Sierra Leone, Freetown, Sierra Leone; 2Basildon University Hospital, Basildon, Essex, United Kingdom

Purpose:              To investigate the prevalence and determinants of depression and anxiety among people with epilepsy in Sierra Leone

Method:              A screening tool previously validated in the primary healthcare setting in Zambia was administered to 142 adult patients with epilepsy in our clinics in Freetown (urban) and Kenema (rural), Sierra Leone. This tool scores from a minimum of 10 to a maximum of 40 points to 10 questions asked.  The diagnostic cut off point for depression and/or anxiety is 18. In addition various socio-demographic and clinical characteristics were recorded for each patient . Chi squared test was used to determine significant association of these variables.

Results:                The mean score for the sampled population was 16.3. Thirty nine patients (27.5%) scored 18 or above thus satisfying the criteria for depression and/or anxiety.  Variables showing significant association with these psychiatric comorbidities were female gender (p<0.015), seizure frequency of >2per month (p<001),  and self reporting of sedation and/or dizziness as side effects of antiepileptic medications (p<0.006).  There was no difference between rural and urban populations.

Conclusion:        Depression and anxiety are common in patients with epilepsy in Sierra Leone. Given the negative impact on quality of life,  primary health care workers in Sierra Leone should be trained to use simple tools to diagnose and ultimately treat those affected.

 

Management of psychiatric disorders in patients with epilepsy

Zaineb El Moutassim, Fatima Asri

Medecine Faculty of Cadi Aayad University of Marrakech, Marrakech, Marrakech, Morocco

 

Purpose:              This work aims to review evidence-based guidelines of major psychiatric comorbidities of epilepsy, namely mood and anxiety disorders and psychoses. We will propose practical and adapted stratégies to the specific needs of patients with this condition.

Method:              Critical litterature review of articles through PubMed supplemented with data from scientific presentations.

Results:                Generally, new psychotropic agents are better tolerated with few side effects and a low potential for drug interactions with antiepileptic drugs. Careful attention to special needs of the patient, to drug–drug interactions and the adoption of individualized doses and titration schedules represent important variables.

Conclusion:        Psychiatric disorders in epilepsy are still underdiagnosed and undertreated. Better recognition will help to implement appropriate treatment programs, and improve functional outcomes and quality of life in people with epilepsy.

 

Status Epilepticus

Juvenile myoclonic epilepsy (EMJ) at the Fann CHNU of Dakar (Senegal)

Fatimata Hassane DJIBO1, Lala Bouna Seck2, Moustapha Ndiaye2, Kamadore Touré2, Amadou Gallo DIOP2, Mouhamadou Mansour NDIAYE2

1University Mohamed V, Rabat, Morroco; 2CHNU Fann UCAD, Dakar, Senegal

Purpose:              To study the electro-clinical, therapeutic and evolutionary aspects in nineteen patients.

Method:               Prospective study from May 2014 to July 2015 at the epileptology consultation of the clinical neurophysiology department

Results:               19 cases( 11 H +9 F), sex ration( 1,22), average starting age(16,15 years, extremes 9 to 30). Most affected age : 14 to 19 years, frequency: 36,85 %. familial epilepsy (73.68%), consanguinity (5.26%). Myoclonic + CGTC (64%), absences (10%). Pathologic EEG  all patients. The most characteristic epileptic discharge was the poly-wave-wave complex,  corresponds to the results in other studies (57.89%). PHB was the most used treatment and allowed the control of seizures (63,15 %). Neurological examination was normal . Favorable evolution: (78.45%).

Conclusion:        Our results corroborate with those of the other published series concerning the age of onset, clinical semiology and evolution. Treatment and EEG do not match. The PHB allowed crisis control in 63.15% .

 

Stigma, Discrimination & Access to Care

Quality of life in adults with epilepsy in a Cameroonian referral hospital

Hotcho Corine

Faculté des Sciences delLa Santé de Cotonou, Université d’Abomey Calavi, Cotonou, Littoral, Benin

Purpose:              The aim of this study was to determine the quality of life (QOL) of adults with epilepsy.

Method:              A cross sectional and descriptive study was conducted from February to July 2013 at the Neurology Department of the Yaoundé Central Hospital. Patients were adults aged at least 18 years old with a diagnosis of active epilepsy. Only patients with at least 1 year of follow-up were included. Data on QOL were obtained by Quality of Life in Epilepsy-31 Inventory: QOLIE-31. A score less than 50 corresponded to poor QOL. The univariate analysis was performed using SPSS version 17.0 software. Differences were considered to be significant for p-values <0.05.

Results:                During the study, 82 patients were enrolled. The mean age was 32.3 ± 11.5 (extremes 18-65 years old) with 51.2% of male. The mean duration of epilepsy was 9.3 ± 9.1 (range 1-48 years). The mean total score of QOLIE-31 was 59.67 ± 16.57 (range 26-97). A poor QOL score was found in 30.5% of patients. The lowest subscale was worry seizures with a mean of 42.9 ± 29.9. The factors that influenced negatively QOL were high seizure frequency (>10 seizures / year) [P = 0.02, CI = 1.24-12.56], antiepileptic drugs effects [P = 0.03, CI= 1.05-7.63] and previous traditional treatment [P = 0.01, CI = 1.34-14.46].

Conclusion:        The quality of life was poor at 1/3 of patients. A good seizures control and patient information remain essential for better QOL of adults with epilepsy in Cameroon.

 

Quality of life in adults with epilepsy in a Cameroonian referral hospital

Hotcho Corine¹, Sini Victor², Kuate Tegueu Calixte², Nguefack Seraphin², Ngoungoure Halima F.S³, Njamnshi Alfred², Njientcheu Vincent De Paul²

1University Abomey Calavi, Faculty of Medecine, CNHU Neurology, Cotonou, Benin; 2University of Yaoundé 1, Faculty of Medecine, Yaoundé, Cameroon; 3University Cheikh Anta Diop, Faculty of Medicine, CHNU FANN, Neurology, Dakar, Senegal

Purpose:              determine the quality of life (QOL) of adults with epilepsy.

Method:              A cross sectional and descriptive study was conducted from February to July 2013 at the Neurology Department of the Yaoundé Central Hospital. Patients were adults aged at least 18 years old with a diagnosis of active epilepsy. Only patients with at least 1 year of follow-up were included. Data on QOL were obtained by Quality of Life in Epilepsy-31 Inventory: QOLIE-31. A score less than 50 corresponded to poor QOL. The univariate analysis was performed using SPSS version 17.0 software. Differences were considered to be significant for p-values <0.05.

Results:                During the study, 82 patients were enrolled. The mean age was 32.3 ± 11.5 (extremes 18-65 years old) with 51.2% of male. The mean duration of epilepsy was 9.3 ± 9.1 (range 1-48 years). The mean total score of QOLIE-31 was 59.67 ± 16.57 (range 26-97). A poor QOL score was found in 30.5% of patients. The lowest subscale was worry seizures with a mean of 42.9 ± 29.9. The factors that influenced negatively QOL were high seizure frequency (>10 seizures / year) [P = 0.02, CI = 1.24-12.56], antiepileptic drugs effects [P = 0.03, CI= 1.05-7.63] and previous traditional treatment [P = 0.01, CI = 1.34-14.46].

Conclusion:        The quality of life was poor at 1/3 of patients. A good seizures control and patient information remain essential for better QOL of adults with epilepsy in Cameroon.

 

Spouse-led education to reduce stigma and improve Epilepsy care

Larbie Thomas1, Francisca Larbie1, Patrick Adjei2

1Larbie family, Accra, Ghana; 2Epilepsy Society of Ghana, Accra, Ghana

Purpose:              In Ghana there is a high rate of stigma associated with epilepsy. The level of misconceptions about epilepsy relating to marriage, family life, child birth and education makes it more difficult living with epilepsy

Method:              The spouse of a person living with Epilepsy has started and is leading an educational initiative to contribute to the reduction of stigma associated with epilepsy and also demonstrating practical ways in living with epilepsy.  The Larbie family have participated in documentaries focusing on epilepsy and stigma by Seth Kwame Boateng, titled “I shake, I fall, I die” which incidentally won the Journalist of the year award in 2015, and have received training from the Epilepsy Society of Ghana and the Ghana Fights against Epilepsy Initiative

Results:                The spouse led awareness drive has educated 4,203 persons inclusive of talks to schools, different church denominations and the general public from July 2014 to date in several localities in the Greater Accra region.   After one of the presentations a gentleman from the audience said “If I had know these information or had this education earlier my brother wouldn’t have died”. Several persons living with epilepsy who were previously untreated have been referred to the Epilepsy clinic by the initiative.

Conclusion:        The spouse-led approach is unique and breaks many barriers and should be emulated across the continent to bring Epilepsy out of the shadows. Persons and families living with epilepsy can live a more fruitful and a fulfilling life with education and awareness creation

 

Barriers to employment for people with epilepsy in Harare, Zimbabwe

Jacob Mugumbate

University of Newcastle, Newcastle, New South Wales, Australia

Purpose:              People with epilepsy encounter numerous barriers to employment resulting in economic losses for themselves and their countries. There is an absence of research on epilepsy and employment in Zimbabwe. Hence this study sought to understand employment barriers with a view to developing effective strategies.

Method:              This qualitative study involved 30 in-depth interviews with people with epilepsy in Harare, Zimbabwe’s capital, and a focus group discussion with seven service providers at Epilepsy Support Foundation. Data were analysed using N-Vivo, a computer-assisted qualitative data analysis package.

Results:                Five barriers to employment were found: misconceptions about epilepsy; competing traditional and medical treatment approaches; ongoing gaps in public service provision; challenging job-seeking and workplace environment; and an individualistic service ethos. Misconceptions were barriers to social inclusion, access to treatment, and education and employment opportunities. Traditional healing practices, though mostly ineffective, were still the first port of call leading to delayed medical treatment, which, once accessed, led to seizure control. Poor public policies and services failed to reduce employment disadvantages, resulting in a challenging job-seeking environment. Employed participants faced an absence of employment services and persistent negative social attitudes in the workplace. They nevertheless demonstrated resilience and sound self-management skills in negotiating many of these difficulties.

Conclusion:        Employment opportunities were precarious due to avoidable barriers, such as negative beliefs, stigma, delayed treatment, and inaccessible public services. Policies need to create the conditions to reduce employment barriers and services need to be more accessible to enable people with epilepsy to gain access to employment.

Acknowledgement

This research was conducted in fulfilment of the requirements for a PhD at the University of Newcastle, New South Wales, Australia.

 

Epilepsy and its experience in southern Benin

Gnonlonfoun Dieu Donné1, Adjien Constant1, Adoukonou Thierry2, Goudjinou Gérard3, Sohou Prudence3,Houinato Dismand1

1FSS/UAC, Cotonou, Littoral, Benin; 2UP, Parakou, Borgou, Benin; 3CNHU-HKM Cotonou, Littoral, Benin

Purpose:              Its aims at the experience of epilepsy in two southern departments in Benin (West Africa).

Method:              This was a cross-sectional study that covered April to June 2016. It covered 168 epileptics. They were recruited exhaustively in the health centers of the two southern departments of Benin (Zou and Littoral) from medical and non-medical sources. The Epi-info 6.04 d fr. was used for the data analysis.

Results:                Approximately 1/10 epileptic reported to have a poor health. 39.9% considered themselves sick most of the time. They believed to live under a spiritual spell (20.8%) and 3.6% of epileptics believed the disease was contagious. 42.3% thought they would have accidents during the crises and 25.6% thought they would die during the crises. The epileptic feels isolated (stigmatized) (29.8%), and 39.9% feel ashamed to inform people about their disease. The strong belief in the contagiousness of the disease is a factor favoring the stigmatization.

Conclusion:        The study reveals the importance of the cultural and social constraints on the experience of epileptics. They remain stigmatized despite vast campaigns of awareness carried out in Benin by the Benin League against Epilepsy.

Keywords: Epilepsy, common belief, stigmatization, Benin.

 

Accessibility to antiepileptic drugs by epileptics in rural areas in Benin

Dieu donné Gnonlonfoun1, Adjien Constant1, Adoukonou Thierry2, Goudjinou Gérard3, Sohou Prudence3, Houinato Dismand1

1FSS/UAC, Cotonou, Littoral, Benin; 2UP, Parakou, Borgou, Benin; 3CNHU-HKM Cotonou, Littoral, Benin

Purpose:              It aims at studying the accessibility to antiepileptic drugs by epileptics in rural areas in Benin.

Method:              This was a transversal study that took place from May to July 2015 in Agbangnizoun, a rural municipality in Benin. It covered 228 people, including 48 agents of the field, 168 epileptics, 8 prescribers and 4 from administrative staff. Epileptics are recruited in health centers from medical and non-medical sources. The Epi-info 6.04 d fr. was used for the data analysis.

Results:                The mean duration of the disease was 9 ± 8.5 years [1-42 years]. Epilepsy was diagnosed in 50% by traditional healers. 17.3% were taking medicinal plants. Phenobarbital was the only antiepileptic available. 117 (69.6%) of epileptics purchase it in appropriate drugs stores. It took an hour for 1% to get supplies. 89% of distributors regularly have antiepileptic breaks. 65% reported to use other supply structures because of the medicine unavailability in the usual place. Financial constraints were found in 34.6% of cases, compared with 63% physical barriers (distance to obtain supplies) and 18.9% for social barriers (stigma, lack of information).

Conclusion:        This study highlighted several factors that explain the difficult accessibility to antiepileptic in rural areas in Benin. It is important to wage awareness campaigns and assistance to the distributors in order to improve the rate of its accessibility.

Keywords: Epilepsy, anti-epileptic, accessibility, Benin

 

Lives of people with epilepsy at work in Dakar

Fidelie Scholastique Ngoungoure Halima, Moustapha Ndiaye, Annick Mélanie Magnerou, Hamza Hamza, Adjaratou D Sow, Mouhamadou Mansour Ndiaye

Department of Neurology-Fann National Teaching Hospital-Cheikh Anta Diop University-Faculty of Medicine, Dakar, Senegal

Purpose:              The purpose of this study was to determine the experience of people with epilepsy (PWE) at their workplace in Dakar.

Method:              This was a cross-sectional study conducted from May to July 2014 at the Neurology Clinic of the Fann National Teaching Hospital. A self-administered questionnaire was completed by 43 adults PWE working in Dakar, during their routine consultation. The following data were collected: demographics, professions, clinics, therapeutics, the information of their employer about their illness, analysis of the impact of epilepsy on their profession and vice versa. Statistical analysis was performed using SPSS 18.0 software.

Results:                The mean age was 36 years (range 21-58) with a sex ratio of 1.15. Most PWE (95%) were on monotherapy. The mean disease duration was 15.9 years. The tertiary sector was the most represented among workers (98%) and 81% belonged to the private sector. Most of PWE (78%) had informed their employers about their illness. Twenty-four PWE (56%) though that work had an impact on their epilepsy, among them 18 noted an increase in the frequency of their seizures. In turn, 84% of PWE found that epilepsy had an impact on their work: two-third felt discriminated because of their illness mainly by job degradation (6), lack of promotion (7), threat of dismissal (4); while others incriminated epilepsy in absenteeism (14) and somnolence (9) at work.

Conclusion:        The PWE working in Dakar had experienced a mutual impact between their illness and their work. Discrimination was real and well present in this population.

 

The Need for Epilepsy Mobile Clinics to Plug the Knowledge Gap in Rural Settings

Marie Angele Abanga

The Gbm Foundation for Epilepsy and Mental Wellbeing, Douala, Littoral, Cameroon

Purpose:              Expose the knowledge gaps in rural settings which frustrates access to diagnosis and care, and to fight the stigma surrounding Epilepsy

Method:              Base line study was conducted, results analyzed, medical mission organized and carried out with a visiting neurologist

Results:                Many persons living with epilepsy are abandoned to themselves, most will hardly go to a hospital or get properly diagnosed for various reasons especially lack of access to care

Conclusion:        Just like maternity clinics, the introduction of epilepsy mobile clinics will tremendously help bring epilepsy out of the shadows in rural areas. The more people talk about it, the more stigma is combatted.

 

Public’s perception and mental representations of epilepsy in Kinshasa

Etiennette Mukwanga Ebwilanzem1, Daniel Okitundu Luwa E-Andjafono1, Richard Ngub’Usim Mpey Nka2

1Centre Neuro-Psycho-Pathologique, Université de Kinshasa, Kinshasa, DR Congo

2Faculté de Psychologie et Sciences de l’Education, Université de Kinshasa, Kinshasa, Kinshasa, DR Congo

Purpose:              Public’s perception of epilepsy in the Democratic Republic of Congo is dominated by magic-religious thoughts so that epilepsy is considered as a disease of spiritual origin, demonic or due to the witchcraft. This study tried to understand this superstitious perception for an adequate management of epilepsy in Congolese area.

Method:              A case study analyzed believes, descriptions and behaviors related to epilepsy among 13 subjects living in Kinshasa. It was about 5 women and 8men who accepted to participate in the study and whose age varied from 18 to 41 years. There were 12 singles and 1 married, and all Christian. Interview technique by a guide talk and content analysis technique have been used.

Results:                It emerged from this study that 10 out of 13 participants (76.9 %) had the thought of death when observing epileptic seizures and perceived the sexual act with an epileptic as dangerous to oneself or to the other one and thought that one cannot get married an epileptic.  Epilepsy was also a contagious disease for 7/13 (54.8 %). The prevention of epilepsy thus therefore not  to marry an epileptic for 10 on 13 (76.9 %).In addition, they believed  that the people capable of treating epilepsy were traditional healers and medical doctors  in  both 10/13 (76. 6 %).

Conclusion:        This study shows the need for a biopsychosocial approach to effectively combat and study epilepsy in Congolese settings.

 

Knowledge,attitudes and practices of healthcare professionals with respect to epilepsy in public hospitals in Douala

Jacques Doumbe1, Donald Phalmond Bikek1, Callixte Kuate2, Alfred Njamnshi2

1Faculty of Medicine and Pharmaceutical Sciences, Douala, Cameroon; 2Faculty of Medicine and Pharmaceutical Sciences, Yaounde, Cameroon

Purpose:              the aim of our study was to evaluate the knowledge,attitudes and practices of healthcare professionals with respect to epilepsy in public hospitals in douala.

Method:              This cross-sectional descriptive study was carried out from december 2015 to april 2016 by an interview with participants using a structured and pretested questionnaire constituted of 39 items addressing to 650 healthcare professionals(medical and paramedical) of district hospitals in Douala-Cameroon.

Results:               Four hundred and fifteen healthcare professionals were retained for the study with a favorable answer rate of63.84%.Ninety-seven point eigtht percent had received a lesson on epilepsy ,23.1% said epilepsy was contagious, 65.8% said epilepsy could be treated;19.3% thought epilepsy was a mental disease,86.7% had witnessed a seizure,and 78.3% would turn the patient on the side during the seizure.Factors associated with poor knowledge were female gender(p=0.002),low level of education(p=0.001) and professional experience less than 5 years(p=0.036).Factors associated with negative attitude were being single(p=0.030),low level of education(p=0.0001).Age between 30-39 year was associated with bad practices(p=0.047).The predictor factor of negative attitude was the belief that epilepsy was contagious.

Conclusion:        We found a poor level of knowledge,negative and discriminative attitudes and acceptable practices with regards to epilepsy.

 

Traditional Medicine and Epilepsy / Fostering Collaboration with Traditional Healers

Epilepsie et médecine traditionnelle: connaissances, attitudes et pratiques des tradithérapeutes de la ville de Bamako (Mali)

Diallo Seybou Hassane, Maiga Y, Diallo S, Sogoba Y, Coulibaly D, Coulibaly A, Traore I, Keita B.

Service de Neurologie CHU Gabriel Toure, Bamako, Mali

Purpose:              La haute prévalence de l’épilepsie dans les pays en développement en général et en Afrique en particulier est bien documentée. En dépit de cette situation cette pathologie reste méconnue dans notre contexte. Les facteurs socioculturels influencent la perception de cette maladie en Afrique. Ainsi les tradithérapeutes constituent le premier niveau de recours pour la majorité des patients. Ce constat a motivé ce travail qui avait pour objectif d’étudier les connaissances, attitudes et pratiques des tradithérapeutes de la ville de Bamako.

Method:              Il s’agissait d’une étude descriptive, analytique et prospective qui s’est déroulée de Janvier 2010 à Décembre 2010. Elle a porté sur les tradithérapeutes de la ville de Bamako regroupés au sein de la fédération des herboristes et tradithérapeutes du Mali (FEMATH).

Results:                sur 1134 tradithérapeutes recensés par la FEMATH dans le district de Bamako, l’étude a porté sur 150 tradithérapeutes soit 13,22% des membres. La tranche d’âge de 41-60 ans était la plus représentée (53.3%) et 52,7% était de sexe masculin. La majorité (66.67%) avait une expérience professionnelle de plus de 10 ans. En ce qui concerne les connaissances, 36% disaient que l’épilepsie touchait tous les âges ; 58.67% affirmaient que l’épilepsie n’était pas contagieuse, 28.67% trouvaient le contraire. Dans notre échantillon, 34% des  tradithérapeutes pensaient que l’épilepsie pouvait toucher la descendance de celui qui soigne cette maladie. La quasi totalité des tradithérapeutes  (97.33%) affirmaient que les épileptiques ne devaient pas mener certains métiers seulement 2.67% estimaient qu’ils pouvaient faire toutes les taches. Pour 34,67% des tradithérapeutes les épileptiques pouvaient avoir des difficultés pour se marier et 47.33% déclaraient que la maladie pouvait être  une cause de divorce. Plus  de la moitié des tradithérapeutes (62.67%)  affirmaient que l’épilepsie était curable. Comme  moyens thérapeutiques, les plantes étaient utilisées par 22,67%, les prières par 3,33% ; les incantations et invocations des esprits par 13,33%.

Conclusion:        Notre travail à l’instar des études précédentes confirment l’importante des tradithérapeutes dans le réseau de prise en charge des patients épileptiques au Mali. Ce travail nous a permis de monter la méconnaissance de cette maladie par les tradithérapeutes. Nous pensons qu’une meilleure connaissance des réseaux de prise en charge des patients au niveau des tradithérapeutes permettra d’améliorer la prise en charge et la qualité de vie des patients épileptiques.

 

Place of traditional medicine in management of epilepsy in Guinea

Elhadj Saidou Balde1, Fodé Abass Cisse1, Abdoulaye Toure1, Yamourougbe Kouyate1, Aliou Mamadou Balde2

1Université Gamal Abdel Nasser, Conakry, Guinea; 2Centre de recherche et de valorisation des plantes médicinales, Dubréka, Guinea

Purpose:              In Guinea, few studies have been carried out on the cause of the delay in the management of epilepsy. The aim of this study was to analyze the place of traditional medicine in the therapeutic itinerary of epileptic patients which consult at the Neurologic department of Ignace Deen National Hospital

Method:              This was a prospective and descriptive study of epileptic patients. A structured interview schedule was used to obtain demographic data, perception of seizure and care facilities which were consulted by the epileptic patient. Data were descripted as mean ± SD for quantitative variable and proportion for qualitative variables. Analyses were performed by using SPSS version 20

Results:                Forty epileptic patients (21 Men; 19 Women) with a mean age of 22.28 ± 11.15 years participated in the study. 75 % of the patients (30/40) were unemployed or students; and first seek treatment in traditional medicine. Only one patient among those who consulted in traditional medicine did not consult later in conventional medicine. 25 % of the patients (10/40) first seek treatment in conventional medicine, four patients were consulted in traditional medicine later. The cost of treatment, the family recommendations were the principal reason for consultation in traditional medicine. Spiritual and medicinal plants are the principal remedies.

Conclusion:        In Guinea, traditional medicine is the first health facility for the epileptic patients. It is necessary to instaure communication between traditional healers and physicians regarding knowledge and perception of epilepsy in order to improve the epilepsy management in Guinea.

 

Antiepileptogenic and neuroprotective effects of aqueous extract of the roots of Pergularia daemia (Forsk.) on pilocarpine-induced status epilepticus in mice

Antoine Kavaye Kandeda1, Simon Pale2, Fleur Clarisse Moto Okomolo1, Germain Sotoing Taiwe2, Elisabeth Ngo Bum3

1University of Yaounde I, Yaounde, Centre Region, Cameroon; 2University of Buea, Buea, South West Region, Cameroon; 3University of Ngaounder, Ngaoundere, Adamawa Region, Cameroon

Purpose:              Pergularia daemia is used in Cameroonian folk medicine for the management of febrile seizure and epilepsy. Considering the current need for new classes of drugs able to prevent epileptogenesis, we assessed the potential antiepileptogenic and neuroprotective efficacy of P. daemia aqueous extracts.

Method:              After inducing status epilepticus by pilocarpine (360 mg/kg), mice were treated orally once daily for 7 days with sodium valproate (300 mg/kg), vitamin C (250 mg/kg), or P. daemia (4.9, 12.3, 24.5, and 49 mg/kg). Then, animals were challenged with pentylenetetrazol, and memory and cognition assessed in the elevated plus maze (EPM) and T-maze paradigms. After sacrifice, antioxidant enzymes determined. Otherwise, embryonic rat primary cortical cultures were exposed to glutamate. Subsequently, the amount of cell survival was measured by LDH and MTT assays. Hoechst and propidium iodide were used for determining apoptotic and necrotic cell death.

Results:                P. daemia extracts increased (p<0.01) the latency to myoclonic jerks, clonic seizures and generalized tonic-clonic seizures, and the seizure score. In addition, P. daemia extracts decreased (p<0.001) the initial and retention transfer latencies in the EPM, and increased (p<0.001) the time spent and the number of entries in T-maze novel arm. P. daemia extracts also increased (p<0.05) the antioxidant enzymes superoxide dismutase, catalase, and glutathione, and decreased malondialdehyde levels. P. daemia extracts increased viability rate of the primary cortical neurons after glutamate-induced excitotoxicity. Also, P. daemia extract provides its neuroprotective effects mainly by decreasing apoptotic cell death rate.

Conclusion:        These results suggest that P. daemia has antiepileptogenic and neuroprotective properties.

 

Anticonvulsant effects of Cymbopogon giganteus extracts with possible effects on fully kindled seizures and depression in experimental rodent model of epilepsy induced by pilocarpine

Simon Pale1, Antoine Kavaye Kandeda2, Fleur Clarisse Moto Okomolo2, Germain Sotoing Taiwe1, Elisabeth Ngo Bum3

1University of Buea, Buea, South West Region, Cameroon; 2University of Yaounde I, Yaounde, Centre Region, Cameroon; 3University of Ngaoundere, Ngaoundere, South West Region, Cameroon

Purpose:              The leaf extract of Cymbopogon giganteus L. (Amaryllidaceae) is widely used in traditional Cameroonian medicine as antiepileptic remedy and mood disorders associated with epilepsy. Hence, this study was conducted to evaluate the effects of an aqueous extract of Cymbopogon giganteus (34, 80, 170, 340 mg/kg) against seizures, depression-like behaviour and oxidative stress in pentylenetetrazole (PTZ)-induced kindling in mice.

Method:              The effects of Cymbopogon giganteus on pilocarpine (360 mg/kg)-induced kindling, kindling-induced depression like-behaviour and oxidative stress were evaluated. Depression was assessed using tail suspension test and forced swim test while the oxidative stress parameters were estimated in the whole brain.

Results:                Oral administration of Cymbopogon giganteus aqueous extract significantly increased the latency to myoclonic jerks (p<0.001), clonic seizures (p<0.001) as well as generalized tonic-clonic seizures (p<0.01), improved the seizure mean stage (p<0.01) and decreased the number of myoclonic jerks (p<0.01) in PTZ-kindled mice. The data indicated also that the plant extracts significantly reduced the immobility (p<0.001) times in the tail suspension test and the forced swim test. This active fraction has also antioxidant properties by decreasing the lipid peroxidation, and augmenting endogenous antioxidant enzymes in brain.

Conclusion:        These results suggest that pretreatment with C4.4 ameliorates convulsions-induced by PTZ, protects mice against kindling development, depression-like behaviour and oxidative stress in PTZ-kindled mice. These finding provides scientific rationale for the use of Cymbopogon giganteus extracts for the amelioration of epilepsy observed in traditional medicine in Cameroon.

 

Effects of an aqueous extract of Anthocleista djalonenesis (Gentianaceae) on seizures and behavioral alterations in a mouse model of mesial temporal lobe epilepsy induced by kainate

Germain Sotoing Taiwe1, Antoine Kavaye Kandeda2, Fleur Clarisse Moto Okomolo2, Simon Pale1, Elisabeth Ngo Bum3

1University of Buea, Buea, South West Region, Cameroon; 2University of Yaounde I, Yaounde, Centre Region, Cameroon; 3University of Ngaoundere, Ngaoundere, Adamawa, Cameroon

Purpose:              Despite the increasing number and variety of antiepileptic drugs, nearly 30% of epileptic patients who receive appropriate medical attention have persisting seizures. As mesial temporal lobe epilepsy is often associated with resistance to antiepileptic drugs, the pharmacological reactivity to Anthocleista djalonenesis aqueous extracts (20, 40, 80 and 160 mg/kg) of epileptic mice was assessed in this study.

Method:              Both morphological and electroclinical features of human mesial temporal lobe epilepsy have been shown to be mimicked by unilateral injection of 20 mM solution of kainate in the dorsal hippocampus of adult Swiss mice. After an initial status epilepticus and a latent period of two weeks, mice develop spontaneous recurrent hippocampal focal seizures and morphological modifications reminiscent of hippocampal sclerosis.

Results:                Intrahippocampal electroencephalographic recordings showed three distinct phases of paroxystic activity following unilateral injection of kainate into the dorsal hippocampus of adult mice. Hippocampal paroxysmal discharges were significantly suppressed (p<0.001) by Anthocleista djalonenesis aqueous extracts. The number of crisis (n/20 min), the cumulative duration of crisis (sec/20 min), and the mean duration of crisis (sec) recorded in kainate-treated mice were significantly decreased (p<0.001) in all pre-treated mice with the aqueous extracts (40-160 mg/kg). Kainate kindling-induced significant oxidative stress and brain GABA content alteration that was reversed by pretreatment with the aqueous extracts (40-160 mg/kg) in a dose-dependent manner.

Conclusion:        The results indicate that pretreatment with the aqueous extracts of Anthocleista djalonenesis improves mesial temporal lobe epilepsy-induced by kainate, protects mice against kindling development and oxidative stress, and improves brain GABA content in pentylenetetrazole-kindled mice.

 

Basic Sciences

The way we are : photosensitive epilepsy control study of two family groups 25 years later

Domenico Chirchiglia, Attilio Della Torre

University of Catanzaro ” Magna Graecia “, Catanzaro, Italy

Purpose:              To evaluate the state of photosensitive epilepsy in 2 family groups 25 years later

Method:              A clinical-electroencephalographic study was carried out25 years ago in two family groups of photosensitive epileptics, with variability of photoparoxysmal response in each of the 2 groups, one made up of two young women, one of which suffering from generalized seizures, the other, by two females and one male, the females suffering from partial and generalized seizures. AED therapy, sodium valproate, was administered, with reduction in seizure frequency on both groups. The two groups were monitored for 25 years.

Results:                Currently, after 25 years, the clinical-EEG study anything has’changed : EEG-PPR persistent and  both partial and generalized epileptic seizures are still present, though more sporadically.

Conclusion:        These data offer some insights : photosensitive epilepsy is a form of epilepsy that does not have a definite clinical cure, as shown by persistence of seizures as well as PPR-EEG findings, confirming the genetic connotation of the disease.

 

Clinical assessment of epileptic patients’ sleep followed in Fann National University Hospital (Dakar)

Fatoumata BA1, Lala Bouna Seck1, El Hadji Makhtar BA2, Yaborko Kodjo AïchaOuédraogo3, Anna Mbodji Basse2, Ousmane Cissé2

1University Gaston Berger, Saint-Louis, Senegal; 2University Cheikh Anta Diop, Dakar, Senegal; 3University El Hadj Ibrahima Niasse St Christopher Iba Mar Diop, Dakar, Senegal

Purpose:              The relationships between sleep and epilepsy are complex. Some forms of epilepsy occur mostly during sleep. Lack of sleep also promotes the onset of seizures.

This study’s objective was to evaluate sleep of epileptic patients followed in the neurological clinic of Fann National University Hospital Center (CHNU).

Method:              We conducted a cross-sectional, descriptive and prospective study from January to April 2015. Free and informed consent was required. Epileptics 16 years old at least were included. Data were collected using Pittsburgh Sleep Index, Epworth’s Sleepiness Scale, and Zigmond-Snaith Depression Anxiety Scale. They were analyzed with the SPSS version 18 software, with a threshold of significance p <0.5.

Results:                The study involved 100 patients. The mean age was 29.24 years ± 11.78, with a sex ratio of 1.17 in favor of men. The average age of the first crisis onset was 15.76 years. Generalized seizures were more frequent than partial seizures (69% vs 31%). The overall PSQI score was less than 5 for 51% of subjects and more than 6 for the remaining 49%. Poor sleep quality was reported by 60% of our sample. Excessive diurnal somnolence was found in 24% of subjects while 76% had a normal score. A certain depressive state was evoked in 3 cases and a certain anxiety state in 21 cases.

Conclusion:        Given the complexity of the relationship between sleep and epilepsy, extensive research combining subjective and objective methods of sleep assessment deserves to be done.

 

Antiseizure effects of Medium Chain Triglyceride-Ketogenic diets on proconvulsants-induced seizures in Wistar rats

Emmanuel Sanya, Olufemi Desalu, Philip Kolo, John Olarinoye

University of Ilorin, Ilorin, Kwara, Nigeria

Purpose:              Ketogenci diet has been reported to be effective in epilepsy management but there is limited evidence from Nigeria. This study was carried to determine usefulness of this diet in epilepsy treatment using animal model

Method:              The study used 64 Wistar rats fed for 35 days on two dietary types -normal diet (ND) and ketogenic diet (KD). The KD consisted of 15% carbohydrate in rat chow and 5ml sunflower oil (25% (v/w) to supply medium chain triglyceride. The ND was usual rat chow. Seizure was induced with one of three pro-convulsant drugs:  Pentelyntetrazole (GABAergic antagonist); 4-Aminopyridine (KATP channels blocker) and Strychnine -glycine receptor blocker

Results:                The study used 64 Wistar rats fed for 35 days on two dietary types -normal diet (ND) and ketogenic diet (KD). The KD consisted of 15% carbohydrate in rat chow and 5ml sunflower oil (25% (v/w) to supply medium chain triglyceride. The ND was usual rat chow. Seizure was induced with one of three pro-convulsant drugs:  Pentelyntetrazole (GABAergic antagonist); 4-Aminopyridine (KATP channels blocker) and Strychnine -glycine receptor blocker

Conclusion:        Our Medium chain triglyceride-KD produced resistance to PTZ-and AP-induced seizures, but no effect on STR-induced seizures. The antiseizure properties of KD is probably enhanced through facilitation of GABAergic receptor and KATP channels activities amongst others.

 

Anticonvulsant properties of fractions from annona muricat roots

Mireille Sylviane Dongmo Nguepi1, Lauve Rachel Tchokouaha Yamthe2, Faustin Pascal Manfo Tsague1, Smith Babiake Borakaeyabe1, Moses Samje1, Fabrice Fekam Boyom2, Asonganyi Tazoacha2

1university Of Buea, Buea, Southwest, Cameroon; 2institute of Medical Research and Medicinal Plants Studies, Yaounde, Centre, Cameroon

Purpose:             Evaluation of the anticonvulsant properties of annona muricata roots fraction, determination of neurotoxicity, cytotoxicity and phytochemical analysis.

Method:              The experiment was conducted on albino mice of both sexes. The anticonvulsant activity were evaluated using pentylenetetrazole and picrotoxin; whereas the neurotoxicity and cytotoxicity were conducted using the rotarod test and monkey kidney cells respectively. Standard tests were used for phytochemical analysis.

Results:               Of all the fractions and the compound tested, J18 at all the doses tested, significantly delayed the appearance of seizure (P<0.001), followed by J16 at 75, J20 at 150 and P106 at 20 mg/kg body weight. In the neurotoxicity test, 30 min after administration of the fractions a reduction of locomotion was observed, particularly for the compound P106 (P<0.01), but this effect disappeared with time, as the animal were able to remain on the rotating rod till the end of the observation period. Using the LLCMK2 cells for the cytotoxicity, the compounds J17 and P106 were safe products with the IC50 higher than the concentrations tested during the 3 days of observation. Phytochemical screening showed that the fractions contained alkaloids, saponin, steroid and triterpernes.

Conclusion:        The obtained results indicate that A muricata can be effective against convulsions.

 

Etiologies

Prognostic value of early seizure during  the acute phase of stroke

Yacouba Njankouo Mapoure1, Valérie Inès Takam Djoka2, Moustapha Ndiaye2, Henry Namme Luma3, Alfred kongnyu Njamnshi3, Amadou Gallo Diop2, Mohammadou Mansou Ndiaye2

1Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Littoral, Cameroon; 2Faculty of Medicine, Pharmacy and Odonto-stomatology, Cheikh Anta Diop University of Dakar, Dakar, Senegal; 3Faculty of medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon

Purpose:              The aim of this study was to determine the prevalence and predicting factors of early seizure (ES) among acute stroke patients, and their impact on stroke outcome at the Neurological Unit of the Douala General Hospital in Cameroon.

Method:              This was a retrospective cohort study carried out from January 2010 to 2015 and involved 689 stroke patients confirmed by CT scan. Cerebro-vascular risk factors, clinical and paraclinical findings at admission were collected for each patient. ES was defined as occurring within the 15 days after the onset of stroke. Outcome was measured using the in-hospital mortality and the functional outcome by Barthel score (BS) at month 3. Subarachnoid hemorrhage and cerebral veinous thrombosis were excluded. Predictive factors of ES were investigated using the Cox regression model.

Results:                The mean age of patient was 59.4 ± 13.2 Years. Ischaemic stroke was diagnosed in 417 (60%) patients. ES occurred in 73 patients (10.5%) with no difference between ischemic and hemorrhagic stroke (p = 0.19). Predicting factors of early seizures were past history of stroke (OR: 2.1 [1.6 – 4.1], p = 0.025), capillary glycaemia ≥ 1.4 g/l (OR: 2.2 [1.2 – 4], p = 0.026), and lobar hemorrhagic stroke (OR: 3.3 [1.3 – 8.7], p = 0.0001). There was no difference between patients with ES and seizure free according to in-hospital mortality rate was (p = 0, 19) as well as with BS (0.54).

Conclusion:        The prevalence of ES during acute stroke was high. Predictive factors are as found in previous studies.

 

Post-stroke epilepsy in Senegal

Japhari Nyassinde1, Daniel Gams Massi1, Kamadore Toure2, Moustapha Ndiaye1, Amadou Gallo Diop1, Mouhamadou Mansour Ndiaye1

1Cheikh Anta Diop University/Fann National Teaching Hospital, Dakar, Senegal; 2Thies University/Fann National Teaching Hospital, Dakar, Senegal

Purpose:              The aim of this study was to determine the epidemiological and clinical features of post-stroke epilepsy (PSE) in Senegal.

Method:              We conducted a descriptive retrospective  study from the January 1st, 2014 to December 31st, 2015 in the neurology department of Fann national teaching hospital of Dakar. We recorded medical files of all patients admitted for stroke and we selected PSE patients. Incomplete files were excluded. The diagnosis of PSE was considered on the basis of prior stroke of at least 1 month, repeated crises and the absence of other causes of epilepsy.

Results:                Thirty-four cases of PSE were enrolled during the study period on a total of 651 stroke’s patients (frequency of 5.2%). The mean age was 66 ± 14 years old and 64.7% of patients were male. Ischemic stroke was found in 91.2% of cases and the mean time between onset of stroke and epilepsy was 20 months. Recurrent stroke represented 26.5% of cases. Focal seizures accounted for 55.9% of seizure’s type and status epilepticus was found in 17.6% of cases. All patients were treated with antiepileptic drugs. And 94.1% of patients was on monotherapy (with 65.6% receiving Phenobarbital), 44.1% received Diazepam associated to Phenobarbital or Carbamazepine. Mortality rate was 32.4% and was higher in patients with status epilepticus (66.7%).

Conclusion:        The frequency of PSE is relatively low in our study as in most studies. Seizures occurred frequently within the first year after a stroke and were commonly focal. Treatment is not codified, in developing countries it is based on the classic AEDs. Mortality is often linked to status epilepticus.

 

Epilepsy and HIV in the neurology department of loandjili’s hospital

Prince Eliot Galieni Sounga Bandzouzi, Christelle Oko-Lossambo, Saurel Ngassaki, Charles Godefroy Koubemba

Hospital Of Loandjili, Pointe-noire, Congo

Purpose:              To describe the clinical manifestation of epileptic patients with HIV

Method:              from 01 September 2015 to 01 February 2016, we recruited all patients who presented seizures in consultation with the Department of Neurology of  loandjili’s hospital, and having a positive HIV serology confirmed by biology during hospitalization. Excluded were patients with a history of neurological disorders.

Results:                Seizures were the mode of revelation of HIV infection among all our patients. We recruited 32 patients, aged 18 to 71 years. The average age was 44,5 years and the sex ratio: 1,28. HIV-2 was found in 70.6% of patients. Average length of hospitalization was 17.2 ± 1.2 days. Focal seizures were observed about 25 patients (78.2%) including secondarily generalized  76%  and 24% simple. We found 1 cases (3,1%) of status epilepticus. Cerebral toxoplasmosis was the most common etiology (56,2%) followed by tuberculous meningitis (12,5%). No etiology was found

for 31,3% of the patients

Conclusion:        From the manifestations of neurological complications of HIV / AIDS  Epileptic seizures are frequently . Sometimes, they are the mode of revelation. Thus, HIV serology should be research systematically in all adult patients with seizures. In our study, cerebral toxoplasmosis was the most common etiology.

 

Early-onset post stroke seizures ; frequency and clinical characteristics in a Nigerian tertiary center

Babatunde Ademiluyi1, Kolawole Wahab2

1Federal Medical Center, Lokoja, Kogi, Nigeria; 2University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria

Purpose:              This study aimed at determining the frequency and clinical characteristics of early-onset post stroke seizures seen at the University of Ilorin Teaching Hospital

Method:              Consecutively consenting adult Nigerians with acute stroke that met the inclusion criteria were prospectively recruited. Early-onset seizure was defined as the first seizure occurring within 2 weeks of stroke onset. History of seizures before presenting to the hospital was obtained while seizure chart (for seizure type, frequency and duration) was kept for each patient right from admission. All patients had electroencephalogram (EEG) and neuroimaging and were evaluated for the pathologic type, region of brain affected and the hemisphere affected. Stroke severity was assessed using the NIH Stroke Scale (NIHSS). Data was compared between the group with and without seizures. Chi-square test and univariate analysis was used as appropriate.  A p value of less than 0.05 was taken to be statistically significant.

Results:                One hundred (100)patients were recruited and the frequency of early-onset post stroke seizures was 12%. Early-onset post stroke seizure was significantly associated with intracerebral haemorrhage (χ2 = 5.566, p=0.018), cortical stroke (χ2 =6.866, p=0.010), severe stroke i.e. NIHSS > 14 (χ2 =7.924, P=0.005), and presence of other complications (χ2 =7.429, p=0.026). EEG patterns included left focal slowing, periodic left spikes/slow waves and some had normal EEG.

Conclusion:        Early-onset post stroke seizures are common in the cohort of patients studied. Its clinical profile largely does not appear different from earlier studies. However, a larger, multi-center and prospective study will be necessary to clarify the position better.

 

Recessive Genetic Causes of Early Onset Epileptic Encephalopathy

Brahim Tabarki Melaiki, Xena AlQahtani, Saad AlShahwan

Prince Sultan Military Medical City, Riyadh, Saudi Arabia

Purpose:              To identify the underlying genetic defects in patients with unexplained early onset epileptic encephalopathy (EOEE) in a highly consanguineous population.

Method:              We performed genetic studies (Whole exome sequencing or genes panel) is a cohort of patients with unexplained EOEE from 2 centers in Riyadh: Prince Sultan Military Medical City and King Faisal Specialist Hospital & Research Centre. We characterized all phenotypes in detail and classified children according to known electroclinical syndromes where possible. Infants with previous genetic diagnoses, causative brain malformations, hypoxic ischemic insult, or inborn errors of metabolism were excluded.

Results:                215 patients (32%, total EOEE: 688) with unexplained EOEE were included. We identified disease-causing variants in 190 children (88 %), including mainly the following genes: SLC13A5 (n=8), FRRS1L (n=7), ADAT3 (n=6), WWOX (n=5), AFG3L2 (n=5), ARV1 (n=4), PLCB1 (n=2), etc . 185 variants were recessive, and only 5 variants were de novo. Phenotypes were broadened for some variants identified.

Conclusion:        Our study provides for the first time comprehensive epidemiologic information, epilepsy phenotype, and recessive genes on a large cohort of EEOE. Diagnosis of the underlying causes of epileptic encephalopathy is essential for treatment, prognosis and genetic counseling.

 

Epilepsy and cortical malformation type schizencephaly: about two cases revealed in young adults

Eric Gueumekane Bila Lamou1, Adjaratou Dieynabou Sow2, Anna Modji Basse Faye2, Yacouba Njankouo Mapoure1, Soumaila Boubacar2, Ngor Side Diagne2, Kamadore Toure3, Moustapha Ndiaye2, Amadou Gallo Diop2, Mouhamadou Mansour Ndiaye2

1Douala General Hospital, Douala, Cameroon; 2Neurological Clinic, Fann Teaching Hospital, Dakar, Senegal; 3Health UFR, Thies University, Thies, Senegal

Purpose:              The Cortical malformations are one of important causes of epilepsy, mental retardation and other neurological disorders. The Schizencephaly is an abnormality of the cortical organization characterized by cracks connecting the pial’s surface to the lateral ventricle. Considered as a sporadic anomaly, its genetic origin is likely, involving an EMX2 gene mutation. The clinic depends on the size and location of the slot, and the age of diagnosis.

Method:              We report clinical observations of a 32-year old woman and a man of 41 years old.

Results:                The Clinical presentation was totally different but they had a single common denominator as seizures with variable onset and type, which were the origin of diagnosis. Their evolution had been variable with drug resistance in one case and a neurosurgical derivation for tetraventricular hydrocephalus.

Conclusion:        Schizencephaly is a source of earlier onset often focal seizures. Late onset in our case denotes of a certain brain adaptation. Imagery is paramount in the positive diagnosis and the lesional checking.

 

Etiologies of recent seizures in HIV positive patients at Yaounde General Hospital

Paul Cedric Mbonda, Victor Sini, Hadja Cherif, Christophe Nouedjoui

Yaounde General Hospital, Yaounde, Cameroon

Purpose:              Determine the clinical and etiological aspects of seizures in HIV-infected subject

Method:              Was included all patients HIV positive, confirmed by serology, with at least one seizure-onset recent (3 months not reached). Were excluded patients with a history of neurological disorders

Results:                A total of 32 patients were recruited. The prevalence of seizures for patient living with HIV was 13%, the mean age was 44 years and the sex ratio was 0.5. The average hospital stay was 9 days. Seizures constituted 56.2% of the reasons for consultation, revealing HIV infection for 37.5% of patients. Generalized tonic clonic seizures were the most frequent (56%), focal motor seizures were 44%. We found 19% of status epilepticus. Cerebral toxoplasmosis was the most common aetiology (69%) followed by neuro-meningeal cryptococcosis (19%) and abscesses with mild germs (6%); For 6% of patients no etiology was found. And 19% of patients died during hospitalization

Conclusion:        HIV infection remains a real public health problem in our countries, epileptic seizures are frequent neurological complications and this remains a challenge for the clinician in the management

 

Assessment of epileptogenesis in murine model of Neuroschistosomiasis

Ulrich Femoe Membe, Mireille Kameni Poumeni, Hermine Boukeng Jatsa

University of Yaoundé I, Faculty of science, Yaoundé, Centre, Cameroon

Purpose:              According to WHO, schistosomiasis is, after malaria, the second most prevalent neglected tropical disease (NTD) affecting more than 249 million people in 2014, with 92 % of them living in Africa. It is an intravascular disease, caused by dioecious parasitic trematode worms of the genus Schistosoma. Eggs released by adult female are found in the liver, spleen, brain where they are causing inflammatory reaction and lead to granulomatous lesions in brain. One of the major complications resulting the invasion of brain tissue by Schistosoma eggs is epileptic seizures. There are many clinical cases that have been reported and described in the literature, but any experimental investigation have been undertaken to evaluate the epileptogenic potential of Schistosomiasis. Then, this preliminary study was aimed to assess the evidence of epilepsy during Schistosoma infection.

Method:              Thirty two male Balb/c mice (7 – 8 weeks old, weighing 23 – 25g) were subcutaneously infected with 60 Schistosoma mansoni cercariae/mouse. Between 90 and 120 days post-infection, the frequency of epileptic seizures and the hemiplegia were monitored. At the day 121 post-infection, animal were sacrificed brain of each animal were fixed in 10% formaline for histological analysis by Hematoxylin-eosin staining method.

Results:                the data of this preliminary study revealed that, among 32 mice infected with 60 cercariae of S. mansoni, 19 (63.33%) of them exhibited epileptic seizures and/or hemiplegia only 90 months post infection with increasing seizures frequencies and duration up to day 120. After autopsy, histological analyses of the brain and meninges revealed in certain case, the presence of eggs and granuloma formation.

Conclusion:        These observations are in accord with the first description made by Lambertucci et al., (2014) in Brazil. Effectively, they observed granuloma formation in the brain of S. mansoni infested mice. Thus it can be conclude that investigations neuroschistosomiasis are not to be neglected. Then, Our Ph.D work will aim to characterise a murin model of neurohistosomiasis by study physiological mechanisms of epileptic seizures occurring during schistosomiasis. Secondly, In fact we also aimed to test various medicinal plants of the Cameroonian traditherapy, for their protective efficacy on a murine model of neuroshistosomiasis.

 

Epilepsy and HIV in Fann Teaching Hospital

Laura Noutsa Mbonda1, Paul Mbonda Chimi2, Prince Sounga Bandzouzi3, Amadou Gallo Diop4

1Fann Teaching Hospital, Yaounde, Cameroon; 2Yaounde General Hospital, Yaounde, Cameroon; 3Fann Teaching Hospital, Brazzaville, Congo; 4Fann Teaching Hospital, Dakar, Senegal

Purpose:              Determine the etiologies of seizures in patients living with HIV

Method:              We conducted a prospective study from January 2013 to September 2015. All patients who presented with seizures in Fann  Teaching Hospital, and had a positive HIV serology during admission at Infectiology and Neurology units were recruited. Excluded were patients with a history of neurological disorders.

Results:                Seizures were the mode of revelation of HIV infection in all patients. We recruited 17 patients, aged 18 to 61 years. The average age was 35.23 years and the sex ratio: 0.67. HIV-2 was found in 70.58% of patients. The mean duration of hospitalization was 17.2 ± 1.2 days. Partial motor seizures were observed in 12 patients (70.58%), among which 66.6% were secondarily generalized while 33.3% were partial simple seizures. We found 2 cases (11.76%) of status epilepticus. Cerebral toxoplasmosis was the most common etiology (41.17%) followed by tuberculous meningitis (17.64%) and cryptococcal meningitis (11.76%). For 29.41% of the patients no etiology was found.

Conclusion:        Epileptic seizures are common manifestations of neurological complications of HIV / AIDS. Sometimes, they are the mode of revelation. Thus, HIV serology should be sought systematically in all adult patients with seizures. In our study, cerebral toxoplasmosis was the most common etiology.

 

Focal seizures in HIV-patient due to CD8+ encephalitis: a case report

Annick Melanie Magnerou, Halima Fidelie Scolastic Ngoungoure, Daniel Gams Massi, Mouhamadou Mansour Ndiaye

Cheikh Anta Diop University, Neurology Department, Dakar, Senegal

Purpose:              describe an uncommon etiology of seizure

Method:              The introduction of highly active antiretroviral therapy (HAART) has contributed to considerable improvement in both the clinical outcome of those with human immunodeficiency virus (HIV) infection and the spectrum of disorders that affect the central nervous system (CNS). Recently, CD8 encephalitis (CD8E) was reported to be a severe CNS complication among HIV-infected individuals treated with HAART, seizures may be the major clinical manifestation.

Results:                A 49-year-old HIV-infected man was referred with a history of 3 episodes of motor focal seizure. The patient was diagnosed with HIV type 1 at the age of 42, with CD4 count 126/μL. As trigger before the onset of these seizures was modification of HAART 4 weeks ago. He had been treated initially with 2nd line of HAART, and then switched to 3rd line due to viral escape; several years prior to admission, the CD4 count and HIV-Viral load were consistently in the range of 400-800/μL and 0-400 copies/mL, respectively. On admission, physical examination revealed psychic slowdown. A brain magnetic resonance image (MRI) demonstrated multifocal leukoencephalopathy, but no abnormal enhanced lesions. Post-critic EEG was normal, CD4 537 HIV-VL 420, cerebrospinal fluid analysis was within the normal limits. The JC virus has not been researched for lack of financial means. The patient was put on valproate sodium and his third line of HAART.

Conclusion:        Although the diagnosis is made by biopsy, the occurrence of focal seizure, despite satisfactory HIV control indices and leukoencephalopathy on MRI helped us to make the diagnosis of CD8E.

 

Epileptic seizure revealing a diabetes mellitus: a case report

Yacouba Kaba1, Daniel Gams Massi1, Christian Madjirabe1, Lala Bouna Seck2, Ngor Side Diagne1, Moustapha Ndiaye1, Amadou Gallo Diop1, Mouhamadou Mansour Ndiaye1

1Fann National Teaching Hospital/Cheikh Anta Diop University, Dakar, Senegal; 2Gaston Berger University, Saint-Louis, Senegal

Purpose:              The purpose of this study is to describe a case of diabetes mellitus revealed by epileptic seizures.

Method:              It is a case report in Fann national teaching hospital.

Results:                This is a 67 year old women without any past medical history admitted in the neurology department for repeated focal tonic clonic seizures with secondary generalization started ten days before admission. Physical exam revealed obtundation, left body side Todd paralysis with normal blood pressure. The fasting blood sugar was 4.59 g/l and glycated hemoglobin was 15.60%. Brain CT scan and the CSF analysis were normal. Biological tests showed only elevated CRP. I.V Diazepam and Phenobarbital was used to stop seizures and Insuline protocol was administrated. The blood sugar was normalized few days later and she was seizures free. Actually she is regurlarly followed up.

Conclusion:        In Senegal, diabetes is a frequent disease which is rarely diagnosed after seizures. Many should be done to prevent this chronic and serious medical conditions.

 

Epileptic seizures due to probable paraneoplasic encephalitis secondary to lung adenocarcinoma: a case report

Daniel Gams Massi, Marcellin Bugeme, Salaheddine Mourabit, Moustapha Ndiaye, Amadou Gallo Diop, Mouhamadou Mansour Ndiaye

Fann National Teaching Hospital/Cheikh Anta Diop University, Dakar, Senegal

Purpose:              The aim of this study is to describe epileptic seizures in patient admitted for encephalitis associated to lung cancer in Fann national teaching hospital, Dakar.

Method:              It is a case report.

Results:                This is a 51 year old female patient with past medical history of left total pneumectomy indicated for left lung adenocarcinoma. She was admitted on the November 7th, 2016 in the neurology department for repeated right arm and face tonic clonic seizures associated to right bodyside paresthesia started 12 days prior to admission. Clinical exam revealed bilateral visual loss and hypoacusis. Brain MRI showed bilateral temporal and right parietal hypersignal on T2 and FLAIR weighted sequencies. Visual evoked potential demonstrated a bilateral severe optical nerve lesion and electroencephalography done was normal. The CSF analysis showed 12 cells/mm3 predominantly lymphocytic. Concerning the etiology, a chest, abdominal and pelvic CT scan and pleural fluid analysis was done revealing a neoplastic pleuritis and multiple osteophilic metastasis of the spine. The diagnosis of paraneoplastic encephalitis associated to lung cancer was retained, but the dosage of onconeural antibodies (amphiphysin, Hu, CV-2, Ri, Ma-2) was not done due to financial limitations. She received Phenobarbital,  Carbamazepine to stop seizures and oral corticosteroid treatment. The evolution was favourable and she was seizure free and has been discharged for oncology consultation.

Conclusion:        Paraneoplastic encephalitis is a rare complication of lung cancer in our country. The diagnosis is paraneoplastic syndrom was made simple by the dosage of onconeural antibodies, but in our context it is hardly available because of very low social and economic level.

 

Clinical and genetic heterogeneity of progressive myoclonic epilepsies in Mali

Lassana Cisse, Guida Landoure

Teaching Hospital of Point G, Bamako, Mali

Purpose:              Characterize families with progressive myoclonic epilepsy (PME), and identify their underlying genetic defect.

Method:              Patients were seen by neurologists, and EEG and brain imaging were done to consolidate our diagnosis. Epilepsy gene panel testing including 126 genes and mtDNA, and exome sequencing were performed.

Results:                Five families of which three reported consanguinity and eight affected individuals were seen for myoclonic epilepsy. There was a wide inter- and intra-familial variability. The age of onset varied from 1 to 16 years. Symptoms included kinetic tremors, myoclonic jerks, tonic clonic and absence seizures. Some patients presented with cognitive decline leading to poor school performance, and others had mental retardation, and cerebellar and extrapyramidal features. EEG showed generalized spike waves in almost all patients and brain imaging showed cerebral and cerebellar atrophy in some. Although these symptoms are similar to some known PME types, others suggest new entities because of the presence of previously unreported symptoms. In fact, testing of 126 epilepsy genes was negative for two families; suggesting the possibility of new gene(s). Moreover, whole exome sequencing identified a non-synonymous homozygous sequence variant in one family and two heterozygous variants in the other family in a gene not previously associated with PME. Genetic analysis of the remaining families is underway.

Conclusion:        Our results indicate the possibility of finding new genes or variants. Research on the genetics of epilepsy in Africa would expand the clinical and genetic spectrum of this disease and further our understanding of their mechanism to trigger new therapeutic approaches.

 

Post-treatment seizing events related to death in stage II human African trypanosomiasis: a critical appraisal of 23 years of clinical experience in the Democratic Republic of Congo

Léon Kazumba Mbiyangandu, J-C Kaka Tshinzobe, Dieudonne Mumba Ngoyi, Désiré Tshala-Katumbay

DR Congo

Purpose:              To determine whether seizing is a risk factor for death in treated second-stage HAT.

Method:              Clinical records from 788 2nd stage HAT patients admitted at the National Reference Center from 1989 to 2012 have been analyzed with the following  parameters: age, sex, duration of disease, convulsions, location of the parasites in the diagnostic process, white blood cell count in the cerebrospinal (CSF), protein concentration in the CSF (for patients detected in the Reference Center), clinical status on admission, therapeutic regimen, duration of stay and outcome at discharge as predictors of death in logistic regression models (significance level 0.05).

Results:                Dysfunctional status on admission and treatment regimen were found to influence significantly the outcome, with odds ratios of, respectively, OR = 10.9 (95% CI 6.83-17.31; p = 0.000) for dysfunction and OR = 0.71 (95%CI 0.58-0.87; p < 0.001) for treatment in general. The study of treatment-specific ORs for the different therapeutic regimens reveals that eflornithine as first line treatment bears the lowest risk: 2.26 (95% CI 0.11-0.57; p = 0.00). Overall, convulsions were associated with higher risk for death (OR = 3.92 (95%CI: 3.03 – 5.02; p <0.001). Convulsions associated with death showed a particular chronological profile in the short schedule of melarsoprol with most of the events occurring on Day 8 or 9 (60%) and in patients admitted in relatively good clinical condition. Such chronological clustering was not observed with any other treatment regimen.

Conclusion:        Clinical pattern on admission and seizures are significant risk factors for death in second-stage HAT patients. Patients treated with eflornithine were at lower risk of dying. These results outline the importance of clinical assessment in the management of HAT patients.

 

Paediatric Epileptology

Febrile Seizures : A 116 cases study at the Children’ Hospital Albert Royer – Dakar

Laila Belarabi1, Moustapha Ndiaye1, Mamadou Sarr2, Assane Sylla3, Mouhamadou Mansour Ndiaye1

1Neurology Department, CHNU Fann, Dakar, Senegal; 2CHNEAR, Dakar, Senegal; 3Pediatric Department, Le Dantec Hospital (HALD), Dakar, Senegal

Purpose:              The aim of our study was to determinate the epidemiological, clinical, para-clinical and etiological profil of febrile seizures and their management in the Pediatric Department of the Children’ Hospital Albert Royer.

Method:              We conducted a prospective study from 11/07/12 to 07/11/13 at the Pediatric Department of the Children’ Hospital Albert Royer. Patients enrolled had simple or complex febrile seizures as defined by the NIH. Was collected the epidemiological data, personal and family history, immunization status, clinical and laboratory data,  the evolution and the therapeutic management.

Results:                116 children were collected, ages 3 months to 5 years, with a sex ratio of 2.05%. 13.8% had a family history of febrile seizures. The average age of onset of febrile seizures was 25.6 months with a peak incidence between 12 and 18 months.

Febrile seizures were simple (68.10%) or complex (31.9%). ENT infections were the primary cause. The evolution was favorable in 97.4% of children under antipyretic and etiological treatment.

Conclusion:        Febrile Seizures are strongly correlated with age, with a maximum peak to 18 months depending on studies and a male predominance. Genetic predisposition has long been recognized. The evolution are favorable as in our series, with a low risk of subsequent onset of epilepsy. However, it is necessary to establish a standardized management according to established criteria.

 

Childhood epilepsy in Cameroon: about 330 patients in Yaounde

Daniel Gams Massi1, Paul Urich Tambekou Tchatchuang2, Séraphin Nguefack3, Elie Mbonda3

1Cheikh Anta DIOP University/Fann National Teaching Hospital, Dakar, Senegal; 2Lome teaching hospital/Lome University, Lome, Maritime, Togo; 3Faculty Of Medicine And Biomedical Sciences/Yaounde I University, Yaounde, Centre, Cameroon

Purpose:              The aim of this study was to determine clinical features and to identify etiologies of childhood epilepsy in Yaounde.

Method:              We conducted a cross-sectional and descriptive study at the neuropaediatric and epileptology subunit in the Yaounde gynaeco-obstetric and pediatric hospital. Patients aged between 0 to 16 years responding to the inclusion criteria were consecutively admitted from February to July 2012.

Results:                We enrolled 330 patients, the sex ratio was 1.21 and the mean age was 6.58 ± 4.5 years. The seizures started before the age of five in 76.96% and 55.15% of patients had focal seizures. EEG was abnormal in 63.63% of cases with 72.73% of focal abnormalities mainly temporal, frontal and centrotemporal. Concerning neuroimaging, 153 patients did a brain CT scan showing lesions in 62.1% these patients. The main lesion found was cerebral atrophy. Etiological factors were found in 79.67% of cases including neonatal asphyxia (31%), past history of febrile convulsions (17%), meningitis (9.87%) and family history of epilepsy was present in 18.12% of children. According to classification, 26.36% and 29.09% of patients had respectively symptomatic focal and generalized epilepsy while 26.36% of epilepsy remained undetermined.

Conclusion:        At the end of our study, it appears that symptomatic epilepsy was most common in our context. The main etiological factors were neonatal asphyxia, past history of febrile seizures and meningitis. We should therefore reinforce the mother and child care, the management of febrile seizures and immunization against meningitis and others childhood diseases to reduce the frequency of epilepsy in Africa, especially in Cameroon.

 

Early epileptic encephalopathies with suppression burst

Prisca-Rolande Bassolé, Adjaratou Dièynaba Sow, Moustapha Ndiaye, Amadou Gallo Diop, Mouhamadou Mansour Ndiaye

Neurology Department of Fann Teaching Hospital, Dakar, Senegal

Purpose:              Early epileptic encephalopathies (EEP) with suppression burst (SB) are serious because of their drug resistance and the impact on psychomotor development of children involved. Our objective is to identify the determinants of this pathology in Dakar.

Method:              This is a retro-and prospective study from medical records from January 2013 to January 2015, performed on children who followed at the Neurological clinic of Fann Teaching Hospital. Children with early epilepsy, delayed psychomotor development and EEG pattern of SB were interested. Anamnestic, clinical, electroencephalographic and progressive aspects under treatment were evaluated

Results:                We report four cases of children with family history of epilepsy who presented early encephalopathy with seizures polymorphic dominated by tonic seizures that began on the first day of life in two, 30 days of life and the beginning of the third month in the other two. The sleep EEG showed a pattern of SB. The electro-clinical evolution is favorable for some patients with treatment, based mainly on sodium valproate at a dose of 20mg/Kg/day in average. It is marked by the disappearance or decreasing of seizures and by improvement of sleep EEG control with disappearance of SB for three, while for the fourth, encephalopathy became West syndrome. The Psychomotor retardation remained evident in all patients

Conclusion:        The EEP with SB represent a disease entity vast and serious. Results of this work open the perspective for further studies that will deal with additional aspects such as epidemiology, optimizing the etiological research especially for treatable causes and finally the identification of major prognostic factors.

 

Scholar course of children and adolescents with an idiopathic epilepsy in Dakar

Prince Eliot Galieni Sounga Bandzouzi1, Christelle Cadnelle Affognon2, Moustapha Ndiaye2, Amadou Gallo Diop2, Ndiaye Mahamadou Mansour2

1Hospital of Loandjili, Pointe-Noire, Congo; 2Fann Teaching Hospital, Dakar, Senegal

Purpose:              To evaluate the scholar course of children and adolescents with idiopathic epilepsy.

Method:              We conducted a prospective analytic longitudinal study at the neurological department of Fann National Teaching Hospital . The study was conducted over a period of one year and three months, dealing with epileptic children and adolescents in school, aged of 6 to 20 years, living in the region of Dakar and regularly followed at the hospital. The survey was conducted in the neurology department with parents and school recruited children

Results:                We recruited 80 patients with a mean age of 13.1 years, ranging from 6 to 20 years; the following results: 45% of patients had a school retardation; 73.7% of patients had learning difficulties which concerned several topics, most of patientswere bad in reading (50%); 21.3% to 17.5% had hyperactivity with attention and concentration disorders; 63.6% of patients on combined therapy had learning difficulties, 15% of patients did not accept their disease and hardly live; 97.5% participated in sports as their classmates

Conclusion:        The education of patients with idiopathic epilepsy still faces obstacles and difficulties; with learning difficulties, neuropsychological disorders and psychomotor disorders

 

West Syndrome in Africa: electroclinical, etiological, therapeutic and scalable specificities in a Senegalese cohort of 93 children followed in Fann Teaching Hospital

Adjaratou Dieynabou Sow1, Moustapha Ndiaye1, Anna Modji Basse Faye1, Jean Marie Dognon2, Marème Soda Diop Sene1, Lala Bouna Seck3, Mouhamadou Mansour Ndiaye1

1Neurological clinic, Fann teaching hospital, Dakar, Senegal; 2Saint Christopher Medical School, Dakar, Senegal; 3Health UFR, Saint Louis University, Saint Louis, Senegal

Purpose:              West syndrom (WS) is a severe epileptic encephalopathy of infants between 3 and 12 months of life. In growing numbers, there is a therapeutic challenge in Africa.

This study tried to evaluate quality of neuropediatric support of WS by describing electroclinical, aetiological, therapeutic and evolutive aspects of infants with WS.

Method:              Descriptive, analytical and evaluative study over 11 years (April 2004 – March 2015) in two centres (Neurological clinic and children’s Hospital). Study of infants followed at least 9 months.

Results:                93 infants with 10 months middle age and 81.7% boys. 86% of spasms (92.5% bending), associated with other seizures (43%) appeared around 1 year, psychomotor delay (88%) or regression (12%); first consultation at 6 months from the spasms beginning. Intercritic EEG showed atypical (66%) and typical (34%) hypsarythmia; Abnormal brain Scan (69%). Average follow-up: 13.4 months. Control spasms in 70% by valproate alone (77%) or with benzodiazepines or corticosteroid therapy (23%).We have positive evolution in 61%: stationary psychomotor development (64% to 53% at 2 years and 3 months follow-up). The WS was symptomatic (74%) with predominance of perinatal aetiologies (51%).

Conclusion:        The Senegalese, and probably African peculiarity is the high prevalence of obstetric causes with foetal pain. Where the interest of an increased awareness for better reproductive health policies.

WS requires a rational diagnostic assessment for aetiological identification. Efficiency of corticosteroid therapy in WS remains to be demonstrated in our regions where most of antiepileptic drugs are not available.

 

Epilepsy with centro-temporal spikes: a Senegalese cohort of 140 cases

Anna Modji Basse, Alassane Dravé, Adjaratou Dieynabou Sow, Marième Soda Diop, Lala Bouna Seck, Ngor Side Diagne, Kamadore Touré, Moustapha Ndiaye, Amadou Gallo Diop

Neurological Clinic of Fann University Hospital, Dakar, Senegal

Purpose:              The purpose of this work was to determine the profile of children with epilepsy with centro-temporal spikes in a Senegalese cohort.

Method:              We conducted a retrospective and prospective study of patients followed in pediatric neurological consultation for epilepsy with centro-temporal spikes between January 2012 and March 2015 in the Neurology Department of the University Hospital Center of Fann.

Results:                We collected 140 patients, 64.29% were boys. The mean age was 5.17. Sixteen children had hyperactivity with attention deficits. Memory disorders were present in 11 children and 7 children had delayed language. For 69.28% of children the neurological examination was normal. Only 12.9% had normal CT scans.

Conclusion:        Because of its benignity and association with neuropsychological disorders, more thorough and long-term studies are needed to elucidate these different aspects.

 

Epilepsy treatment failure associated factors in Togo

Komi Assogba, Panabalo Waklasti, Damelan Kombate, Kossivi Apetse, Agnon A Koffi Balogou

Campus University Teaching Hospital, Lomé, Maritime, Togo

Purpose:              To determine the factors associated to treatment failure of epilepsy

Method:              A reviewed of epileptics patients was conducted in February 2016. These epileptic patients were admitted from January,  2014 to December, 2015. The lack of decrease in the frequency of seizures under 75% and/or the presence of adverse effects of two consecutive major antiepileptic drugs were considered as the criteria of the therapeutic failure.

Results:                One hundred and thirty-two epileptic patients including 57 adults and 75 children were included in our study with an average age of 21,86 years. The sex ratio was 1.8. The tuition rate was 78%. Generalized seizures were the most represented clinical forms of seizures in 76% of cases. The EEG had showed epileptic disorders in 62%. The perinatal life threatenning condition was the main cause of epilepsy in children in 41% of cases. Vascular and infectious diseases were the dominated etiologies in adults. Genetic epilepsies had represented 48% of cases.  The sodium valproate acid, phenobarbital and carbamazepine were the most used drugs in 43%, 36% and 9% respectively. The average duration of treatment was 43 months. Seizures were controlled in 17% of patients and  48% of patients had several seizures recurrence. Lack of therapeutic education, treatment adherence and the quality of the first medical personnel drug deliver were the main reasons associated with treatment failure and poor epilepsy outcome.

Conclusion:        The epilepsy is a chronic neurological non communicable disease. Its management requires a specialization and must take in account a good therapeutic education.

 

Electroencephalogram Findings among Zambian Children: Clinical correlation and Use of Antiepileptic drugs

Ornella Ciccone1, Chishala Chabala1, Manoj Mathews1, Owen Tembo1, Alice Kabwe2, Archana Patel3, Gretchen Birbeck4

1University Teaching Hospital, Lusaka, Zambia; 2Clinton Health Access Initiative, Lusaka, Zambia; 3Boston Children’s Hospital, Boston, Massachusetts, USA; 4University of Rochester, School of Medicine and Dentistry, New York, USA

Purpose:              To describe clinical characteristics, EEG findings, and antiepileptic drug (AED) treatment  among children referred for EEG to the University Teaching Hospital, Lusaka

Method:              EEG requests and reports from 2013-2015 were reviewed. Within the context of routine care, EEGs were interpreted by readers with advanced training in child neurology and clinical neurophysiology.  Clinical data, seizure semiology and EEG findings were systematically extracted.

Results:                Among 1217 children, the median age was 6.7 years (IQR 3.3 – 10.9), 56% were males.  In 22% (n=262) with documented seizure etiology, 77% (202) were associated with perinatal injuries and CNS infections.  Seizures were clinically described in 68% (n=824) of which 64% as generalized, 29 % focal and 7% polymorphic. Sixty-two percent (n=754) were on an AED with 85% on monotherapy. AED usage was 49% carbamazepine, 30% phenobarbitone and 20% sodium valproate. Focal seizure semiology was described in 31% on carbamazepine, 25% on phenobarbitone and 24% on sodium valproate. Melatonin was used prior to EEG in 35% (n=429) and successfully induced sleep in 76% (n=329).  EEG was positive in 72% of the patients (n=879); of these, 62% were focal, 28% multifocal and 10% generalized.

Conclusion:        This study revealed a high prevalence of potentially preventable, localization-related epilepsies consistent with multi-country, population-based data from elsewhere in Africa. Seizure semiology assessed in routine, non-specialist care does not appear to influence AED choice and frequently fails to identify focality evident on EEG. This highlights the need for further training to optimize clinical care and cost-effective use of AEDs.

 

Effectiveness of Adrenocorticotropic Hormone and Vigabatrin in Infantile Spasm and their Unresponsiveness in Lennox-Gastuat in a Pakistani population

Arif Herekar

Neuro Diagnostic Centre, Karachi, SD, Pakistan

Purpose:              To measure & assess effectiveness of Adrenocorticotropic Hormone and Vigabatrin in Infantile Spasm (IS) and their Unresponsiveness in Lennox-Gastuat in a Pakistani population

Method:              This is a retrospective study which was carried on at the Neuro Diagnostic Centre at the Hamdard University Hospital and the National Medical Centre, Karachi, between January 2006 and December 2015. Most patients who were clinically and electroencephalographically diagnosed as IS were included in the study. The total number of patients were 120; out of which 80 were males & 40 females. The age ranges were between 4 months and 1.5 year. All patients had definite evidence of hypsarrhythmia and typical clinical Salaam Attacks and others with changes of Lennox-Gastaut both electroencephalographically and clinically.

Results:                ACTH was administered to 108 patients together with other antiepileptics mostly Vigabatrin, Levetiracetam and Valproate. The response to treatment in 30 patients was excellent and they had become seizure free in the first month of treatment. In 60 patients, the response to treatment was delayed but they still did well six months post treatment. Patients that ranged between 1 and 1.5 year of age showed little or poor response both in control of seizures and improvement of physical and mental status. As far as the electroencephalographic pattern was concerned, 10 patients who were slightly above 1 year of age showed hypsarrhythmia initially and electroencephalographic evidence of Lennox-Gastaut in the follow-up.

Conclusion:        ACTH was highly effective in patients who came in between 4 months to 8 months of age and showed both decline in seizures and improvement in general health. Treatment for Salaam Attacks when started under 1 year of age is ideal and the result show that there is need for more awareness in diagnosing this often debilitating disease under 1 year of age to obtain the optimum results otherwise they tend to decline into Lennox-Gastuat which is unfortunately intractable to all sorts of therapies.

 

Ohtahara syndrome in tropical practice

Komi Assogba, Josué Diatewa, Damelan Kombaté, Kossivi Apetse, Agnon Koffi Balogou

Campus University Teaching Hospital, Lomé, Maritime, Togo

Purpose:              To report a case of Ohtahara syndrome in tropical setting

Method:              clinical observation

Results:                We report the case of a girl with no previous history, followed at the campus university teaching hospital of Lomé, for tonic spasms predominant to the left hemibody. This condition was evolved since the 12th day of life. She had 3 to 6 seizures a day. These crises were resistant to treatment. At the age of 2 months, there was a delay in psychomotor development. The sleeping EEG showed a pattern of SB with slow, ample and mixed spikes and spikes waves. The awakening EEG was partially abnormal with hypsarythmy. Medical imaging, metabolic and biologic assessment were normal. No etiology was retained. The electro-clinical follow up at the age of 5 months was marked by several episodes of convulsive and aggravation of psychomotor impairment. After 3 weeks, the frequency of seizures was reduced by carbamazepine 20 mg / kg / day and phenobarbital 5 mg / kg / day.

Conclusion:        ENPs with SB are under diagnosed in tropical setting. The stigma associated with epilepsy, the lack of investigation tools and early death of patients explain these situation. Awareness raising and scientific research remain the main challenges.

 

Association of non epileptic seizures and epilepsy: 2 cases reports of masturbation seizures

Mariam Doumbia-Ouattara, Kouamé Léonard Kouassi, Ismaila Diakite, Constance , Apo-Ehounoud, Tchwa Muriel Amon-Tanoh, Thérèse Douayoua-Sonan

Department of Medical Sciences, Félix Houphouët Boigny University, Abidjan, Côte d’Ivoire

Purpose:              Make a review of literature on the non epileptic seizures (NES)

Method:              Report two cases de NES at the young girls presenting an epilepsy

Results:                We report 2 observations of 4 years old girls, with normal psychomotor development, and frequent paroxystic seizures, characterized by stereotyped movements of the members, occurring during sleep onset or deep sleep. Electroencephalogram Sleep records showed brief discharges of spikes and spikes-waves. Magnetic Resonance Imaging was normal.

Suspicion of NES associated with epilepsy was based on the following arguments:

– mild regression of the seizures frequency after using antiepileptic drug

– video records of the seizures strongly suggestive of masturbation seizures,

– best regression of the seizures frequency after adjunction of trihexiphenidyl.

Conclusion:        The early diagnosis of the NES allows to avoid the inadequate treatments and an improvement of the prognosis.

 

Benign Partial Epilepsy of Childhood with Centrotemporal Spikes: About 27 cases in the Neurology Department of Yalgado Ouédraogo Teaching Hospital in Ouagadougou (Burkina Faso)

Yiledoma Thierry Modeste Lengané, Julie Marie Adéline Kyelem, Anselme Dabilgou, Christian Napon, Athanase Millogo, Jean Kabore

Department of Neurology, University Teaching Hospital Yalgado Ouédraogo, Ouagadougou, Kadiogo, Burkina Faso

Purpose:              To study the clinical and therapeutic aspects of rolandic epilepsy

Method:              27 patients consulted for epilepsy between January 2015 to October 2016 in the University Teaching Hospital Yalgado Ouédraogo, Neurology Department

Results:                Average age was 8.22 years old and a sex ratio at 1.7. Age of onset was 3.96 years. The distribution of seizures was as follow: 7 (25.92%) generalized tonic-clonic seizures, 6 (22.22%) unilateral brachiofacial seizures, 2 (7.40%) oral clonies. The seizures were nocturnal (29.62%), diurnal and nocturnal (11.11%), on early morning (3.70%); the time of occurrence was not specified in 55.55% of cases. An acute foetal distress was found in 7.4% of cases and familial epilepsy in the same proportion. Patients which had not particular pathological history were 23(85.18%). Neurological examination was normal in all patients. The encephalogram found central or fronto-central, bilateral with a unilateral hemispheric predominance, paroxysmal abnormalities. Brain imaging was performed in 40.74% of cases (CT scan in 29.63%) and was normal; in 59.25% of cases no imaging was obtained. Follow-up length was 1.55 years. Monotherapy was usual. Most commonly used drugs were sodium valproate (80%), lamotrigine (12%) and phenobarbitone (8%). Evolution was marked by a seizure adjustment in 44.44% of the cases, a reduction of seizures 25.92%, a persistency of seizures in 3.70% of the cases

Conclusion:        Clinical and electroencephalographic aspects of the Benign Partial Epilepsy of Childhood with Centrotemporal Spikes are characteristic. Monotherapy and favorable clinical course with the treatment are the rule

 

Epilepsy of the infant: 283 patients followed in Neurology department of Dakar (Senegal)

Anna Modji Basse, Adjaratou Dieynabou Sow, Ousmane Cissé, Marième Soda Diop, Moustapha Ndiaye, Amadou Gallo Diop, Mouhamadou Mansour Ndiaye

Neurology Department of Dakar, Dakar, Senegal

Purpose:              The aim of this study was to determine the biographical, electro-clinical and evolutionary aspects of infant epilepsy in a Senegalese cohort.

Method:              This was a retrospective, descriptive and analytical study of infants following epilepsy from February 2003 to August 2013 at neurological department of Fann teaching hospital

Results:                We collected 283 infants, 66% were boys. The mean age was 17 months. Risk factors were dominated by peri-neonatal (37%) and familial (23%) epilepsy. Symptomatic epilepsies accounted for 68%. One hundred and ninety-one infants (68%) were on monotherapy. The most widely used molecules were Phenobarbital, Sodium Valproate and Carbamazepine. The progression under treatment was favorable for 126 patients.

Conclusion:        Epilepsy encounters, on the one hand, ancestral beliefs and customs and, on the other hand, insufficient material and human resources.

 

Convulsive Status Epilepticus of child at Albert Royer National Pediatric Hospital Center in Dakar

Bertandrie Estelle Boudzoumou Diagambana1, Moustapha Ndiaye1, Amadou Gallo Diop1, Mansour Ndiaye1, JES Kocko2, L Thiam3

1National Center Hospital of Fann, Department of Neurology, Senegal; 2National Center Hospital of Fann, Dakar, Senegal; 3Departement of Pediatric, Regional Hospital of Ziguinchor, Ziguinchor, Senegal

Purpose:              To Evaluate the electro-clinical, etiological, therapeutic and evolutionary aspects of CSE

Method:              Prospective and descriptive study, from 1 August 2014 to 31 May 2015, at Albert Royer  National pediatric  Hospital  center in Dakar

Results:                53 children were included with an average age of 48.5 months. Infants accounted for 54.7%.  17 children were delayed in psychomotor development. Crises were widespread in 42 children (79.2%) and partial in 11 children (20.7%). Convulsions occurred in fever in 38 children (71.7%). Meningitis syndrome, right hemiparesis and hypotonia were found in eight cases (15.1%). Eight children presented with cerebral imaging a cortical atrophy, hydrocephalus, an extradural collection, cerebral ischemia, and opacification of leptomeningeal spaces. At the etiological level, 13 children were known to have epileptic disorders, metabolic disorders such as hyponatremia (14.5%), hypoglycemia (3.7%), and hypomagnesemia (3.7%). Two cases of central nervous system infections. At admission, all children received diazepam intravenously, including 13 (24.5%) within 30 minutes. Persistence of seizures necessitated the combination of diazepam-phenobarbital intravenously with 24 children (45 , 3%). In the short term, the vital prognosis was not committed. Five children presented  stayed  with motor deficiency .

Conclusion:        The child’s CSE involves the vital and functional prognosis and management must be early in a Pediatric Intensive Care unit.

Keywords: Convulsive status epilepticus, child, Intensive Care Unit, anticonvulsant.

 

Electrical status epilepticus during slow wave sleep: about 24 cases

Haoua Ousseini Sidibe, Ben Adji Djibrilla, Konaté Mahadi, Fatimata Hassane Djibo, Issa Malam Djibo

National Hospital of Niamey, Niamey, Niger

Purpose:              The objective was to describe the epidemiologic, clinical, electrophysiological  and evolution after treatment  of the Electrical Status Epilepticus during Slow wawe Sleep (ESESS) .

Method:              A cross-sectional study from January 1st, 2015 to December 1st, 2016.

The general criteria is  patients less than 12 years old  consulted at the Internal medicine Department of Niamey’s National Hospital.

Results:                From a total of 399 patients  , 24 has the pattern of ESESS with a  prevalence of  6% . The sex ratio is 3 . The mean age was 70 months  old [6-132].   The differents complaints  were psychomotor delay (45.8%), nocturnal convulsive seizures(41.6%), atypical absences(8.3%) and a motor partial crisis representing (4.16%).  The medical history was : eight (8) cases of perinatal asphyxia, one (1) case sequelae of cerebral malaria and one (1) case sequelae of meningitis . Electroencephalography (EEG) emphased continuous waves of sleep present  more than 85% of the period in all patients. The total patients had been submitted to CT scans which detected cortical atrophy in 45.8% of cases, porencephalic cavity in 12.5% and normal in 41.6%.

The treatment used antiepileptic  and corticosteroid drugs , disappeared the ESESS  in 87,5% and a moderate  improvement in 12,5%

Conclusion:        Despite the non concensus  of management and the neuropsychological deficit, the evolution of the crisis after treatment of the ESESS is usually favorable.

 

Migrating focal epilepsy in infancy: a neonatal case report

Khalil Abbes, Fatma Kammoun

Child Neurology Department, Sfax hospital, Sfax, Tunisia

Purpose:              Migrating focal epilepsy in infancy (MFEI) is an unusual and often overlooked epilepsy syndrome, with onset before age 6 months, in which nearly continuous seizures involve multiple, independent areas of both hemispheres.

Method:              We describe a 1-month-old boy with MEFI beginning at 3 day on life

Results:                1-month-old boy with MEFI beginning at 3 day on life after neonatal hypoglycemia with multifocal, subtile motor seizures. Ictal EEG showed prolonged migrating discharges in the right and also left hemisphere. Neurological evaluation showed hypotonia with weak suction reflex. The MRI brain imaging concluded to an abnormal posterior cortex architecture, occipital white matter signal abnormalities with ventricular enlargement.  The seizures were refractory to common antiepileptic drugs (valproate, phenobarbital, benzodiazepine).

Conclusion:        MEFI is a rare epileptic encephalopathy that usually misdiagnosed particularly because of subtle seizures semiology and rapid neurological deterioration and death. Repeated EEG recordings are useful for the diagnosis.

 

The Seroprevalence of Cysticercosis and its Association with Symptomatic Neurocysticercosis among Epileptic and Non-epileptic Children Presenting to the University Teaching Hospital, Lusaka- a Case Control Study

Jonathan Ncheengamwa1, Somwe Wa somwe1, Ornella Ciccone2, Doris Lin3, Veronica Sunkutu-Sichizya2, Pierre Dorny4, Sarah Gabriel5, Isaac Phiri1, Kabemba E Mwape1

1University of Zambia, Lusaka, Zambia; 2University Teaching Hospital, Lusaka, Zambia; 3Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; 4Ghent University, Ghent, Belgium; 5Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium

Purpose:              This study sought to identify the importance of neurocysticercosis (NCC) as a cause of epilepsy and explore the usefulness of serology for its diagnosis in children.

Method:              Between May 2014 and March 2016 (26 months), 70 children aged 5-15 years were enrolled. These comprised 35 with epileptic seizures of unknown aetiology (cases) and 35 non-epileptic children of matched sociodemographic characteristics (controls). All cases underwent neuroimaging. Sixty nine participants had their serum samples tested for cysticercal antigens (Ag) by enzyme-linked immunosorbent assay (Ag-ELISA), and 25 also underwent antibody enzyme-linked immuno-electrotransfer blot (Ab-EITB) testing. The primary outcomes were neuroimaging and serology findings.

Results:                The participants’ mean age was 11.0 years (SD = 2.5). NCC was diagnosed by neuroimaging in 20 (57%) of the cases. The most frequent symptom of NCC was recurrent seizures (95%), seconded by headache (40%). The Ag-seroprevalence of cysticercosis was significantly higher among the cases than among the controls (29.4% versus 3% respectively; OR=14; p < 0.05). Cases with symptomatic NCC were significantly more likely to test seropositive than controls (68.4% versus 2.9% respectively; p < 0.01). Seropositive cases, by Ag-ELISA, were significantly more likely to have symptomatic NCC than seropositive controls (100% versus 0.0% respectively; p < 0.01). The Ab-seroprevalence among cases was 33.3% and not significantly higher than the Ag-ELISA results above (p  > 0.05).

Conclusion:        NCC is an important cause of epilepsy among Zambian children presenting to UTH. Ag-ELISA is a reliable diagnostic test for symptomatic NCC in endemic regions when neuroimaging is not readily accessible.

 

Frontal lobe epilepsy in a Senegalese pediatric population

Marieme Soda Diop-Sene, Annick Nsounda, Makhtar Ba, Ousmane Cisse, Moustapha Ndiaye, Amadou Gallo Diop, Mouhamadou Mansour Ndiaye

Fann University Hospital, Dakar, Senegal

Purpose:              Frontal lobe seizure are one of most frequent seizure type in children. Diagnosis and treatment could be difficult sometimes. In a context where there is no stereo EEG, no epilepsy surgery, we need to have the most precise diagnosis, to offer more chance to our patient to benefit from treatment to improve prognosis and outcome in children with frontal lobe seizures.

Method:              we conducted a descriptive study from January to July 2016 at Neurophysiology Department of Fann University Hospital in Dakar. Children with frontal lobe epileptic abnormalities were involved in the study. They had a standard EEG and neurological and neuropsychological assesment.

Results:                9 cases were collected and only 7 patients were included in the study. At the end of the study we found a good correlation between clinical signs and electrophysiologic findings. 4 out of 7 had had their fisrt episode in preschool age, 6 out of 7 had nocturnal seizure, 5 out of 7 had 3 to 5 seizures each time. 4 out of 7 had seizures during EEG recording. EEG findings were fast spike and spike and wave in frontal derivations. 5 out of 7 had neuropsychologic assesment and 4 patients had procedural memory; visio-spatial; planification ; mental flexibility and inhibition impairement. We did not find the etiology in our patients. Evolution was good with antiepileptic treatment. All the patient were really improved.

Conclusion:        Standard EEG remains a useful tool to diagnose frontal lobe epilepsy. We had a good clinical and electrophysiological correlation that help propose a efficient treatment and improve outcome in children with frontal lobe epilepsy.

 

Social Issues / Nursing

Knowledge of, perceptions of and attitudes towards schoolchildren with epilepsy among teachers in south-western Nigeria

Morenikeji Komolafe1, Taofiki Sunmonu2, Olusegun Afolabi3, Ayoade Adebiyi1, John Ajiboye2, Stephen Olaniyan2

1Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun, Nigeria; 2Federal Medical Centre, Owo, Ondo state, Nigeria; 3Obafemi Awolowo University, Ile-Ife, Osun, Nigeria

Purpose:              To evaluate the knowledge , perceptions and  attiudes towards schoolchildren among teachers  in southwestern Nigeria

Method:              Self administered  structured questionnaires were used to obtain information from school teachers in two cities in southwesteern Nigeria.. The questionnaire consisted of   18 items ( 4 – sociodemographic,  6 – knowledge  3 – perception, 4- attitudes  1- Treatment). The data was analyzed by SPSS version 17.0 software and the level of significance was set at p<0.05

Results:                One hundred and fifty three teachers participated in the study and the response rate was 97%.The mean age of the respondents was 44.6 +/- 21.9 years. There were 75 males and 74 females in the study  and all the teachers have tertiary level of education.About 92% of the respondents have heard  about epilepsy while 23 % knew someone with epilepsy. Fifty – seven percent of the teachers thought that epilepsy is a brain disease while 37% thoght that it is contagious  while 12% believed it is a form of mental retardation. About 7% of the respondents were of the opinion that children with epilepsy should never attend school. The teachers: level of education had a direct  impact on their perception about the causes and contagiousness of  epilepsy (p<0.05) while the teachers: age and level of  education have no influence on their ability to decide on the appropriate therapy for epilepsy in schoolchildren (p>0.05)

Conclusion:        In this study, a significant proportion of school teachershave ppoor knowledge , perceptions and attitudes towards schoolchildren with epilepsy  and considerable health education on epilepsy is advocated for this population

 

Family impact and parental perception of childhood epilepsy in Yaounde

Paul Cedric Mbonda1, Mireille Mbonda2, Joelle Sobngwi2, Seraphin Nguefack2

1Yaounde General Hospital, Yaounde, Cameroon; 2Yaounde Gynecological Obstetrics and Pediatric Hospital, Yaounde, Cameroon

Purpose:              Our objective was to assess the impact of epilepsy on the quality of life of parents and their perception of the disease

Method:              For 6 months, 103 children (ages 1-16 years) with epilepsy were recruited and their parents were interviewed, the parent interviewed had been living with the patient for at least 1 year. The presence of major changes in life during the previous 3 months on the social or economic conditions of the family (separation, parental unemployment, etc.), major comorbidities and mental retardation were an exclusion criterion

Results:                Epilepsy has an impact on the health of mothers, 72% of mothers had sleep disorders. More than half of the mothers had seen a significant impact on their work, for 91% of mothers the family finances was affected by the disease. While 65% of parents felt that their child’s epilepsy had brought them together, 31% felt the opposite was true.

According to 12% of mothers, their child’s epilepsy removed any desire to re-conceive

Conclusion:        Epilepsy is an important neurological problem in developing countries and is associated with significant psychosocial maladjustment in both the affected children and the family

 

Women and Epilepsy

Reading epilepsy (about one observation)

Ibrahima Mariam Diallo, Moustapha Ndiaye, Marie Emilie Ndong, Boubacar Aw, Mohamed Lelouma Mansaré, Halima Ngoungouré, Salimata Sagna, Daniel Atsa Kouda, Nyassindé Japhari, Mouhammadou Mansour Ndiaye

Fann National Teaching Hospital, Dakar, Senegal

Purpose:              The aim of this report was to describe a case of reading epilepsy (RE) and make a review of the literature about electroclinical, therapeutically pathophysiological features of RE.

Method:              It is a case report. The subject was a  25-year-old   woman complaining of short-lasting jerk of the mouth associated with asthenia triggered by reading. Neurological examination and brain MRI, resting electroencephalography (EEG)  and Video-EEG during reading were done. The findings were then analysed and linked with clinical features.

Results:                Neurological examination and brain MRI were normal. The resting electroencephalography (EEG) revealed alpha dominant rhythm with diffuse slow activities predominant in temporal regions. Overbeating increased slow activities and photic stimulation was without effect. EEG recording during a long period of reading showed paroxysmal diffuse spikes and sharp-waves activities maximal in the left temporo-occipital region. Video-EEG during reading showed  unset of epileptic seizures. The patient was put on  carbamazepin that worsened the seizures. Phenobarbital at 100mg/day made the patient remain seizure free.

Conclusion:        The reading epilepsy is rare. Few cases have been reported. Phenobarbital seems to be a fine therapeutic option to stop the seizures.