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Garrez I, Teuwen DE, Sebera F, Mutungirehe S, Ndayisenga A, Kajeneza D, Umuhoza G, Kayirangwa J, Düll UE, Dedeken P, Boon PAJM. Very high epilepsy prevalence in rural Southern Rwanda: The underestimated burden of epilepsy in sub-Saharan Africa. Trop Med Int Health 2024; 29:214-225. [PMID: 38124297 DOI: 10.1111/tmi.13963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Up to 85% of people living with epilepsy (PwE) reside in low-and middle-income countries. In sub-Saharan Africa, the lifetime prevalence of epilepsy is 16 per 1000 persons. In Northern rural Rwanda, a 47.7 per 1000 prevalence has been reported. As variations in prevalence across geographical areas have been observed, we studied the prevalence in Southern rural Rwanda using the same robust methodology as applied in the North. METHODS We conducted a three-stage, cross-sectional, door-to-door survey in two rural villages in Southern Rwanda from June 2022 to April 2023. First, trained enumerators administered the validated Limoges questionnaire for epilepsy screening. Second, neurologists examined the persons who had screened positively to confirm the epilepsy diagnosis. Third, cases with an inconclusive assessment were separately reexamined by two neurologists to reevaluate the diagnosis. RESULTS Enumerators screened 1745 persons (54.4% female, mean age: 24 ± 19.3 years), of whom 304 (17.4%) screened positive. Epilepsy diagnosis was confirmed in 133 (52.6% female, mean age: 30 ± 18.2 years) and active epilepsy in 130 persons. Lifetime epilepsy prevalence was 76.2 per 1000 (95% CI: 64.2-89.7‰). The highest age-specific rate occurred in the 29-49 age group. No gender-specific differences were noted. In 22.6% of the PwE, only non-convulsive seizures occurred. The treatment gap was 92.2%, including a diagnosis gap of 79.4%. CONCLUSION We demonstrated a very high epilepsy prevalence in Southern rural Rwanda, with over 20% of cases having only non-convulsive seizures, which are often underdiagnosed in rural Africa. In line with previous Rwandan reports, we reiterate the high burden of the disease in the country. Geographic variation in prevalence throughout Africa may result from differences in risk and aetiological factors. Case-control studies are underway to understand such differences and propose adapted health policies for epilepsy prevention.
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Affiliation(s)
- Ieme Garrez
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Dirk E Teuwen
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Fidèle Sebera
- Department of Neurology, Ndera Neuro-Psychiatric Teaching Hospital, Kigali, Rwanda
- Centre Hospitalier Universitaire Kigali, Kigali, Rwanda
| | | | | | | | - Georgette Umuhoza
- Department of Neurology, Ndera Neuro-Psychiatric Teaching Hospital, Kigali, Rwanda
| | | | - Uta E Düll
- Medicalized Health Center, Gikonko, Rwanda
| | - Peter Dedeken
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
- Heilig Hart Ziekenhuis, Lier, Belgium
| | - Paul A J M Boon
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
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Otabil KB, Ankrah B, Bart-Plange EJ, Donkoh ES, Avarikame FA, Ofori-Appiah FO, Babae TN, Kudzordzi PC, Darko VA, Ameyaw J, Bamfo JG, Sakibu RA, Antwi-Berko D, Fodjo JNS, Basáñez MG, Schallig HDFH, Colebunders R. Prevalence of epilepsy in the onchocerciasis endemic middle belt of Ghana after 27 years of mass drug administration with ivermectin. Infect Dis Poverty 2023; 12:75. [PMID: 37587500 PMCID: PMC10433588 DOI: 10.1186/s40249-023-01117-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/29/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND In onchocerciasis-endemic areas with high ongoing Onchocerca volvulus transmission, a high prevalence of epilepsy has been reported. This study aimed to determine the prevalence and clinical characteristics of epilepsy in the Bono Region of Ghana following 27 years of implementation of ivermectin mass drug administration (MDA). METHODS Between October 2020 and August 2021, cross-sectional surveys were conducted in nine communities in the Tain District and Wenchi Municipality of the Bono Region of Ghana. In the first stage, a random door-to-door approach was used to screen the population for epilepsy using a pre-tested questionnaire. Persons suspected of having epilepsy were invited for a second-stage neurological examination for case verification. Community O. volvulus microfilarial infection status and Ov16 seropositivity were also determined. Ninety-five confidence intervals (95% CI) for prevalence values were calculated using the Wilson Score Interval. RESULTS Of the 971 participants, 500 (51.5%) were females, and the median age (interquartile range) was 26 (15‒43) years. Fourteen participants (1.4%, 95% CI: 1.0‒2.0) were diagnosed as having epilepsy with generalized seizures being the most frequent seizure type (85.7%, 12/14). The overall microfilarial prevalence of O. volvulus was 10.3% (November 2020) and 9.9% (August 2021); the Ov16 seroprevalence was 22.2% (June 2021). Only 63.2% took ivermectin in the last round of MDA distribution in March 2021. CONCLUSIONS The 1.4% prevalence of epilepsy in the Bono region is similar to the median epilepsy prevalence in sub-Saharan Africa. However, the persistent microfilarial prevalence and low ivermectin study coverage call for the Ghana Onchocerciasis Elimination Programme to step up its efforts to ensure that the gains achieved are consolidated and improved to achieve the elimination of onchocerciasis by 2030.
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Affiliation(s)
- Kenneth Bentum Otabil
- NeTroDis Research Group, Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Bono Region, Sunyani, Ghana.
- Department of Biological Science, School of Sciences, University of Energy and Natural Resources, Bono Region, Sunyani, Ghana.
- Global Health Institute, University of Antwerp, Antwerp, Belgium.
| | - Blessing Ankrah
- NeTroDis Research Group, Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Bono Region, Sunyani, Ghana
| | - Emmanuel John Bart-Plange
- NeTroDis Research Group, Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Bono Region, Sunyani, Ghana
- Department of Medical Laboratory Science, School of Sciences, University of Energy and Natural Resources, Bono Region, Sunyani, Ghana
| | - Emmanuel Sam Donkoh
- Department of Medical Laboratory Science, School of Sciences, University of Energy and Natural Resources, Bono Region, Sunyani, Ghana
| | - Fiona Amoabil Avarikame
- Department of Medical Laboratory Science, School of Sciences, University of Energy and Natural Resources, Bono Region, Sunyani, Ghana
| | - Fredrick Obeng Ofori-Appiah
- Department of Medical Laboratory Science, School of Sciences, University of Energy and Natural Resources, Bono Region, Sunyani, Ghana
| | - Theophilus Nti Babae
- NeTroDis Research Group, Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Bono Region, Sunyani, Ghana
| | - Prince-Charles Kudzordzi
- NeTroDis Research Group, Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Bono Region, Sunyani, Ghana
| | - Vera Achiaa Darko
- NeTroDis Research Group, Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Bono Region, Sunyani, Ghana
- STU Clinic, Sunyani Technical University, Bono Region, Sunyani, Ghana
| | - Joseph Ameyaw
- Happy Family Hospital, Bono East Region, Nkoranza, Ghana
| | | | - Raji Abdul Sakibu
- Department of Biological Science, School of Sciences, University of Energy and Natural Resources, Bono Region, Sunyani, Ghana
| | - Daniel Antwi-Berko
- Department of Medical Laboratory Science, School of Sciences, University of Energy and Natural Resources, Bono Region, Sunyani, Ghana
| | | | - María-Gloria Basáñez
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis (MRC GIDA), and London Centre for Neglected Tropical Disease Research, School of Public Health, Imperial College London, London, UK
| | - Henk D F H Schallig
- Department of Medical Microbiology, Experimental Parasitology Unit, Amsterdam University Medical Centres, Academic Medical Centre at the University of Amsterdam, Amsterdam, The Netherlands
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Ae-Ngibise KA, Sakyi L, Adwan-Kamara L, Lund C, Weobong B. Prevalence of probable mental, neurological and substance use conditions and case detection at primary healthcare facilities across three districts in Ghana: findings from a cross-sectional health facility survey. BMC Psychiatry 2023; 23:280. [PMID: 37081409 PMCID: PMC10117267 DOI: 10.1186/s12888-023-04775-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/12/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Few studies have examined the prevalence of mental, neurological and substance use (MNS) conditions, case detection and treatment in primary healthcare in rural settings in Africa. We assessed prevalence and case detection at primary healthcare facilities in low-resource rural settings in Ghana. METHODS A cross-sectional survey was conducted at the health facility level in three demonstration districts situated in Bongo (Upper East Region), Asunafo North (Ahafo Region) and Anloga (Volta Region) in Ghana. The study participants were resident adult (> 17 years) out-patients seeking healthcare at primary care facilities in each of the three demonstration districts. Data were collected on five priority MNS conditions: depression, psychosis, suicidal behaviour, epilepsy and alcohol use disorders. RESULTS Nine hundred and nine (909) people participated in the survey. The prevalence of probable depression was 15.6% (142/909), probable psychotic symptoms was 12% (109/909), probable suicidal behaviour was 11.8% (107/909), probable epilepsy was 13.1% (119/909) and probable alcohol use disorders was 7.8% (71/909). The proportion of missed detection for cases of depression, self-reported psychotic symptoms, epilepsy and alcohol use disorders (AUD) ranged from 94.4 to 99.2%, and was similar across study districts. Depression was associated with self-reported psychotic symptoms (RR: 1.68; 95% CI: 1.12-1.54). For self-reported psychotic symptoms, a reduced risk was noted for being married (RR: 0.62; 95% CI: 0.39-0.98) and having a tertiary level education (RR: 0.12; 95% CI: 0.02-0.84). Increased risk of suicidal behaviour was observed for those attending a health facility in Asunafo (RR: 2.31; 95% CI: 1.27-4.19) and Anloga districts (RR: 3.32; 95% CI: 1.93-5.71). Age group of 35 to 44 years (RR: 0.43; 95% CI: 0.20-0.90) was associated with reduced risk of epilepsy. Being female (RR: 0.19; 95% CI: 0.12-0.31) and having a tertiary education (RR: 0.27; 95% CI: 0.08-0.92) were associated with reduced risk of AUD. CONCLUSIONS Our study found a relatively high prevalence of probable MNS conditions, and very low detection and treatment rates in rural primary care settings in Ghana. There is a need to improve the capacity of primary care health workers to detect and manage MNS conditions.
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Affiliation(s)
- Kenneth Ayuurebobi Ae-Ngibise
- Ghana Somubi Dwumadie (Ghana Participation Programme), PMB 6 Asoyi Crescent, East Legon, Accra, Ghana
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Lionel Sakyi
- Ghana Somubi Dwumadie (Ghana Participation Programme), PMB 6 Asoyi Crescent, East Legon, Accra, Ghana
| | - Lyla Adwan-Kamara
- Ghana Somubi Dwumadie (Ghana Participation Programme), PMB 6 Asoyi Crescent, East Legon, Accra, Ghana
| | - Crick Lund
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s Global Health Institute, King’s College London, London, UK
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Benedict Weobong
- Department of Social and Behavioural Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
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Alizadeh Khatir A, Sepidarkish M, Daryabari Y, Taghipour A, Mollalo A, Aghapour S, Rostami A. Malaria infection and the risk of epilepsy: a meta-analysis. Parasitology 2023; 150:1-9. [PMID: 36705577 PMCID: PMC10090621 DOI: 10.1017/s0031182022001780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/21/2022] [Accepted: 12/21/2022] [Indexed: 01/28/2023]
Abstract
Epilepsy, a chronic disease of the central nervous system, is highly prevalent in malaria-endemic regions. Therefore, several studies have evaluated the associations between malaria infection and epilepsy development. A meta-analysis of observational studies published from inception to 10 May 2022 has been conducted to synthesize and pool the existing data on this topic. The relevant publications were systematically searched in PubMed/Medline, Scopus, Embase and Web of Science database collections. A random-effects meta-analysis model (REM) was utilized to generate the pooled odds ratio (OR) at 95% confidence intervals (CIs). The between-studies heterogeneity was assessed with I2, as well as several subgroups, meta-regression and sensitivity analysis were performed to identify the source of heterogeneity. Overall, 17 eligible studies containing 6285 cases and 13 909 healthy controls were included. The REM showed a significant positive association between malaria infection and epilepsy development (OR 2.36; 95% CI 1.44–3.88). In subgroup analyses, significant positive associations were observed in studies that: epilepsy was the outcome in the follow-up of patients with cerebral malaria (OR 7.10; 95% CI 3.50–14.38); used blood smear to diagnose malaria (OR 4.80; 95% CI 2.36–9.77); included only children (OR 3.92; 95% CI 1.81–8.50); published before 2010 (OR 6.39; 95% CI 4.25–9.62). Our findings indicated that patients with malaria, especially those with cerebral malaria, are at a high risk of epilepsy development; however, further well-designed and controlled studies are needed to verify the strength of the association.
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Affiliation(s)
- Ali Alizadeh Khatir
- Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mahdi Sepidarkish
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
| | - Yasaman Daryabari
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ali Taghipour
- Zoonoses Research Center, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Abolfazl Mollalo
- Department of Public Health and Prevention Science, School of Health Sciences, Baldwin Wallace University, Berea, Ohio, USA
| | - Saeed Aghapour
- Department of Neurosurgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Quansah Amissah R. Ghana's preparedness to exploit the medicinal value of industrial hemp. J Cannabis Res 2022; 4:58. [PMID: 36329502 PMCID: PMC9632111 DOI: 10.1186/s42238-022-00167-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 10/22/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Interest in industrial hemp is increasing steadily, as can be seen by the growing number of countries that have either decriminalized industrial hemp or are contemplating its decriminalization. In line with this trend, Ghana recently decriminalized the cultivation of industrial hemp (the cannabis variety with low Δ9-tetrahydrocannabinol (THC) and high cannabidiol (CBD) content), resulting in the need for research into its benefits to Ghanaians. This article examines cannabis (including industrial hemp) production, facilities for industrial hemp exploitation, and the potential benefits of industrial hemp in Ghana. MAIN BODY Indigenous cannabis strains in Ghana have high THC to CBD ratios suggesting the need for the government to purchase foreign hemp seeds, considering that the alternative will require significant research into decreasing the THC to CBD ratio of indigenous cannabis strains. Furthermore, there are several facilities within the country that could be leveraged for the production of medicinal hemp-based drugs, as well as the existence of a number of possible regulatory bodies in the country, suggesting the need for less capital. Research has also shown the potential for treatment of some medical conditions prevalent among Ghanaians using medicinal hemp-based products. These reasons suggest that the most feasible option may be for the government to invest in medicinal hemp. CONCLUSION Considering the challenges associated with the development of other hemp-based products, the availability of resources in the country for exploitation of medicinal hemp, and the potential benefits of hemp-based drugs to Ghanaians, investing in medicinal hemp may be the best option for the government of Ghana.
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Affiliation(s)
- Richard Quansah Amissah
- grid.34429.380000 0004 1936 8198Department of Biomedical Sciences, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1 Canada
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Sheriff B, Sakyi K, Malm EK, Zabel C, Owusu PG, Sowah LA, Anum A. Knowledge of developmental disabilities and referral sources among health workers in two Ghanaian hospitals. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 70:458-468. [PMID: 38699501 PMCID: PMC11062274 DOI: 10.1080/20473869.2022.2097413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/28/2022] [Indexed: 05/05/2024]
Abstract
Proper treatment of developmental disabilities requires health workers to have adequate knowledge of etiology and referral procedures. There is a dearth of research on knowledge of developmental disabilities among health workers in Ghana. The purpose of this study was to document knowledge about developmental disorders, causes, and referral procedures among health workers. Researchers used a successive free-listing method to interview 37 health workers. Developmental disabilities which present with physical symptoms were the most salient disorders identified among health workers, while learning disabilities and attention deficit disorder were largely overlooked. The most commonly listed developmental disabilities were cerebral palsy, Down syndrome, and autism spectrum disorder. Respondents had limited knowledge about the causes of and referral resources for developmental disabilities. Results show the need for continuing medical education, public awareness, and enhanced resources to support the identification and care of children with developmental disabilities in Ghana.
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Affiliation(s)
- Blessed Sheriff
- Center for Learning and Childhood Development, Accra, Ghana
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kwame Sakyi
- Department of Public and Environmental Wellness, Oakland University, Rochester Hills, OK, USA
| | - Esther K. Malm
- Center for Learning and Childhood Development, Accra, Ghana
- Department of Psychology, Murray State University, Murray, KY, USA
| | | | | | | | - Adote Anum
- Center for Learning and Childhood Development, Accra, Ghana
- Department of Psychology, University of Ghana, Ghana
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Diaz MM, Sokhi D, Noh J, Ngugi AK, Minja FJ, Reddi P, Fèvre EM, Meyer ACL. Prevalence of Epilepsy, Human Cysticercosis, and Porcine Cysticercosis in Western Kenya. Am J Trop Med Hyg 2022; 106:1450-1455. [PMID: 38223984 PMCID: PMC9128686 DOI: 10.4269/ajtmh.21-0594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 12/21/2021] [Indexed: 01/16/2024] Open
Abstract
Cysticercosis is the leading cause of acquired epilepsy worldwide and has been shown to be highly prevalent in pig populations in western Kenya. We conducted a community-based door-to-door survey in a region of western Kenya with a high proportion of pig-keeping households. Persons with epilepsy (PWE) were determined using a screening questionnaire followed by a neurologist evaluation. Cysticercosis serum apDia antigen ELISAs and Western blot for LLGP and rT24h antigen were performed on all PWE and 2% of screen-negative patients. All PWE or people with positive apDia underwent contrast-enhanced brain computed tomography (CT). Of a sample of 810 village residents, 660 (81%) were present in the homestead, of whom 648 (98%) participated. Of these, 17 were confirmed to have lifetime epilepsy, an estimated crude prevalence of 2.6%. No humans with (N = 17) or without (N = 12) epilepsy had serological evidence of cysticercosis infection. Fourteen PWE and one individual with borderline positive apDia antigen ELISA underwent brain CT; none had radiographic findings consistent with neurocysticercosis. Nearly 30% of households kept pigs, with 69% always tethered in both wet and dry seasons. More than 8% (6/72) of pigs had palpable lingual cysts; these pigs all originated from homesteads with latrines, one-third of which were free-ranging at least some of the time. Epilepsy prevalence in our study was greater than the national prevalence, but we found no individuals with epilepsy attributable to cysticercosis. Additional studies are required to identify causes of epilepsy, human and porcine cysticercosis, the role of spatial clustering, and protective factors like host-pathogen immunity.
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Affiliation(s)
- Monica M. Diaz
- Yale University, New Haven, Connecticut
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Dilraj Sokhi
- International Livestock Research Institute, Nairobi, Kenya
| | - John Noh
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Prabhakhar Reddi
- Aga Khan University East Africa, Nairobi, Kenya
- Aga Khan Hospital, Kisumu, Kenya
| | - Eric M. Fèvre
- International Livestock Research Institute, Nairobi, Kenya
- University of Liverpool, Liverpool, United Kingdom
| | - Ana-Claire L. Meyer
- Yale University, New Haven, Connecticut
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Kwon CS, Wagner RG, Carpio A, Jetté N, Newton CR, Thurman DJ. The worldwide epilepsy treatment gap: A systematic review and recommendations for revised definitions - A report from the ILAE Epidemiology Commission. Epilepsia 2022; 63:551-564. [PMID: 35001365 DOI: 10.1111/epi.17112] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE In order to more appropriately apply and understand the "epilepsy treatment gap" (ETG) concept in current health systems, revised conceptual and operational definitions of ETG are timely and necessary. This article therefore systematically reviews worldwide studies of the ETG, distinguishing high-, middle-, and low-income regions, and provides recommendations for an updated International League Against Epilepsy (ILAE) definition of ETG. METHODS A systematic review of the ETG was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. The search was conducted from January 1990 to July 2019, in the online databases of Ovid MEDLINE and Embase. Identified abstracts were reviewed in duplicate and data independently extracted using a standard proforma. Data describing treatment gap information including both diagnostic and therapeutic aspects of access to epilepsy treatment were recorded. Descriptive statistics are presented. RESULTS The treatment gap reported in the 45 distinctive populations represented 33 countries. Treatment gap definitions varied widely. The reported ETGs ranged broadly from 5.6% in Norway to 100% in parts of Tibet, Togo, and Uganda. The wide range of reported ETGs was multifactorial in origin including true differences in the availability and utilization of health care among study populations, variations in operational definitions of the epilepsy treatment gap, and methodological differences in sampling and identifying representative epilepsy cases in populations. Significance and recommendations For the ETG to be a useful metric to compare levels of unmet epilepsy care across different countries and regions, a standardized definition must be adapted, recognizing some of the limitations of the current definitions. Our proposed definition takes into account the lack of effective health care insurance, the diagnostic gap, the therapeutic gap, quality-of-care, and other unmet health care needs."
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Affiliation(s)
- Churl-Su Kwon
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Neurology, Icahn school of Medicine at Mount Sinai, New York, New York, USA.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ryan G Wagner
- MRC/Wits Agincourt Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Arturo Carpio
- Research Institute, University of Cuenca School of Medicine, Cuenca, Ecuador
| | - Nathalie Jetté
- Department of Neurology, Icahn school of Medicine at Mount Sinai, New York, New York, USA
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Kwofie SK, Broni E, Yunus FU, Nsoh J, Adoboe D, Miller WA, Wilson MD. Molecular Docking Simulation Studies Identifies Potential Natural Product Derived-Antiwolbachial Compounds as Filaricides against Onchocerciasis. Biomedicines 2021; 9:biomedicines9111682. [PMID: 34829911 PMCID: PMC8615632 DOI: 10.3390/biomedicines9111682] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/20/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022] Open
Abstract
Onchocerciasis is the leading cause of blindness and severe skin lesions which remain a major public health problem, especially in tropical areas. The widespread use of antibiotics and the long duration required for effective treatment continues to add to the increasing global menace of multi-resistant pathogens. Onchocerca volvulus harbors the endosymbiont bacteria Wolbachia, essential for the normal development of embryos, larvae and long-term survival of the adult worm, O. volvulus. We report here results of using structure-based drug design (SBDD) approach aimed at identifying potential novel Wolbachia inhibitors from natural products against the Wolbachia surface protein (WSP). The protein sequence of the WSP with UniProtKB identifier Q0RAI4 was used to model the three-dimensional (3D) structure via homology modelling techniques using three different structure-building algorithms implemented in Modeller, I-TASSER and Robetta. Out of the 15 generated models of WSP, one was selected as the most reasonable quality model which had 82, 15.5, 1.9 and 0.5% of the amino acid residues in the most favored regions, additionally allowed regions, generously allowed regions and disallowed regions, respectively, based on the Ramachandran plot. High throughput virtual screening was performed via Autodock Vina with a library comprising 42,883 natural products from African and Chinese databases, including 23 identified anti-Onchocerca inhibitors. The top six compounds comprising ZINC000095913861, ZINC000095486235, ZINC000035941652, NANPDB4566, acetylaleuritolic acid and rhemannic acid had binding energies of −12.7, −11.1, −11.0, −11, −10.3 and −9.5 kcal/mol, respectively. Molecular dynamics simulations including molecular mechanics Poisson-Boltzmann (MMPBSA) calculations reinforced the stability of the ligand-WSP complexes and plausible binding mechanisms. The residues Arg45, Tyr135, Tyr148 and Phe195 were predicted as potential novel critical residues required for ligand binding in pocket 1. Acetylaleuritolic acid and rhemannic acid (lantedene A) have previously been shown to possess anti-onchocercal activity. This warrants the need to evaluate the anti-WSP activity of the identified molecules. The study suggests the exploitation of compounds which target both pockets 1 and 2, by investigating their potential for effective depletion of Wolbachia. These compounds were predicted to possess reasonably good pharmacological profiles with insignificant toxicity and as drug-like. The compounds were computed to possess biological activity including antibacterial, antiparasitic, anthelmintic and anti-rickettsials. The six natural products are potential novel antiwolbachial agents with insignificant toxicities which can be explored further as filaricides for onchocerciasis.
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Affiliation(s)
- Samuel K. Kwofie
- Department of Biomedical Engineering, School of Engineering Sciences, College of Basic and Applied Sciences, University of Ghana, PMB LG 77, Legon, Accra LG 77, Ghana; (E.B.); (F.U.Y.); (J.N.); (D.A.)
- West African Centre for Cell Biology of Infectious Pathogens, Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra LG 54, Ghana
- Correspondence: ; Tel.: +233-203-797922
| | - Emmanuel Broni
- Department of Biomedical Engineering, School of Engineering Sciences, College of Basic and Applied Sciences, University of Ghana, PMB LG 77, Legon, Accra LG 77, Ghana; (E.B.); (F.U.Y.); (J.N.); (D.A.)
- West African Centre for Cell Biology of Infectious Pathogens, Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra LG 54, Ghana
- Department of Parasitology, Noguchi Memorial Institute for Medical Research (NMIMR), College of Health Sciences (CHS), University of Ghana, P.O. Box LG 581, Legon, Accra LG 581, Ghana;
| | - Faruk U. Yunus
- Department of Biomedical Engineering, School of Engineering Sciences, College of Basic and Applied Sciences, University of Ghana, PMB LG 77, Legon, Accra LG 77, Ghana; (E.B.); (F.U.Y.); (J.N.); (D.A.)
| | - John Nsoh
- Department of Biomedical Engineering, School of Engineering Sciences, College of Basic and Applied Sciences, University of Ghana, PMB LG 77, Legon, Accra LG 77, Ghana; (E.B.); (F.U.Y.); (J.N.); (D.A.)
| | - Dela Adoboe
- Department of Biomedical Engineering, School of Engineering Sciences, College of Basic and Applied Sciences, University of Ghana, PMB LG 77, Legon, Accra LG 77, Ghana; (E.B.); (F.U.Y.); (J.N.); (D.A.)
| | - Whelton A. Miller
- Department of Medicine, Loyola University Medical Center, Maywood, IL 60153, USA;
- Department of Molecular Pharmacology and Neuroscience, Loyola University Medical Center, Maywood, IL 60153, USA
- Department of Chemical and Biomolecular Engineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, IL 19104, USA
| | - Michael D. Wilson
- Department of Parasitology, Noguchi Memorial Institute for Medical Research (NMIMR), College of Health Sciences (CHS), University of Ghana, P.O. Box LG 581, Legon, Accra LG 581, Ghana;
- Department of Medicine, Loyola University Medical Center, Maywood, IL 60153, USA;
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10
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Angwafor SA, Bell GS, Ngarka L, Otte WM, Tabah EN, Nfor LN, Njamnshi TN, Sander JW, Njamnshi AK. Epilepsy in a health district in North-West Cameroon: Clinical characteristics and treatment gap. Epilepsy Behav 2021; 121:107997. [PMID: 33994085 DOI: 10.1016/j.yebeh.2021.107997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Epilepsy is a common yet misunderstood condition in Cameroon, including in the Batibo Health district. METHODS This cross-sectional study describes epilepsy clinical characteristics, the treatment gap, and associated factors in a rural district in Cameroon. After screening for epilepsy using a door-to-door survey, physicians confirmed suspected cases of epilepsy. Detailed information on the medical, seizure, and treatment history was collected from everyone with epilepsy, followed by a general and neurological examination. RESULTS We diagnosed 546 people with active epilepsy (at least one seizure in the previous 12 months). The mean age of people with active epilepsy was 25.2 years (SD: 11.1). The mean age at first seizure was 12.5 years (SD: 8.2). Convulsive seizures (uncertain whether generalized or focal) were the most common seizure types (60%), while 41% had focal-onset seizures. About 60% of people had seizures at least monthly. One-quarter of participants had had at least one episode of status epilepticus. Anti-seizure medication (ASM) was taken by 85%, but most were receiving inappropriate treatment or were non-adherent, hence the high treatment gap (80%). Almost a third had had seizure-related injuries. Epilepsy was responsible for low school attendance; 74% of school dropouts were because of epilepsy. CONCLUSION The high proportion of focal-onset seizures suggests acquired causes (such as neurocysticercosis and onchocerciasis, both endemic in this area). The high epilepsy treatment gap and the high rates of status epilepticus and epilepsy-related injuries underscore the high burden of epilepsy in this rural Cameroonian health district.
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Affiliation(s)
- Samuel A Angwafor
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks SL9 0RJ, United Kingdom; Faculty of Health Sciences, University of Bamenda, Cameroon; Neurology Department, Central Hospital Yaoundé/Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé I, Cameroon
| | - Gail S Bell
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks SL9 0RJ, United Kingdom
| | - Leonard Ngarka
- Neurology Department, Central Hospital Yaoundé/Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé I, Cameroon; Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon; Brain Research Africa Initiative (BRAIN), Geneva, Switzerland
| | - Willem M Otte
- Department of Pediatric Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Earnest N Tabah
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University Of Dschang, Cameroon
| | - Leonard N Nfor
- Neurology Department, Central Hospital Yaoundé/Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé I, Cameroon; Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon; Brain Research Africa Initiative (BRAIN), Geneva, Switzerland
| | | | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks SL9 0RJ, United Kingdom; Stichting Epilepsie Instelligen Nederland (SEIN), Heemstede, Netherlands.
| | - Alfred K Njamnshi
- Neurology Department, Central Hospital Yaoundé/Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé I, Cameroon; Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon; Brain Research Africa Initiative (BRAIN), Geneva, Switzerland
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11
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Angwafor SA, Bell GS, Ngarka L, Otte W, Tabah EN, Nfor LN, Njamnshi TN, Njamnshi AK, Sander JW. Incidence and prevalence of epilepsy and associated factors in a health district in North-West Cameroon: A population survey. Epilepsy Behav 2021; 121:108048. [PMID: 34083120 DOI: 10.1016/j.yebeh.2021.108048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/28/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
This population-based cross-sectional survey with a follow-up case-control study assessed the prevalence, incidence, and risk factors for epilepsy in a rural health district in the North-West Region of Cameroon. Community-based epilepsy screening targeted all inhabitants, six years and older, in all 16 health areas in the Batibo Health District. During door-to-door visits, trained fieldworkers used a validated questionnaire to interview consenting household heads to screen for epilepsy in eligible residents. Trained physicians subsequently assessed people with suspected seizures. After clinical assessment, they confirmed or refuted the diagnosis and estimated the date of epilepsy onset. A trained nurse interviewed people with epilepsy and randomly selected healthy individuals, obtaining relevant demographic details and information on exposure to risk factors for epilepsy. Out of 36,282 residents screened, 524 had active epilepsy. The age-standardized prevalence of active epilepsy was 33.9/1,000 (95% CI: 31.0-37.1/1,000). We estimated the one-year age-standardized epilepsy incidence at 171/100,000 (95%CI: 114.0-254.6). Active epilepsy prevalence varied widely between health areas, ranging between 12 and 75 per 1,000. The peak age-specific prevalence was in the 25-34 age group. In adults, multivariate analysis showed that having a relative with epilepsy was positively associated with epilepsy. Epilepsy characteristics in this population, geographical heterogeneity, and the age-specific prevalence pattern suggest that endemic neurocysticercosis and onchocerciasis may be implicated. Further investigations are warranted to establish the full range of risk factors for epilepsy in this population.
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Affiliation(s)
- Samuel A Angwafor
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG and Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks SL9 0RJ, United Kingdom; Faculty of Health Sciences, University of Bamenda, Cameroon
| | - Gail S Bell
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG and Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks SL9 0RJ, United Kingdom
| | - Leonard Ngarka
- Neurology Department, Central Hospital Yaoundé/Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé I, Yaoundé, Cameroon; Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon/Geneva, Switzerland
| | - Willem Otte
- Department of Pediatric Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Earnest N Tabah
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University Of Dschang, Cameroon & Department of Disease Control, Ministry of Public Health, Yaounde, Cameroon
| | - Leonard N Nfor
- Neurology Department, Central Hospital Yaoundé/Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé I, Yaoundé, Cameroon; Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon/Geneva, Switzerland
| | - Theophilus N Njamnshi
- Department of Medical Laboratory Science, School of Health and Medical Science, Kumbo, Catholic University of Cameroon, Bamenda, Cameroon
| | - Alfred K Njamnshi
- Neurology Department, Central Hospital Yaoundé/Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé I, Yaoundé, Cameroon; Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon/Geneva, Switzerland.
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG and Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks SL9 0RJ, United Kingdom; Stichting Epilepsie Instelligen Nederland (SEIN), Heemstede, Netherlands
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12
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Akpalu A, Adjei P, Nkromah K, Poku FO, Sarfo FS. Neurological disorders encountered at an out-patient clinic in Ghana's largest medical center: A 16-year review. eNeurologicalSci 2021; 24:100361. [PMID: 34377844 PMCID: PMC8327338 DOI: 10.1016/j.ensci.2021.100361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/08/2021] [Accepted: 07/21/2021] [Indexed: 12/01/2022] Open
Abstract
Background With a rising age of its population, sub-Saharan Africa(SSA) is currently experiencing an unprecedented rise in burden of neurological disorders. There is limited data on the demographic profile of neurological diseases in SSA. Objective To describe the spectrum of neurological disorders at the adult neurology clinic at Ghana's leading medical center. Methods This retrospective study was conducted at the adult neurology clinic at the Korle Bu Teaching Hospital between 2003 and 2019. We retrospectively reviewed charts of all cases seen at the clinic over the period to document main neurological diagnosis, and captured age and sex of participants. Neurologic diseases were classified using the revised International Statistical Classification of Diseases and Related Health Problems ICD 11 tool. Results There were 7950 patients sought consultation over the period with 7076 having a primary neurological disorder. The mean age ± SD of patients included in the analysis was 43.0 ± 19.8 years with 3777 (53.4%) being males. The frequencies of the top 5 neurological disorders were epilepsy (23.0%), peripheral neuropathies (19.6%), movement disorders (14.7%), cerebrovascular diseases (11.1%) and headache disorders (7.7%). Neurocognitive disorders, autoimmune demyelinating disorders of the nervous system, and motor neuron disorders were infrequently observed. Conclusion A wide spectrum of neurological disorders were encountered in this clinic, similar to previous report from other centers in SSA. There is an urgent need to build local capacity to provide optimal care to meet the demand of the rising burden of neurological diseases in Ghana.
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Affiliation(s)
- Albert Akpalu
- University of Ghana Medical School, Accra, Ghana.,Korle Bu Teaching Hospital, Accra, Ghana
| | - Patrick Adjei
- University of Ghana Medical School, Accra, Ghana.,Korle Bu Teaching Hospital, Accra, Ghana
| | | | - Foster Osei Poku
- Korle Bu Teaching Hospital, Accra, Ghana.,Akwatia Hospital, Ghana
| | - Fred Stephen Sarfo
- Kwame Nkrumah University of Science and Technology, School of Medical Sciences, Kumasi, Ghana
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13
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Colebunders R, Njamnshi AK, Menon S, Newton CR, Hotterbeekx A, Preux PM, Hopkins A, Vaillant M, Siewe Fodjo JN. Onchocerca volvulus and epilepsy: A comprehensive review using the Bradford Hill criteria for causation. PLoS Negl Trop Dis 2021; 15:e0008965. [PMID: 33411705 PMCID: PMC7790236 DOI: 10.1371/journal.pntd.0008965] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The possibility that onchocerciasis may cause epilepsy has been suggested for a long time, but thus far, an etiological link has not been universally accepted. The objective of this review is to critically appraise the relationship between Onchocerca volvulus and epilepsy and subsequently apply the Bradford Hill criteria to further evaluate the likelihood of a causal association. METHODS PubMed and gray literature published until September 15, 2020, were searched and findings from original research were synthesized. Adherence to the 9 Bradford Hill criteria in the context of onchocerciasis and epilepsy was determined to assess whether the criteria are met to strengthen the evidence base for a causal link between infection with O. volvulus and epilepsy, including the nodding syndrome. RESULTS Onchocerciasis as a risk factor for epilepsy meets the following Bradford Hill criteria for causality: strength of the association, consistency, temporality, and biological gradient. There is weaker evidence supporting causality based on the specificity, plausibility, coherence, and analogy criteria. There is little experimental evidence. Considering the Bradford Hill criteria, available data suggest that under certain conditions (high microfilarial load, timing of infection, and perhaps genetic predisposition), onchocerciasis is likely to cause epilepsy including nodding and Nakalanga syndromes. CONCLUSION Applying the Bradford Hill criteria suggests consistent epidemiological evidence that O. volvulus infection is a trigger of epilepsy. However, the pathophysiological mechanisms responsible for seizure induction still need to be elucidated.
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Affiliation(s)
- Robert Colebunders
- Global Health Institute, University of Antwerp, Antwerp, Belgium
- * E-mail:
| | - Alfred K. Njamnshi
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé Cameroon
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Sonia Menon
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Charles R. Newton
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - An Hotterbeekx
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Pierre-Marie Preux
- Institute of Epidemiology and Tropical Neurology, INSERM UMR1094, University of Limoges, Limoges, France
| | - Adrian Hopkins
- Neglected and Disabling Diseases of Poverty Consultant, Kent, United Kingdom
| | - Michel Vaillant
- Competence Center in Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg
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Al Habbal A, AlSharif A, Almubark A, Fattouh H, Hamzeh G, Kakaje A. Risk factors associated with epilepsy in children and adolescents: A case-control study from Syria. Epilepsy Behav 2021; 114:107596. [PMID: 33246894 DOI: 10.1016/j.yebeh.2020.107596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/19/2020] [Accepted: 10/24/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Epilepsy is a major public health concern in low-income countries (LIC) as they contain 80% of total cases worldwide. Syria has been in war since 2011 which made it difficult to prevent epilepsy risk factors which made this the first study on that matter. METHODS This is a case-control study from 3 medical centers in Damascus, Syria. Data were collected using questionnaires introduced by trained doctors. The control group included patients from a general practice clinic while the cases were taken from the three pediatric neurology clinics. RESULTS The sample consisted of 334 patients with 167 cases and 167 controls. Multivariable analysis confirmed the association between positive family history (FH) in 1st degree (OR, 3.37, 95%CI 1.2-9.47) and 2nd degree relatives (OR, 3.98, 95%CI 1.84-8.62), febrile seizures whether they were simple (OR, 15.08, 95%CI 3.27-69.5) or complex (OR, 13.32, 95%CI 1.58-112.32), developmental delay/regression (OR, 14.31, 95%CI 6.3-32.49), and central nervous system (CNS) infection (OR, 34.05, 95%CI 2.02-573.92). Head trauma, parental factors, consanguinity, asphyxia parameters, and other risk factors were not found to be significantly associated with epilepsy (P > 0.05). CONCLUSION While some results were similar to other studies, others were not. Efforts should be made to facilitate healthcare access and proper diagnosis.
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Affiliation(s)
| | | | - Amjad Almubark
- Neurology Department, Children's University Hospital, Damascus, Syria
| | | | - Ghassan Hamzeh
- Neurology Department, Al Assad University Hospital, Damascus, Syria
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15
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Siewe Fodjo JN, Remme JHF, Preux PM, Colebunders R. Meta-analysis of epilepsy prevalence in West Africa and its relationship with onchocerciasis endemicity and control. Int Health 2020; 12:192-202. [PMID: 32141502 PMCID: PMC7320426 DOI: 10.1093/inthealth/ihaa012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/04/2020] [Accepted: 02/19/2020] [Indexed: 01/28/2023] Open
Abstract
Background A high prevalence and incidence of epilepsy has been reported in onchocerciasis-endemic regions in Central and East Africa. There is compelling epidemiological evidence suggesting that this high burden is caused by onchocerciasis-associated epilepsy (OAE). We hypothesized that OAE had also occured in West African onchocerciasis foci. Methods We searched PubMed, the African Journals Online platform and grey literature for population-based epilepsy studies in West African countries. Epilepsy and onchocerciasis prevalence data were extracted. The pre-control onchocerciasis endemicity in the study sites was estimated from historical data of onchocerciasis control programmes. The prevalence of epilepsy in different sites was analysed, taking into account onchocerciasis endemicity and the duration of control. Results The pooled prevalence of epilepsy in the West African study sites was 13.14 per 1000 (95% confidence interval 11.28–15.00). Higher pre-control endemicity and a shorter duration of onchocerciasis control were both associated with increased epilepsy prevalence (p<0.001). Two studies in Ivory Coast that provided detailed descriptions of persons with epilepsy in onchocerciasis-endemic settings revealed that most of them had features of OAE (73.7% and 83.3%, respectively). Conclusions Our findings suggest that before and during the early years of implementing onchocerciasis control in West Africa, high onchocerciasis endemicity resulted in a high prevalence of OAE and that subsequent control efforts significantly reduced the prevalence of OAE.
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Affiliation(s)
| | | | - Pierre-Marie Preux
- INSERM, University of Limoges, CHU Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, GEIST, 87000 Limoges, France
| | - Robert Colebunders
- Global Health Institute, University of Antwerp, Doornstraat 331, 2610 Antwerp, Belgium
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16
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Sadeghi M, Riahi SM, Mohammadi M, Saber V, Aghamolaie S, Moghaddam SA, Aghaei S, Javanian M, Gamble HR, Rostami A. An updated meta-analysis of the association between Toxoplasma gondii infection and risk of epilepsy. Trans R Soc Trop Med Hyg 2020; 113:453-462. [PMID: 31034025 DOI: 10.1093/trstmh/trz025] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/08/2019] [Accepted: 03/26/2019] [Indexed: 12/19/2022] Open
Abstract
Toxoplasma gondii is a neurotropic pathogen with worldwide distribution. To evaluate the association between Toxoplasma infection and the risk of epilepsy by meta-analysis, observational peer-reviewed studies were retrieved from PubMed, Embase, Web of Science, Scopus and Google Scholar (up to 10 October 2018) and by reference review. Pooled risk estimates were calculated using a random effects model. Heterogeneity was assessed using Cochrane's Q-test and I2. In total, 16 eligible studies involving 19 data sets were included for the final analysis. A total 7897 participants (3771 epileptic patients, 4026 healthy controls) were included. The pooled odds ratio (OR) for Toxoplasma infection was increased to 1.72 (95% confidence interval [CI] 1.37 to 2.16) among patients with epilepsy. There was moderate heterogeneity among the studies (χ2=39.8, I2=62.3%, p=0.001). The ORs from subgroup analyses showed that both cryptogenic epilepsy (OR 2.65 [95% CI 1.91 to 3.68]) and active convulsive epilepsy (OR 1.37 [95% CI 1.09 to 1.72]) were significantly associated with Toxoplasma infection. Another subgroup analyses according to age showed a significant positive association in children (OR 1.33), adults (OR 1.57) and in all ages (OR 1.89). Our findings support the association between Toxoplasma infection and epilepsy. More prospective studies with larger sample sizes and more experimental studies are recommended to elucidate a causative relationship.
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Affiliation(s)
- Maryam Sadeghi
- Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Riahi
- Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mona Mohammadi
- Clinical Parasitology Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Vafa Saber
- Department of Microbiology, Islamic Azad University, Varamin Pishva Branch, Tehran, Iran
| | - Somayeh Aghamolaie
- Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Shima Aghaei
- Department of Medical Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mostafa Javanian
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - H Ray Gamble
- National Academy of Sciences, Washington, DC, USA
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.,Immunoregulation Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Owolabi LF, Owolabi SD, Adamu B, Jibo A, Alhaji ID. Epilepsy treatment gap in Sub-Saharan Africa: Meta-analysis of community-based studies. Acta Neurol Scand 2020; 142:3-13. [PMID: 32219865 DOI: 10.1111/ane.13246] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/16/2020] [Accepted: 03/20/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate the prevalence, highlight the variation and determine the trend over time, of epilepsy treatment gap (ETG) in Sub-Saharan Africa (SSA). METHODS We systematically searched PubMed, MEDLINE, Embase, ISI databases, and African Journal Online (AJOL). We determined the pooled prevalence estimate of ETG and the degree of heterogeneity in the region. Further subgroup analysis by sub-region, settlement setting, and cutoff adopted for active epilepsy in the studies was carried out. Meta-regression technique was also used to determine the trend of the ETG magnitude over time. RESULTS Twenty-three studies from SSA met the inclusion criteria. We found a high level of discordance among the studies that were included. Collectively, the estimated ETG was 68.5% (95% CI: 59.5%-77.5%). On subgroup analysis, the prevalence of the ETG was 67% (95% CI: 52%, 83%) in the Western, 68% (95% CI: 56%, 80%) in the Eastern, and 63% (95% CI: 53%, 73%) in the Southern Africa sub-regions. On stratified analysis based on 1-year, 5-year, and 2-year cutoffs for definition of active epilepsy, the prevalence figures for the ETG were 71% (95% CI: 56%, 85%), 55% (95% CI: 33%, 77%), and 57% (95% CI: 43%, 71%), respectively. Meta-regression result suggested that the prevalence of the ETG decreases by approximately by 0.006 per year. CONCLUSION The study showed a high prevalence of ETG, higher than the average for resource poor countries, and twice in rural compared with urban settlements in SSA.
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Affiliation(s)
- L. F. Owolabi
- Departments of Medicine Bayero University Kano Nigeria
| | - S. D. Owolabi
- Department of Psychiatry, Bayero University Kano Nigeria
| | - B. Adamu
- Department of Medicine University of Bisha Bisha Saudi Arabia
| | - A.M. Jibo
- Department of Community Medicine Bayero University Kano Nigeria
| | - I. D. Alhaji
- Departments of Medicine Bayero University Kano Nigeria
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Muhigwa A, Preux PM, Gérard D, Marin B, Boumediène F, Ntamwira C, Tsai CH. Comorbidities of epilepsy in low and middle-income countries: systematic review and meta-analysis. Sci Rep 2020; 10:9015. [PMID: 32488109 PMCID: PMC7265529 DOI: 10.1038/s41598-020-65768-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/06/2020] [Indexed: 01/30/2023] Open
Abstract
Epilepsy is a major public health concern in low and middle-income countries (LMICs) and comorbidities aggravate the burden associated with the disease. The epidemiology of these comorbidities has not been well described, although, identifying the main comorbidities of epilepsy, and their relative importance, is crucial for improving the quality of care. Comorbidities were defined as disorders coexisting with or preceding epilepsy, or else compounded or directly attributed to epilepsy or to its treatment. A meta-analysis of the proportion of main comorbidities by subcontinent as well as overall was also conducted. Out of the 2,300 papers identified, 109 from 39 countries were included in this systematic review. Four groups of comorbidities were identified: parasitic and infectious diseases (44% of comorbid conditions), somatic comorbidities (37%), psychosocial (11%), as well as psychiatric comorbidities (8%). Heterogeneity was statistically significant for most variables then random effect models were used. The most frequently studied comorbidities were: neurocysticercosis (comorbid proportion: 23%, 95% CI: 18-29), head trauma (comorbid proportion: 9%, 95% CI: 5-15) malnutrition (comorbid proportion: 16%, 95% CI: 28-40), stroke (comorbid proportion: 1.3%, 95% CI: 0.2-7.0), and discrimination for education (comorbid proportion: 34%, 95% CI: 28-40). Many comorbidities of epilepsy were identified in LMICs, most of them being infectious.
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Affiliation(s)
- Aline Muhigwa
- INSERM, IRD associated unit, U1094, Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, CHU Limoges, GEIST, 87000, Limoges, France
- Faculté de médecine, Université officielle de Bukavu/1, Avenue Kasongo, Commune d'Ibanda, B.P. 570, Bukavu, Democratic Republic of the Congo
| | - Pierre-Marie Preux
- INSERM, IRD associated unit, U1094, Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, CHU Limoges, GEIST, 87000, Limoges, France.
| | - Daniel Gérard
- INSERM, IRD associated unit, U1094, Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, CHU Limoges, GEIST, 87000, Limoges, France
| | - Benoit Marin
- INSERM, IRD associated unit, U1094, Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, CHU Limoges, GEIST, 87000, Limoges, France
| | - Farid Boumediène
- INSERM, IRD associated unit, U1094, Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, CHU Limoges, GEIST, 87000, Limoges, France
| | - Charles Ntamwira
- Faculté de médecine, Université officielle de Bukavu/1, Avenue Kasongo, Commune d'Ibanda, B.P. 570, Bukavu, Democratic Republic of the Congo
| | - Chung-Huang Tsai
- Department of family medicine, Chung-Kang Branch, Cheng Ching hospital, Taiwan No.966.sec. 4, Taiwan Blvd. Xitun Dist., Taichung, Taiwan, ROC
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Owolabi LF, Adamu B, Jibo AM, Owolabi SD, Isa AI, Alhaji ID, Enwere OO. Prevalence of active epilepsy, lifetime epilepsy prevalence, and burden of epilepsy in Sub-Saharan Africa from meta-analysis of door-to-door population-based surveys. Epilepsy Behav 2020; 103:106846. [PMID: 31941583 DOI: 10.1016/j.yebeh.2019.106846] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 12/06/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is marked variation in the prevalence of epilepsy across Sub-Saharan Africa (SSA). In order to accurately estimate the clinical and public health impacts of epilepsy in the region, robust and reliable epidemiological data are required for appropriate estimation of logistical, economical, and social impacts of epilepsy including policy formulation and intervention in the region. OBJECTIVE We sought to evaluate the prevalence of active epilepsy (AE) and lifetime epilepsy prevalence in SSA using available data collected at community level. METHODS We carefully searched online databases and identified the required articles using prespecified criteria. Random-effects model (REM) was used to estimate the active and lifetime prevalence from data generated from studies in SSA.. The burden of epilepsy, in terms of the number of people with the disease, was also obtained. Heterogeneity in the analysis was further explored using subgroup analysis and meta-regression techniques. RESULT A total of 39 and 12 community-based door-to-door surveys addressing AE and lifetime epilepsy, respectively, from different countries of SSA met the inclusion criteria for the study. Random-effects model estimates of overall prevalence of epilepsy were 9 per 1000 persons (95% confidence interval (CI): 8.0-9.9 per 1000 persons) for AE and 16 per 1000 persons (95% CI: 12.3-19.7 per 1000 persons) for lifetime epilepsy. The prevalence was highest in the Central Africa subregion with 30.2 per 1000 persons (95% CI: 6.2 to 66.7 per 1000 persons). The prevalence of AE in the rural settlement was twice that of the urban settlements. About 9,596,551 (95% CI: 8,530,267-10,556,206) people with AE and 17,060,535 (95% CI: 13,115,286-21,005,784) people with lifetime epilepsy live in SSA. CONCLUSION This study estimates the active (9/1000) and lifetime (16/1000) epilepsy with a remarkable burden of the disease in SSA. However, the prevalence, which is higher in the rural setting, varies within the subregion of SSA.
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Affiliation(s)
| | - Bappa Adamu
- University of Bisha College of Medicine, University of Bisha, Saudi Arabia
| | | | | | - Adamu Imam Isa
- University of Bisha College of Medicine, University of Bisha, Saudi Arabia
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Siewe Fodjo JN, Mandro M, Mukendi D, Tepage F, Menon S, Nakato S, Nyisi F, Abhafule G, Wonya’rossi D, Anyolito A, Lokonda R, Hotterbeekx A, Colebunders R. Onchocerciasis-associated epilepsy in the Democratic Republic of Congo: Clinical description and relationship with microfilarial density. PLoS Negl Trop Dis 2019; 13:e0007300. [PMID: 31314757 PMCID: PMC6663032 DOI: 10.1371/journal.pntd.0007300] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/29/2019] [Accepted: 06/13/2019] [Indexed: 11/21/2022] Open
Abstract
Background High epilepsy prevalence and incidence were observed in onchocerciasis-endemic villages in the Democratic Republic of Congo (DRC). We investigated the clinical characteristics of onchocerciasis-associated epilepsy (OAE), and the relationship between seizure severity and microfilarial density. Methods In October 2017, ivermectin-naive persons with epilepsy (PWE) were recruited from onchocerciasis-endemic areas in the Logo health zone in the DRC. Additional PWE were enrolled in the Aketi health zone, where ivermectin had been distributed annually for 14 years. Past medical history, clinical characteristics and skin snips for Onchocerca volvulus detection were obtained from participants. Bivariate and multivariable analyses were used to investigate associations with microfilarial density. Results Of the 420 PWE in the Logo health zone, 392 were skin snipped (36.5% positive). Generalized motor seizures were most frequent (392 PWE, 93.3%), and nodding seizures were reported in 32 (7.6%) participants. Twelve PWE (3.1%) presented Nakalanga features. Sixty-three (44.1%) skin snip-positive PWE had a family history of epilepsy, compared to only 82 (32.9%) skin snip-negative PWE (p = 0.027). Eighty-one onchocerciasis-infected PWE were recruited in the Aketi health zone. Positive correlations between seizure frequency and microfilarial density were observed in Logo (Spearman-rho = 0.175; p<0.001) and Aketi (Spearman-rho = 0.249; p = 0.029). In the multivariable model adjusted for age, gender, and previous treatment, high seizure frequency was associated with increasing microfilarial density in Aketi (p = 0.025) but not in Logo (p = 0.148). Conclusion In onchocerciasis-endemic regions in the DRC, a wide spectrum of seizures was observed. The occurrence of Nodding seizures and Nakalanga features, as well as an association between seizure severity and O. volvulus microfilarial density suggest a high OAE prevalence in the study villages. Trial registration ClinicalTrials.gov NCT03052998. Several epidemiological surveys suggest that onchocerciasis (a disease resulting from an infection with the parasite Onchocerca volvulus) is a cause of epilepsy. We conducted a study to describe the clinical characteristics of persons with epilepsy (PWE) living in onchocerciasis-endemic villages in the Democratic Republic of Congo. In some study sites, the frequency of seizures increased with increasing number of O. volvulus microfilariae detected in the skin snips of participants. A wide spectrum of seizures was observed, including generalized tonic-clonic seizures, absence seizures, and focal seizures. Growth retardation and household clustering of PWE were common. Specific clinical presentations such as nodding seizures and Nakalanga features were encountered. These results suggest a high prevalence of onchocerciasis-associated epilepsy (OAE) in the study villages.
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Affiliation(s)
| | - Michel Mandro
- Ministry of Health, Ituri, Democratic Republic of Congo
| | - Deby Mukendi
- Mont Amba Neuropsychopathologic Center, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | | | - Sonia Menon
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Swabra Nakato
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Françoise Nyisi
- Centre de Recherche en Maladies Tropicales de l'Ituri, Rethy, Democratic Republic of Congo
| | - Germain Abhafule
- Centre de Recherche en Maladies Tropicales de l'Ituri, Rethy, Democratic Republic of Congo
| | | | - Aimé Anyolito
- Hôpital Général de Référence de Logo, Ituri, Democratic Republic of Congo
| | - Richard Lokonda
- Mont Amba Neuropsychopathologic Center, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - An Hotterbeekx
- Global Health Institute, University of Antwerp, Antwerp, Belgium
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Dassi Tchoupa Revegue MH, Marin B, Ibinga E, Boumediene F, Preux PM, Ngoungou EB. Meta-analysis of perinatal factors associated with epilepsy in tropical countries. Epilepsy Res 2018; 146:54-62. [DOI: 10.1016/j.eplepsyres.2018.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/27/2018] [Accepted: 07/14/2018] [Indexed: 12/18/2022]
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Vaughan KA, Lopez Ramos C, Buch VP, Mekary RA, Amundson JR, Shah M, Rattani A, Dewan MC, Park KB. An estimation of global volume of surgically treatable epilepsy based on a systematic review and meta-analysis of epilepsy. J Neurosurg 2018:1-15. [PMID: 30215556 DOI: 10.3171/2018.3.jns171722] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 03/12/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEEpilepsy is one of the most common neurological disorders, yet its global surgical burden has yet to be characterized. The authors sought to compile the most current epidemiological data to quantify global prevalence and incidence, and estimate global surgically treatable epilepsy. Understanding regional and global epilepsy trends and potential surgical volume is crucial for future policy efforts and resource allocation.METHODSThe authors performed a systematic literature review and meta-analysis to determine the global incidence, lifetime prevalence, and active prevalence of epilepsy; to estimate surgically treatable epilepsy volume; and to evaluate regional trends by WHO regions and World Bank income levels. Data were extracted from all population-based studies with prespecified methodological quality across all countries and demographics, performed between 1990 and 2016 and indexed on PubMed, EMBASE, and Cochrane. The current and annual new case volumes for surgically treatable epilepsy were derived from global epilepsy prevalence and incidence.RESULTSThis systematic review yielded 167 articles, across all WHO regions and income levels. Meta-analysis showed a raw global prevalence of lifetime epilepsy of 1099 per 100,000 people, whereas active epilepsy prevalence is slightly lower at 690 per 100,000 people. Global incidence was found to be 62 cases per 100,000 person-years. The meta-analysis predicted 4.6 million new cases of epilepsy annually worldwide, a prevalence of 51.7 million active epilepsy cases, and 82.3 million people with any lifetime epilepsy diagnosis. Differences across WHO regions and country incomes were significant. The authors estimate that currently 10.1 million patients with epilepsy may be surgical treatment candidates, and 1.4 million new surgically treatable epilepsy cases arise annually. The highest prevalences are found in Africa and Latin America, although the highest incidences are reported in the Middle East and Latin America. These regions are primarily low- and middle-income countries; as expected, the highest disease burden falls disproportionately on regions with the fewest healthcare resources.CONCLUSIONSUnderstanding of the global epilepsy burden has evolved as more regions have been studied. This up-to-date worldwide analysis provides the first estimate of surgical epilepsy volume and an updated comprehensive overview of current epidemiological trends. The disproportionate burden of epilepsy on low- and middle-income countries will require targeted diagnostic and treatment efforts to reduce the global disparities in care and cost. Quantifying global epilepsy provides the first step toward restructuring the allocation of healthcare resources as part of global healthcare system strengthening.
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Affiliation(s)
- Kerry A Vaughan
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.,5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Christian Lopez Ramos
- 2University of California San Diego School of Medicine, La Jolla, California.,5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Vivek P Buch
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rania A Mekary
- 3Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS University, Boston.,4Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School
| | - Julia R Amundson
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,6Miller School of Medicine, University of Miami, Florida
| | - Meghal Shah
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,7Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Abbas Rattani
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,8Meharry Medical College, School of Medicine, Nashville; and
| | - Michael C Dewan
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,9Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kee B Park
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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Kpobi L, Swartz L, Keikelame MJ. Ghanaian traditional and faith healers' explanatory models for epilepsy. Epilepsy Behav 2018; 84:88-92. [PMID: 29754110 DOI: 10.1016/j.yebeh.2018.04.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/22/2018] [Accepted: 04/23/2018] [Indexed: 01/07/2023]
Abstract
Epilepsy is the most common neurological condition in sub-Saharan Africa. A significant number of people with epilepsy in low- and middle-income countries do not receive formal biomedical care. They utilize the services of various traditional and alternative medicine practitioners. However, there is relatively little information about the beliefs and methods of alternative healthcare providers about epilepsy in many African countries. Using explanatory models of illness framework, we interviewed thirty-six traditional and faith healers in Ghana on their beliefs and perceptions about epilepsy, as well as how they would treat epilepsy. The healers' beliefs about the nature of epilepsy were reflected in the labels they assigned to the condition. These indicated a belief in the influence of the moon in epilepsy. Furthermore, the participants held multiple, simultaneous explanatory models of causes for epilepsy, including biological, social, and supernatural causes. Epilepsy was also considered to have serious social implications for patients, especially for women. Finally, their treatment methods involved a range of herbal and spiritual practices. These varied based on the identified cause of the condition, as well as the orientation of the healer. We discuss these findings with reference to their implications for potential collaboration between biomedical and alternative healthcare systems.
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Affiliation(s)
- Lily Kpobi
- Department of Psychology, Stellenbosch University, South Africa.
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, South Africa
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Boling W, Means M, Fletcher A. Quality of Life and Stigma in Epilepsy, Perspectives from Selected Regions of Asia and Sub-Saharan Africa. Brain Sci 2018; 8:brainsci8040059. [PMID: 29614761 PMCID: PMC5924395 DOI: 10.3390/brainsci8040059] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/26/2018] [Accepted: 03/29/2018] [Indexed: 11/16/2022] Open
Abstract
Epilepsy is an important and common worldwide public health problem that affects people of all ages. A significant number of individuals with epilepsy will be intractable to medication. These individuals experience an elevated mortality rate and negative psychosocial consequences of recurrent seizures. Surgery of epilepsy is highly effective to stop seizures in well-selected individuals, and seizure freedom is the most desirable result of epilepsy treatment due to the positive improvements in psychosocial function and the elimination of excess mortality associated with intractable epilepsy. Globally, there is inadequate data to fully assess epilepsy-related quality of life and stigma, although the preponderance of information we have points to a significant negative impact on people with epilepsy (PWE) and families of PWE. This review of the psychosocial impact of epilepsy focuses on regions of Asia and Sub-Saharan Africa that have been analyzed with population study approaches to determine the prevalence of epilepsy, treatment gaps, as well as factors impacting psychosocial function of PWE and their families. This review additionally identifies models of care for medically intractable epilepsy that have potential to significantly improve psychosocial function.
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Affiliation(s)
- Warren Boling
- Department of Neurosurgery, Loma Linda University, Loma Linda, CA 92354, USA.
| | - Margaret Means
- School of Medicine, University of Louisville, Louisville, KY 40202, USA.
| | - Anita Fletcher
- Department of Neurology, University of Louisville, Louisville, KY 40202, USA.
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Alsharif MM, El-Fetoh NMA, Ali GY, Alanazi KF, Alanazi AN, FalahAlanazi O, Alshalan MH, Alfuhigi ZD, Alruwaili AE, Alhazmi RS, Alruwaili ASM, Alanizy TMA, Alshammari JH, Altimyat AO, Alshammari MMM. Epilepsy as a health problem among school children in Turaif, Northern Saudi Arabia, 2017. Electron Physician 2017; 9:5036-5042. [PMID: 28979739 PMCID: PMC5614289 DOI: 10.19082/5036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 07/11/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Epilepsy is the most common serious neurological disorder and is one of the world's most prevalent non-communicable diseases. There are no recently published data on the prevalence of epilepsy in school children in Northern Saudi Arabia. OBJECTIVE This study was conducted to determine the prevalence of epilepsy and to show some of its risk factors in school children and adolescents (6-18 years) in Turaif city, Northern Saudi Arabia. METHODS This, population-based, cross-sectional study was conducted in Turaif city, over a 6-month period, from July 2016 to January 2017. It included pupils aged 6 to18 years in all primary, preparatory and secondary schools in Turaif city. Multi-stage sampling was employed. A designated structured questionnaire was completed for each patient and included the patient's history, clinical examination, investigations and medications. Data were analyzed by SPSS version 16, using Chi-Squared test and descriptive statistics. RESULTS Out of 1,230 children, 66 (5.5%) had epilepsy; 68.2% of them were males and 31.8% females (p=0.000). Consanguinity between parents plays a significant role where 59.1% of cases had parents who were cousins (p=0.000). Family history also had a significant effect as 68.2% of cases had epilepsy cases in their families (p=0.000). CONCLUSION Epilepsy prevalence among school children (6-18 years) in Turaif city is higher in males than females. Consanguinity and positive family history are important factors. Decision makers must take effective steps to limit the causes and risk factors of the problem.
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Affiliation(s)
| | - Nagah Mohamed Abo El-Fetoh
- Associate Professor, Community Medicine Department, Faculty of medicine, Northern Border University, Arar, Saudi Arabia
| | - Gihan Yousef Ali
- Lecture of Pediatric, Pediatric Department, Sohag College of Medicine, Sohag University, Eygpt
| | | | | | - Ohud FalahAlanazi
- Student, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
| | | | | | - Anwar Eid Alruwaili
- Student, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
| | - Reem Sebeh Alhazmi
- Student, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
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Ae-Ngibise KA, Adiibokah E, Nettey OEA, Nyame S, Doku VCK, Asante KP, Owusu-Agyei S. "Making the Mentally Ill Count", lessons from a Health and Demographic Surveillance System for people with mental and neurological disorders in the Kintampo districts of Ghana. Int J Ment Health Syst 2017; 11:22. [PMID: 28293283 PMCID: PMC5348759 DOI: 10.1186/s13033-017-0130-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 03/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background Persons with mental and neurological disorders (PMNDs) are among the most marginalised groups in developing countries, as they are socially excluded and overlooked in most developmental efforts. Due to high levels of stigma and other operational difficulties, PMNDs are often marginalised in routine enumeration exercises. Health and Demographic Surveillance System is an important public health research platform especially in countries that lacks reliable data systems, as it registers and monitor basic demographic and health events such as births, deaths and migration in a geographically defined population. This information is essential for policy development and resource distribution and service delivery. We aim to document the reasons for not counting PMNDs in our communities and demonstrate the usefulness of the Kintampo Health and Demographic Surveillance Systems (KHDSS) platform in counting PMNDs over time. We also documented strategies in providing vital information that helps in establishing the rights of PMNDs. Methods As a longitudinal study, psychiatric case register was established. Both quantitative and qualitative data collection techniques were used to solicit responses from stakeholders regarding the non-consideration of PMNDs as part of household membership in the study area. PMNDs were identified using the KHDSS and followed every 6 months. The “targeted” (actively searching for PMNDs) and “service provision” (providing medical treatment for PMNDs) approaches were adopted to enhance the identification of PMNDs. Results Stigma was the main reason cited for the non-counting of PMNDs in the area. Following a “targeted” and “service provision” approach, the number of PMNDs enrolled into the psychiatric case register went up to 68% in 2010; as against the previous levels of 49 and 54% in 2005 and 2008 respectively. The study highlights the intrinsic value of such an approach for social inclusion of PMNDs. Conclusions Stigma against PMNDs was report in this study. We provided evidence that the KHDSS platform is useful for identification of PMNDs for service provision. The paper highlights evidence for policy formulation and implementation.
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Affiliation(s)
| | | | | | - Solomon Nyame
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Victor Christian Korley Doku
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
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Asadollahi A, Saberi LF, Havasi A, Kaveh MH. Psychometric Properties of the Persian Version of the Quality of Life in Epilepsy Inventory in the Later Life. J Epilepsy Res 2017; 6:59-65. [PMID: 28101476 PMCID: PMC5206101 DOI: 10.14581/jer.16012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 06/06/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND AND PURPOSE The reports indicate on the incidence of seizure disorder about 1.5 per cent of the normal elderly population. The Quality of Life in Epilepsy Inventory (QOLIE-31) has been pervasive simple tool to screen seizure in the busy neurophysiological settings and monitoring. It was constructed as self-administered tool in two formats, 89 and 31-items. To the reliability and validity of the QOLIE-31 across older adults in the southwest Iran and discuss its role in the detection of health-related quality of elderly patients with epilepsy. METHODS About 73 older adults (mean age = 66.3 ± 1.71) were sampled from the eight hospitals and caring centres. They replied to the QOLIE-31. External and criterion validity was calculated by correlation to the SF-36 questionnaire, to check and validate the epilepsy specific dimensions. The QOLIE-31 includes seven subscales: overall quality of life, seizure worry, emotional well-being, energy/fatigue, cognitive, medication effects, and social function. RESULTS There was significant difference within sample groups regarding main variables (p < 0.05). The coefficients of Cronbach's alpha (α= 0.76), convergent validity (0.81), divergent validity (-0.21), external validity with overall score of SF-36 (0.87), and criterion validity (0.78) were estimated, which were significant at p < 0.01. The exploratory factor analysis demonstrated that the QOLIE-31 is organized into six factors, which clarifies 92 per cent of the scale's variance. Second-order confirmatory factor analysis pointed out that the factor is well matched up onto a principal factor. Consequently, the 6-factors model was well appropriate for the data by the fit index techniques for adjusting the scale (AGFI = 0.94, GFI = 0.96, RMSEA = 0.003, IFI = 0.90, NFI = 0.95, CFI = 0.95). CONCLUSIONS The results pointed to the well-adjusted reliability and psychometric properties of the QOLIE-31 and its usefulness for the relevant studies as well.
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Affiliation(s)
- Abdolrahim Asadollahi
- Australian Centre for Quality of Life, Deakin University, Melbourne, Australia; Department of Healthy Aging, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Laleh Fani Saberi
- Department of Community Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Havasi
- Department of Social Work, University of Applied Science & Technology, Ahwaz, Iran
| | - Mohammad-Hossein Kaveh
- Department of Health Promotion, School of Health, Shiraz University of Medical Science, Shiraz, Iran
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Severance EG, Xiao J, Jones-Brando L, Sabunciyan S, Li Y, Pletnikov M, Prandovszky E, Yolken R. Toxoplasma gondii-A Gastrointestinal Pathogen Associated with Human Brain Diseases. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2016; 131:143-163. [PMID: 27793216 DOI: 10.1016/bs.irn.2016.08.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Serious psychiatric disorders such as schizophrenia, bipolar disorder, and major depression are important causes of mortality and morbidity worldwide. While these are primarily diseases involving altered brain functioning, numerous studies have documented increased rates of gastrointestinal inflammation and dysfunction in many individuals with these disorders. Toxoplasma gondii is an apicomplexan protozoan intracellular parasite with a widespread distribution in both developed and developing countries. Toxoplasma organisms enter the ecosystem through the shedding of oocysts by Toxoplasma-infected felines. In almost all cases of postnatal human infection, Toxoplasma enters its hosts through the intestinal tract either by the ingestion of oocysts or by the consumption of meat from food animals which themselves were infected by Toxoplasma oocysts. It had previously been thought that most cases of Toxoplasma infection in immune competent children and adults were inapparent and asymptomatic. However, recent studies cast doubt on this concept as exposure to Toxoplasma has been associated with a range of acute and chronic symptoms. Of particular note has been the finding of an increased rate of a range of neurological and psychiatric disorders associated with serological evidence of Toxoplasma exposure. A role of Toxoplasma infection in brain diseases is also supported by the consistent finding of altered cognition and behavior in animal models of infections. Much of the attention relating to the role of Toxoplasma infection in neuropsychiatric disorders has focused on the brain, where Toxoplasma tissue cysts can persist for extended periods of time. However, recent discoveries relating to the role of the gastrointestinal tract in cognition and behavior suggest that Toxoplasma may also increase susceptibility to human brain diseases through immune activation, particularly involving the gastrointestinal mucosa. The study of the pathways relating to the pathobiology and immunology of Toxoplasma infection may provide insights into the pathogenesis of a range of human neuropsychiatric disorders as well as into cognitive functioning in otherwise healthy individuals.
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Affiliation(s)
- E G Severance
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - J Xiao
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - L Jones-Brando
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - S Sabunciyan
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Y Li
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - M Pletnikov
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - E Prandovszky
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - R Yolken
- Johns Hopkins School of Medicine, Baltimore, MD, United States.
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