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Kegele J, Wagner T, Kowenski T, Wiesmayr M, Gatterer C, Alber M, Matuja W, Schmutzhard E, Lerche H, Winkler AS. Long-term clinical course and treatment outcomes of individuals with Nodding Syndrome. J Neurol Sci 2024; 457:122893. [PMID: 38278097 DOI: 10.1016/j.jns.2024.122893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 12/28/2023] [Accepted: 01/13/2024] [Indexed: 01/28/2024]
Abstract
Nodding Syndrome is a poorly understood epilepsy disorder in sub-Saharan Africa. The cause(s) of the disease, risk factors and long-term outcomes are unknown or controversial. The objectives of this study were to describe the long-term clinical course and treatment outcomes of individuals suffering from Nodding Syndrome. In addition, we aimed to provide a comprehensive characterization of the epileptological and social features of patients with Nodding Syndrome. From 11/2014 to 4/2015, we conducted a hospital-based, cross-sectional and observational study in Mahenge, Tanzania. Seventy-eight individuals (female:male ratio: 40:38, age at examination: 21.1 ± 6.39 (SD) years) have been enrolled, of whom 38 (49%) had also been examined in 2005 and in 2009. The 10-year clinical course analysis of this revisited subgroup revealed a calculated case fatality of 0.8-2.3%. Progressive physical or cognitive deterioration has not been observed in any of the 78 individuals and more than half of the people studied (38/69; 55%) managed to live and work independently. 14/78 individuals (18%) were seizure-free, (no head nodding, no other seizure types), 13 of whom were taking antiseizure medication. Phenytoin was more effective against head nodding seizures (14/19 (74%)) than monotherapy with other available antiseizure medication (phenobarbitone 12/25 (48%) and carbamazepine 7/22 (32%), p = 0.02, chi-square test). Our ten-year clinical outcome data show that Nodding Syndrome is not a fatal disease, however, the response to treatment is worse than in epilepsy patients in general. Phenytoin may be more effective than carbamazepine and phenobarbitone, but further studies are needed to confirm this observation.
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Affiliation(s)
- Josua Kegele
- Department of Neurology and Epileptology, Hertie Institute of Clinical Brain Research, University of Tübingen, Hoppe-Seyler Straße 3, 72076 Tuebingen, Germany.
| | - Thomas Wagner
- Centre for Pediatric and Adolescent Medicine, University Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Teresa Kowenski
- Medical University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria
| | - Matthias Wiesmayr
- Medical University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria
| | | | - Michael Alber
- Pediatric Neurology and Developmental Medicine, University of Tübingen, Hoppe-Seyler Straße 3, 72076 Tuebingen, Germany.
| | - Wiliam Matuja
- Department of Neurology, Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - Erich Schmutzhard
- Department of Neurology, Medical University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria.
| | - Holger Lerche
- Department of Neurology and Epileptology, Hertie Institute of Clinical Brain Research, University of Tübingen, Hoppe-Seyler Straße 3, 72076 Tuebingen, Germany.
| | - Andrea S Winkler
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany; Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Forskningsveien 3A, 0373 Oslo, Norway; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
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Mohammed AS, Mishore KM, Tafesse TB, Jambo A, Husen AM, Alemu A. Seizure Remission and Its Predictors Among Epileptic Patients on Follow-Up at Public Hospitals in Eastern Ethiopia: A Retrospective Cohort Study. Int J Gen Med 2023; 16:5343-5354. [PMID: 38021051 PMCID: PMC10658939 DOI: 10.2147/ijgm.s436814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023] Open
Abstract
Background Epilepsy is one of the common chronic neurological disorders with varying therapeutic responses. Despite the high prevalence of epilepsy and the significant treatment gaps in developing nations, such as Ethiopia, there is a dearth of data on seizure remission and its predictors in Eastern Ethiopia in particular. Objective This study aimed to determine seizure remission and its predictors among epileptic patients on follow-up in Hiwot Fana Specialized University Hospital (HFSUH) and Dilchora Referral Hospital (DCRH), from July 2 to 31, 2021. Methods A retrospective cohort study was conducted among 418 newly diagnosed epilepsy patients receiving anti-seizure drugs (ASDs) between July 1, 2014, and July 31, 2019, in two public hospitals in Eastern Ethiopia. Relevant data were collected for all patients with a minimum follow-up period of two years. Data were analyzed using SPSS Version 21. Cox proportional hazards model was performed to identify predictors of seizure remission. Results Overall, 252 (60.3%) of the study participants have achieved seizure remission for at least one year. The mean time to achieve seizure remission was 1.9 ± 0.87 years. Regarding the seizure remission pattern, 171 (40.9%) patients achieved early remission, 81 (19.4%) achieved late remission, and 166 (39.7%) achieved no remission. Shorter pre-treatment duration (AHR = 2.36, 95% CI: 1.28-4.37); good adherence to ASDs (AHR = 2.40, 95% CI: 1.33-4.34); and monotherapy (AHR = 0.56, 95% CI: 0.32-0.98) were predictors of seizure remission. Conclusion We observed that less than two-thirds of epileptic patients had achieved seizure remission. A shorter pre-treatment duration, good adherence to ASDs, and monotherapy were predictors of seizure remission. Therefore, we recommend the requirement of an integrated effort from different health disciplines that increases patients' adherence to ASDs, promotes early visits to medical facilities, and improves the health-seeking behavior of epileptic patients.
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Affiliation(s)
- Ammas Siraj Mohammed
- Clinical Pharmacy Department, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kirubel Minsamo Mishore
- Clinical Pharmacy Department, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tadesse Bekele Tafesse
- Department of Pharmaceutical Chemistry and Pharmacognosy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abera Jambo
- Clinical Pharmacy Department, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ahmed Mohammed Husen
- Department of Pediatrics, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addisu Alemu
- Department of Reproductive Health and Nutrition, School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Singh G, Sharma S, Bansal N, Sharma M, Chowdhury A, Sharma S, Bansal RK, Goraya JS, Setia RK, Paul BS, Sander JW. A cluster-randomized trial comparing home-based primary health care and usual clinic care for epilepsy in a resource-limited country. Epilepsia Open 2022; 7:781-791. [PMID: 36213959 PMCID: PMC9712458 DOI: 10.1002/epi4.12659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/05/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To ascertain whether home-based care with community and primary healthcare workers' support improves adherence to antiseizure medications, seizure control, and quality of life over routine clinic-based care in community samples of people with epilepsy in a resource-poor country. METHODS Participants included consenting individuals with active epilepsy identified in a population survey in impoverished communities. The intervention included antiseizure medication provision, adherence reinforcement and epilepsy self- and stigma management guidance provided by a primary health care-equivalent worker. We compared the intervention group to a routine clinic-based care group in a cluster-randomized trial lasting 24 months. The primary outcome was antiseizure medication adherence, appraised from monthly pill counts. Seizure outcomes were assessed by monthly seizure aggregates and time to first seizure and impact by the Personal Impact of Epilepsy scale. RESULTS Enrolment began on September 25, 2017 and was complete by July 24, 2018. Twenty-four clusters, each comprising ten people with epilepsy, were randomized to either home- or clinic-care. Home-care recipients were more likely to have used up their monthly-dispensed epilepsy medicine stock (regression coefficient: 0.585; 95% confidence intervals, 0.289-0.881; P = 0.001) and had fewer seizures (regression coefficient: -2.060; 95%CI, -3.335 to -0.785; P = 0.002). More people from clinic-care (n = 44; 37%) than home-care (n = 23; 19%) exited the trial (P = 0.003). The time to first seizure, adverse effects and the personal impact of epilepsy were similar in the two arms. SIGNIFICANCE Home care for epilepsy compared to clinic care in resource-limited communities improves medication adherence and seizure outcomes and reduces the secondary epilepsy treatment gap.
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Affiliation(s)
- Gagandeep Singh
- Research & Development UnitDayanand Medical CollegeLudhianaIndia,Department of NeurologyDayanand Medical CollegeLudhianaIndia,UCL Queen Square Institute of NeurologyLondon WC1N 3BGLondonUK
| | - Suman Sharma
- Research & Development UnitDayanand Medical CollegeLudhianaIndia
| | - Namita Bansal
- Research & Development UnitDayanand Medical CollegeLudhianaIndia
| | - Meenakshi Sharma
- Non‐communicable Diseases DivisionIndian Council of Medical ResearchNew DelhiIndia
| | - Anurag Chowdhury
- Department of Social & Preventive MedicineDayanand Medical CollegeLudhianaIndia
| | - Sarit Sharma
- Department of Social & Preventive MedicineDayanand Medical CollegeLudhianaIndia
| | | | | | | | | | - Josemir W. Sander
- UCL Queen Square Institute of NeurologyLondon WC1N 3BGLondonUK,Chalfont Centre for EpilepsyChalfont St Peter SL9 0RJLondonUK,Stichting Epilepsie Instellingen Nederland (SEIN)HeemstedeThe Netherlands,Neurology DepartmentWest of China Hospital, Sichuan UniversityChengduChina
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Singh G, Sharma M, Krishnan A, Dua T, d'Aniello F, Manzoni S, Sander JW. Models of community-based primary care for epilepsy in low- and middle-income countries. Neurology 2020; 94:165-175. [PMID: 31919114 DOI: 10.1212/wnl.0000000000008839] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 11/07/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To review systematically community-based primary care interventions for epilepsy in low- and middle-income countries to rationalize approaches and outcome measures in relation to epilepsy care in these countries. METHODS A systematic search of PubMed, EMBASE, Global Index Medicus, CINAHL, and Web of Science was undertaken to identify trials and implementation of provision of antiseizure medications, adherence reinforcement, and/or health care provider or community education in community-based samples of epilepsy. Data on populations addressed, interventions, and outcomes were extracted from eligible articles. RESULTS The 24 reports identified comprise mostly care programs addressing active convulsive epilepsy. Phenobarbital has been used most frequently, although other conventional antiseizure medications (ASMs) have also been used, but none of the newer. Tolerability rates in these studies are high, but overall attrition is considerable. Other approaches include updating primary health care providers, reinforcing treatment adherence in clinics, and raising community awareness. In these programs, the coverage of existing treatment gap in the community, epilepsy-related mortality, and comorbidity burden are only fleetingly addressed. None, however, explicitly describe sustainability plans. CONCLUSIONS Cost-free provision, mostly of phenobarbital, has resulted in short-term seizure freedom in roughly half of the people with epilepsy in low- and middle-income countries. Future programs should include a range of ASMs. These should cover apart from seizure control and treatment adherence, primary health care provider education, community awareness, and referral protocols for specialist care. Programs should incorporate impact assessment at the local level. Sustainability in the long term as much as resilience and scalability should be addressed in future initiatives.
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Affiliation(s)
- Gagandeep Singh
- From the Department of Neurology (G.S.), Dayanand Medical College, Ludhiana, India; Division of Non-Communicable Diseases (M.S.), Indian Council of Medical Research; Department of Community Medicine (A.K.), All India Institute of Medical Sciences, New Delhi, India; Mental Health Division (T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Medicine and Surgery (F.d'.A.), University of Naples Federico II, ; University of Campania (S.M.), Luigi Vanvitelli, Naples, Italy; NIHR University College London Hospitals Biomedical Research Centre (G.S., J.W.S.), UCL Queen Square Institute of Neurology, London, Chalfont Centre for Epilepsy (G.S., J.W.S.), Chalfont St Peter, United Kingdom; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Meenakshi Sharma
- From the Department of Neurology (G.S.), Dayanand Medical College, Ludhiana, India; Division of Non-Communicable Diseases (M.S.), Indian Council of Medical Research; Department of Community Medicine (A.K.), All India Institute of Medical Sciences, New Delhi, India; Mental Health Division (T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Medicine and Surgery (F.d'.A.), University of Naples Federico II, ; University of Campania (S.M.), Luigi Vanvitelli, Naples, Italy; NIHR University College London Hospitals Biomedical Research Centre (G.S., J.W.S.), UCL Queen Square Institute of Neurology, London, Chalfont Centre for Epilepsy (G.S., J.W.S.), Chalfont St Peter, United Kingdom; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Anand Krishnan
- From the Department of Neurology (G.S.), Dayanand Medical College, Ludhiana, India; Division of Non-Communicable Diseases (M.S.), Indian Council of Medical Research; Department of Community Medicine (A.K.), All India Institute of Medical Sciences, New Delhi, India; Mental Health Division (T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Medicine and Surgery (F.d'.A.), University of Naples Federico II, ; University of Campania (S.M.), Luigi Vanvitelli, Naples, Italy; NIHR University College London Hospitals Biomedical Research Centre (G.S., J.W.S.), UCL Queen Square Institute of Neurology, London, Chalfont Centre for Epilepsy (G.S., J.W.S.), Chalfont St Peter, United Kingdom; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Tarun Dua
- From the Department of Neurology (G.S.), Dayanand Medical College, Ludhiana, India; Division of Non-Communicable Diseases (M.S.), Indian Council of Medical Research; Department of Community Medicine (A.K.), All India Institute of Medical Sciences, New Delhi, India; Mental Health Division (T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Medicine and Surgery (F.d'.A.), University of Naples Federico II, ; University of Campania (S.M.), Luigi Vanvitelli, Naples, Italy; NIHR University College London Hospitals Biomedical Research Centre (G.S., J.W.S.), UCL Queen Square Institute of Neurology, London, Chalfont Centre for Epilepsy (G.S., J.W.S.), Chalfont St Peter, United Kingdom; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Francesco d'Aniello
- From the Department of Neurology (G.S.), Dayanand Medical College, Ludhiana, India; Division of Non-Communicable Diseases (M.S.), Indian Council of Medical Research; Department of Community Medicine (A.K.), All India Institute of Medical Sciences, New Delhi, India; Mental Health Division (T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Medicine and Surgery (F.d'.A.), University of Naples Federico II, ; University of Campania (S.M.), Luigi Vanvitelli, Naples, Italy; NIHR University College London Hospitals Biomedical Research Centre (G.S., J.W.S.), UCL Queen Square Institute of Neurology, London, Chalfont Centre for Epilepsy (G.S., J.W.S.), Chalfont St Peter, United Kingdom; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Sara Manzoni
- From the Department of Neurology (G.S.), Dayanand Medical College, Ludhiana, India; Division of Non-Communicable Diseases (M.S.), Indian Council of Medical Research; Department of Community Medicine (A.K.), All India Institute of Medical Sciences, New Delhi, India; Mental Health Division (T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Medicine and Surgery (F.d'.A.), University of Naples Federico II, ; University of Campania (S.M.), Luigi Vanvitelli, Naples, Italy; NIHR University College London Hospitals Biomedical Research Centre (G.S., J.W.S.), UCL Queen Square Institute of Neurology, London, Chalfont Centre for Epilepsy (G.S., J.W.S.), Chalfont St Peter, United Kingdom; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Josemir W Sander
- From the Department of Neurology (G.S.), Dayanand Medical College, Ludhiana, India; Division of Non-Communicable Diseases (M.S.), Indian Council of Medical Research; Department of Community Medicine (A.K.), All India Institute of Medical Sciences, New Delhi, India; Mental Health Division (T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Medicine and Surgery (F.d'.A.), University of Naples Federico II, ; University of Campania (S.M.), Luigi Vanvitelli, Naples, Italy; NIHR University College London Hospitals Biomedical Research Centre (G.S., J.W.S.), UCL Queen Square Institute of Neurology, London, Chalfont Centre for Epilepsy (G.S., J.W.S.), Chalfont St Peter, United Kingdom; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands.
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Treatment response and predictors in patients with newly diagnosed epilepsy in Ethiopia: a retrospective cohort study. Sci Rep 2019; 9:16254. [PMID: 31700030 PMCID: PMC6838070 DOI: 10.1038/s41598-019-52574-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/21/2019] [Indexed: 12/03/2022] Open
Abstract
Epilepsy is a chronic neurological disease with a variable therapeutic response. To design effective treatment strategies for epilepsy, it is important to understand treatment responses and predictive factors. However, limited data are available in Africa, including Ethiopia. The aim of this study was therefore to assess treatment response and identify prognostic predictors among patients with epilepsy at Jimma university medical center, Ethiopia. We conducted a retrospective cohort study of 404 newly diagnosed adult epilepsy patients receiving antiepileptic treatment between May 2010 and May 2015. Demographic, clinical, and outcome data were collected for all patients with a minimum follow-up of two years. Cox proportional hazards model was used to identify predictors of poor seizure remission. Overall, 261 (64.6%) of the patients achieved seizure remission for at least one year. High number of pre-treatment seizures (adjusted hazard ratios (AHR) = 0.64, 95% CI: 0.49–0.83) and poor adherence (AHR = 0.57, 95% CI: 0.44–0.75) were significant predictors of poor seizure remission. In conclusion, our study showed that only about two-thirds of patients had achieved seizure remission. The high number of pre-treatment seizures and non-adherence to antiepileptic medications were predictors of poor seizure remission. Patients with these characteristics should be given special attention.
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Menon S, Siewe Fodjo JN, Weckhuysen S, Bhwana D, Njamnshi AK, Dekker M, Colebunders R. Women with epilepsy in sub-Saharan Africa: A review of the reproductive health challenges and perspectives for management. Seizure 2019; 71:312-317. [PMID: 31521949 DOI: 10.1016/j.seizure.2019.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/28/2019] [Accepted: 08/30/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Epilepsy is one of the commonest neurological conditions affecting women of reproductive age. Epilepsy management during pregnancy is a clinical conundrum, requiring a balance between seizure control and risk minimization for the women with epilepsy (WWE) as well as for their fetuses. The objective of this comprehensive review is to explore the reproductive health challenges of WWE in sub-Saharan Africa (SSA) and ways to address them. METHOD Relevant documentation published until June 2019 were retrieved via literature searches performed in PubMed and Google Scholar, as well as a manual search to identify grey literature. RESULTS WWE in SSA are generally more stigmatized and sexually exploited than women without epilepsy. Contraception use among WWE was reported only in Senegal (51%) and Kenya (14.7%). Only two prospective studies (one in Senegal and one in Nigeria) investigated pregnancy outcomes for a total of 97 WWE. The prevalence of convulsive epilepsy in pregnancy was estimated at 3.33 per 1000. Among pregnant WWE treated with first line anti-epileptic drugs, 16.2% had miscarriages, 41.9% premature births, and 4.1% had babies with malformations. Carbamazepine, which is frequently prescribed to pregnant WWE in SSA, still entails a 2.1-fold increased risk of congenital malformation. No reports were found concerning pre-conceptual counseling and post-natal outcomes in WWE in SSA. CONCLUSION Our review underscores the need for contextualized evidence-based clinical guidelines and a collaborative approach to treat WWE in SSA. High risks of congenital malformations and drug interactions with first line AED warrant the provision of safer second line alternatives.
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Affiliation(s)
- Sonia Menon
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | | | - Sarah Weckhuysen
- Department of Neurology, University of Antwerp, Antwerp, Belgium; Neurogenetics group, University of Antwerp, Antwerp, Belgium
| | - Dan Bhwana
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
| | - 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; Brain Research Africa Initiative (BRAIN), Geneva, Switzerland
| | - Marieke Dekker
- Department of Internal Medicine and Pediatrics, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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Sun W, Wang J, Ding D, Zhang Q, Wang T, Hong Z. Blood concentration, efficacy, and adverse events of phenobarbital: A prospective study in rural China. Epilepsy Behav 2019; 90:247-251. [PMID: 30563756 DOI: 10.1016/j.yebeh.2018.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/17/2018] [Accepted: 10/08/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVE This study evaluated the relationship between blood concentration of phenobarbital (PB) and its efficacy as well as adverse events in people with epilepsy in rural China. METHODS People with epilepsy being treated with PB monotherapy were recruited and followed up for averagely 2.5 years. Data of clinical characteristics were collected using a standardized questionnaire by face-to-face interviews both at baseline and follow-up. Plasma concentration of PB was detected by the high-performance liquid chromatography. RESULTS Data on treatment response and PB blood concentration was obtained from 225 subjects. Among them, 119 (52.9%) were recognized as effective cases and 106 (47.1%) as ineffective cases. In the effective group, the blood concentration of 95% subjects ranged from 1.22 μg/ml to 41.36 μg/ml with a median at 13.18 μg/ml (IQR = 8.32-20.19 μg/ml). The PB concentration of 95% of the subjects in the ineffective group ranged from 2.73 μg/ml to 70.16 μg/ml with a median at 19.80 μg/ml (IQR = 11.30-30.40 μg/ml), which was significantly higher than that of the effective group (p < 0.001). Multivariate logistic regression analysis showed that PB concentration ≥26.38 μg/ml was related to a 4.5-fold (95% confidence interval [CI], 1.85-11.08) higher risk of inefficacy. A receiver operation characteristic curve was performed to determine the cutoff value of concentration for PB efficacy at 19.02 μg/ml. SIGNIFICANCE Blood concentration may be an important indicator for clinical decision making when PB monotherapy cannot achieve a good efficacy and more attention should be paid on it in clinical practice especially in resource-poor settings.
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Affiliation(s)
- Wanbing Sun
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianhong Wang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
| | - Ding Ding
- Institute of Neurology, WHO Collaborating Center for Research and Training in Neuroscience, Huashan Hospital, Fudan University, Shanghai, China.
| | - Qing Zhang
- Department of Neurology, Ningxia Medical University Affiliated Hospital, Yinchuan, Ningxia Hui Autonomous Region, China
| | - Taiping Wang
- Jincheng Emergency Center, Shanxi Province, China
| | - Zhen Hong
- Institute of Neurology, WHO Collaborating Center for Research and Training in Neuroscience, Huashan Hospital, Fudan University, Shanghai, China
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Nicoletti A, Giuliano L, Colli C, Cicero CE, Padilla S, Vilte E, Rojo Mayaregua D, Martinez MDC, Camargo M, Zappia M, Bartoloni A, Crespo Gómez EB. Treating People With Epilepsy in Rural Low-Income Countries Is Feasible. Observations and Reflections From a "Real Life Experience" After a Long Lasting Intervention in the Rural Chaco. Front Neurol 2018; 9:855. [PMID: 30364141 PMCID: PMC6191465 DOI: 10.3389/fneur.2018.00855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/21/2018] [Indexed: 01/20/2023] Open
Abstract
Introduction: Epilepsy represents an important public health issue, in particular in low and middle-income countries where significant disparities are present in the care available for patients with epilepsy. Treatment cost and unavailability of drugs represent important barriers in treating people with epilepsy especially in rural setting. Aim of the study was to evaluate, by means of routine data, the current real-life clinical practice in epilepsy in the rural communities of the Plurinational State of Bolivia. Treatment activity followed educational campaigns and an anthropological fieldwork over more than 20 years. Material and Methods: Medical records of people with epilepsy (PWE) living in the rural communities of the Bolivian Chaco who received antiepileptic drugs (AEDs), from 2012 to 2016, and were followed-up for at least 1 year were analyzed. Treatment delivery and follow up visits were managed by a neurologist with the support of rural health care workers. Results: From 2012 to 2016, 157 PWE (76 men with a mean age of 24.2 ± 15.7) have been included in the study. Structural epilepsy was the most common type, recorded in 54 cases (34.4%) and the most common reported causes were perinatal factors, present in 11 subjects (20.0%). Almost all patients presented epilepsy with generalized tonic-clonic seizures (91.4%). The most common AED prescribed was phenobarbital followed by carbamazepine. During the follow-up, a dramatic seizures reduction was observed, with 31 subjects (19.7%) being seizures-free at the last follow-up. However, 48 subjects (30.6%) did not assume the medication regularly and 10 interrupted the drug intake. More than 20% of PWE did not receive any financial supports for AEDs. During the follow-up period 10 patients died but only in one case the death was probably caused by epilepsy. Conclusion: Our study demonstrated that PWE in rural areas of the Bolivian Chaco are willing to seek medical attention and to receive antiepileptic treatment. However, improvement in care is needed to assure compliance to AED treatment, including activity to increase awareness toward epilepsy among community members and health staff of the rural communities and to guarantee the coverage of treatment costs and drug supply.
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Affiliation(s)
- Alessandra Nicoletti
- Department of Medical and Surgical Sciences and Advanced Technologies "G. F. Ingrassia, " Section of Neurosciences, University of Catania, Catania, Italy
| | - Loretta Giuliano
- Department of Medical and Surgical Sciences and Advanced Technologies "G. F. Ingrassia, " Section of Neurosciences, University of Catania, Catania, Italy
| | - Chiara Colli
- Department of Experimental and Clinical Medicine, Infectious Diseases Unit, University of Florence, Florence, Italy
| | - Calogero Edoardo Cicero
- Department of Medical and Surgical Sciences and Advanced Technologies "G. F. Ingrassia, " Section of Neurosciences, University of Catania, Catania, Italy
| | - Sandra Padilla
- Center of Anthropological Researches of the Teko Guaraní, Gutierrez, Bolivia
| | - Estela Vilte
- Center of Anthropological Researches of the Teko Guaraní, Gutierrez, Bolivia
| | | | - Maria Del Carmen Martinez
- Department of Experimental and Clinical Medicine, Infectious Diseases Unit, University of Florence, Florence, Italy
| | - Mario Camargo
- Bolivian League Against Epilepsy, Santa Cruz, Bolivia
| | - Mario Zappia
- Department of Medical and Surgical Sciences and Advanced Technologies "G. F. Ingrassia, " Section of Neurosciences, University of Catania, Catania, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, Infectious Diseases Unit, University of Florence, Florence, Italy
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Zavala-González MA, Covarrubias-Bermúdez MDLÁ, Cabrera-Pivaral CE, Ramos-Herrera IM, Celis-de-la-Rosa ADJ, Orozco-Valerio MDJ. Prescripción inadecuada de medicamentos: aportaciones de los paradigmas científicos a su conocimiento. SAUDE E SOCIEDADE 2018. [DOI: 10.1590/s0104-12902018180857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumen Se realizó una revisión narrativa con análisis temático sobre las aportaciones de los paradigmas científicos al conocimiento de la prescripción inadecuada de medicamentos. Se buscaron artículos de acceso abierto indexados en PubMed© entre 2010-2014, y se sistematizó información sobre el paradigma, tipo de publicación, perspectiva teórica, objetivo, método y resultados. De los 992 artículos encontrados, se seleccionaron 118, y se tomó una muestra propositiva de 15, según su diseño, representando los cuatro paradigmas. Los artículos positivistas reportaron prevalencia, factores asociados, efectividad de intervenciones y criterios de evaluación; los interpretativos explicaron las causas del problema según los involucrados; los críticos denunciaron la influencia de la industria farmacéutica; y el participativo abordó el problema secundariamente y lo solucionó en un escenario para una enfermedad y grupo farmacológico específicos. Se concluyó que la prescripción inadecuada de medicamentos como problema de investigación en salud pública recibe aportes de los cuatro paradigmas, con dominio del positivismo, lo que se atribuye al carácter paradigmático de la ciencia desde la que se le aborda habitualmente, y que una perspectiva multi-paradigmática es el mejor abordaje.
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10
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Jost J, Moyano LM, Auditeau E, Boumediene F, Ratsimbazafy V, Preux PM. Interventional programs to improve therapeutic management of people with epilepsy in low- and middle-income countries. Epilepsy Behav 2018; 80:337-345. [PMID: 29398627 DOI: 10.1016/j.yebeh.2018.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 01/08/2018] [Accepted: 01/08/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the current status of initiatives carried out in developing countries to improve therapeutic management of people with epilepsy. METHODS A literature review was performed in 2015 to identify and analyze interventional programs carried out in countries with low- and middle-income economies. Electronic databases were reviewed with no time restriction. Each intervention was categorized according to the level of evidence achieved (A: blind randomized controlled trial, B: randomized controlled trial, C1: randomized trial, C2: controlled trial, D: prospective cohort, E: retrospective evaluation). RESULTS A total of 46 intervention projects were identified, 13 with no quantitative assessment. The 31 remaining projects were carried out in 18 countries, 52% (16) in Africa, 42% (13) in Asia, and 6% (2) in Latin America. Among those, 13% (4) were level B, 3% (1) C1, 6% (2) C2, 74% (23) D, and 3% (1) were level E. The effectiveness of the intervention, assessed by the efficacy of antiepileptic drugs, was the primary objective in 81% (25). People with epilepsy were on average seizure-free in 44.6%±14.4% of cases at one year, ranging from 25.0% to 78.4%. At two years, on average 50.9%±29.7% are seizure-free, ranging from 4.6 to 92.7%. The median compliance was 79.3% with a minimum of 21.6% and a maximum of 100.0%. DISCUSSION No blind randomized controlled trial has been used to assess the efficacy of a program to improve access to antiepileptic drugs (AEDs) in developing countries, and the level of evidence was globally low. Phenobarbital remains the AED predominantly used in programs. Adherence to treatment management has been pointed out to be a key element in the success of a program, sometimes not sufficiently considered. Monthly supply of AEDs, at specific and community level, reducing the costs and time spent traveling, appeared to be the most effective strategies. Homogenization and standardization of evaluation practices of programs to improve the management of epilepsy in resource-limited settings would lead to comparison and meta-analysis which would ultimately improve strategies of support for not only epilepsy but also other noncommunicable diseases in developing countries.
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Affiliation(s)
- Jeremy Jost
- INSERM, Univ. Limoges, CHU Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, Limoges, France; CHU Limoges, Department of Pharmacy, F-87000 Limoges, France.
| | - Luz Maria Moyano
- INSERM, Univ. Limoges, CHU Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, Limoges, France; Cysticercosis Elimination Program and Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Tumbes, Peru
| | - Emilie Auditeau
- INSERM, Univ. Limoges, CHU Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, Limoges, France
| | - Farid Boumediene
- INSERM, Univ. Limoges, CHU Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, Limoges, France.
| | - Voa Ratsimbazafy
- INSERM, Univ. Limoges, CHU Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, Limoges, France; CHU Limoges, Department of Pharmacy, F-87000 Limoges, France
| | - Pierre-Marie Preux
- INSERM, Univ. Limoges, CHU Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, Limoges, France.
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11
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Watila MM, Keezer MR, Angwafor SA, Winkler AS, Sander JW. Health service provision for people with epilepsy in sub-Saharan Africa: A situational review. Epilepsy Behav 2017; 70:24-32. [PMID: 28410462 DOI: 10.1016/j.yebeh.2017.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/05/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Epilepsy is a public health issue in sub-Saharan Africa (SSA) where many people with the condition receive no treatment. Health-care services for epilepsy in this region have not been comprehensively assessed. We examined key features of epilepsy health services provided in SSA. METHODOLOGY This was a scoping review conducted using pre-specified protocols. We implemented an electronic search strategy to identify relevant citations using PUBMED, EMBASE, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), African Index Medicus (AIM), Open Grey, Cochrane database, and Google Scholar. Articles eligible for full-text review were screened and data of interest were reported. RESULT The search identified 81 eligible articles, forty-nine from East Africa, 19 from West Africa, 8 from South Africa, and 5 from Central Africa. A variety of care services were identified, with reporting of rural epilepsy care in 75% of retrieved articles mainly from East and South African countries. The majority of the rural epilepsy clinics were health worker- or nurse-led, reporting good seizure control in about two-thirds of patients using phenobarbital as the most commonly prescribed antiepileptic drug. Funding for rural epilepsy care came mainly from external donor agencies. CONCLUSION We attempted to provide a 'snapshot' of epilepsy care services in SSA. The successes achieved in some of the centers are due to the use of existing primary health-care systems and employing non-physician health-care personnel. The true picture of epilepsy care coverage is not apparent due to the lack of data and proper health system structure in most parts of SSA. As more individuals begin to receive care, the long-term funding for epilepsy care in African countries will depend on the commitment of their respective governments.
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Affiliation(s)
- Musa M Watila
- Neurology Unit, Department of Medicine, University of Maiduguri Teaching Hospital, PMB 1414, Maiduguri, Borno State, Nigeria; NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0RJ, UK
| | - Mark R Keezer
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0RJ, UK; Centre Hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame, Montréal, Québec H2L 4M1, Canada; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103 SW Heemstede, Netherlands
| | - Samuel A Angwafor
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0RJ, UK
| | - Andrea S Winkler
- Centre for Global Health, Institute of Health and Society, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; Department of Neurology, Technical University Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0RJ, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103 SW Heemstede, Netherlands.
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12
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Yu J, Luo N, Wang Z, Lin W. Current status of epilepsy treatment and efficacy of standard phenobarbital therapy in rural areas of Northern China. Int J Neurosci 2016; 127:659-666. [PMID: 27545698 DOI: 10.1080/00207454.2016.1225047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the current status of epilepsy treatment and the efficacy and adverse effects of phenobarbital therapy in rural areas of Northern China. METHODS A total of 2192 patients diagnosed with convulsive epilepsy were recruited from seven different rural regions in Jilin Province, China to investigate the current status of epilepsy treatment, and 1379 of them were enrolled in a standard phenobarbital therapy trial. Patients were selected according to strict inclusion and exclusion criteria, and medical records for all patients were collected and analyzed before the standard treatment was started. Patients were followed up monthly, and efficacy in 1218 patients was analyzed at 1, 3, 6 and 12 months of treatment. RESULTS More patients had the initial seizure in juveniles than in adults, and 40.72% of the 2192 patients were not receiving any treatment before the treatment trial. The efficacy of phenobarbital increased and adverse effects decreased within the treatment period. Among the 349 patients who were followed up for 12 months from the beginning of the phenobarbital treatment, seizures were decreased by more than 75% in 71.3% of patients using a low-to-medium dose of phenobarbital. Major adverse effects of phenobarbital included mild exhaustion, drowsiness, dizziness and headache. CONCLUSIONS Standardized long-term and regular administration of phenobarbital at a low-to-medium dose can be used as an effective, economic and safe treatment against epilepsy in rural areas.
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Affiliation(s)
- Jinbei Yu
- a Department of Neurology, Neuroscience Center , The First Hospital of Jilin University , Changchun , China
| | - Nan Luo
- a Department of Neurology, Neuroscience Center , The First Hospital of Jilin University , Changchun , China.,b Department of Neurology , Tengzhou Central People's Hospital , Tengzhou , China
| | - Zan Wang
- a Department of Neurology, Neuroscience Center , The First Hospital of Jilin University , Changchun , China
| | - Weihong Lin
- a Department of Neurology, Neuroscience Center , The First Hospital of Jilin University , Changchun , China
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Ba-Diop A, Marin B, Druet-Cabanac M, Ngoungou EB, Newton CR, Preux PM. Epidemiology, causes, and treatment of epilepsy in sub-Saharan Africa. Lancet Neurol 2014; 13:1029-44. [PMID: 25231525 PMCID: PMC5497080 DOI: 10.1016/s1474-4422(14)70114-0] [Citation(s) in RCA: 188] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
SUMMARY Epilepsy is a common neurological disease in tropical countries, particularly in sub-Saharan Africa. Previous work on epilepsy in sub-Saharan Africa has shown that many cases are severe, partly a result of some specific causes, that it carries a stigma, and that it is not adequately treated in many cases. Many studies on the epidemiology, aetiology, and management of epilepsy in sub-Saharan Africa have been reported in the past 10 years. The prevalence estimated from door-to-door studies is almost double that in Asia, Europe, and North America. The most commonly implicated risk factors are birth trauma, CNS infections, and traumatic brain injury. About 60% of patients with epilepsy receive no antiepileptic treatment, largely for economic and social reasons. Further epidemiological studies should be a priority to improve understanding of possible risk factors and thereby the prevention of epilepsy in Africa, and action should be taken to improve access to treatment.
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Affiliation(s)
- Awa Ba-Diop
- INSERM UMR1094, Tropical Neuroepidemiology, and Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
| | - Benoît Marin
- INSERM UMR1094, Tropical Neuroepidemiology, and Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France; CEBIMER: Center of Epidemiology, Biostatitics, and Research Methodology, CHU Limoges, France
| | - Michel Druet-Cabanac
- INSERM UMR1094, Tropical Neuroepidemiology, and Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
| | - Edgard B Ngoungou
- INSERM UMR1094, Tropical Neuroepidemiology, and Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France; Unit of Neuroepidemiology and Tropical Infectious Diseases, Department of Epidemiology, Biostatistics, University of Health Sciences, Libreville, Gabon
| | - Charles R Newton
- KEMRI/Wellcome Trust Collaborative Programme, Centre for Geographical Medicine, Kilifi, Kenya; Department of Psychiatry, University of Oxford, Oxford, UK
| | - Pierre-Marie Preux
- INSERM UMR1094, Tropical Neuroepidemiology, and Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France; CEBIMER: Center of Epidemiology, Biostatitics, and Research Methodology, CHU Limoges, France.
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14
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Landouré G, Maiga Y, Samassékou O, Nimaga K, Traoré M, Fischbeck KH. Epilepsy genetics in Africa: challenges and future perspectives. NORTH AFRICAN AND MIDDLE EAST EPILEPSY JOURNAL 2014; 3:5-7. [PMID: 26413584 PMCID: PMC4580280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Despite the diversity of the African population, genetic studies, of epilepsy in particular, have been limited, especially in sub-Saharan Africa. In recent years, with the regression of infectious diseases in developing countries, the focus has shifted more towards non communicable disorders. The prevalence of epilepsy in Africa is higher compared to other continents. Although this has been attributed to the high rate of infectious diseases, genetic contributions should not be ignored. Research in genetic epilepsy in Africa could well benefit from the decreasing cost of genetic analysis, and could contribute to further our knowledge on the spectrum of these diseases in Africa. The growing collaboration between African research institutions and those of developed countries offers a unique opportunity to boost research in Africa and improve our global understanding of human disease, thus leading to the development of better therapeutic approaches.
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Affiliation(s)
- Guida Landouré
- Service de Neurologie, Centre Hospitalier Universitaire du Point "G", Bamako, (Mali)
| | - Youssoufa Maiga
- Service de Neurologie, Centre Hospitalier Universitaire de Gabriel Touré, Bamako, (Mali)
| | | | | | - Mahamadou Traoré
- Service de Cytogénétique et de Biologie Reproductive, INRSP, Bamako, (Mali)
| | - Kenneth H Fischbeck
- Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, (USA)
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15
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Maiga Y, Albakaye M, Diallo LL, Traoré B, Cissoko Y, Hassane S, Diakite S, Clare McCaughey K, Kissani N, Diaconu V, Buch D, Kayentoa K, Carmant L. Current beliefs and attitudes regarding epilepsy in Mali. Epilepsy Behav 2014; 33:115-21. [PMID: 24657502 DOI: 10.1016/j.yebeh.2014.02.031] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 02/22/2014] [Accepted: 02/26/2014] [Indexed: 01/09/2023]
Abstract
PURPOSE In Mali, epilepsy affects 15 individuals per thousand. Perceptions and attitudes have not seemingly evolved with advancing medical knowledge. The objective of this study was to assess parental beliefs and attitudes in families with and without affected children. METHODS We enrolled 720 pediatric patients, half of whom had epilepsy, at Mali's largest hospital. We conducted semistructured interviews with the accompanying parent. Control families with unaffected patients and also had affected children were excluded. RESULTS In total, 67% and 24% of families with and without epilepsy, respectively, lived in rural environments. Interviewees were mostly mothers in their 30s; 80% had not completed high school. About 22% of parents without an affected child had witnessed a seizure. During a seizure, 94% of parents with an affected child and 49% of parents without an affected child, respectively, would intervene; 7.5% and 21%, respectively, would wet the patient's face with cool water. Although parents with an affected child had more intimate knowledge of seizures, misconceptions prevailed, perhaps more so than in families without epilepsy: 79% and 66% of parents, respectively, considered epilepsy contagious; 43% vs. 69% thought that it inevitably led to psychosis; and 53% vs. 29% attributed epilepsy to supernatural causes. Finally, 63% of parents with an affected child reported consulting a traditional healer as first-line management for epilepsy. CONCLUSIONS Our study demonstrates widespread misconceptions in Mali regarding epilepsy. Our findings argue for more education initiatives focused on the entire population, including traditional healers, to provide knowledge, reduce stigma, and improve quality of life for individuals living with epilepsy.
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Affiliation(s)
- Youssoufa Maiga
- Neurology Department, Gabriel Touré Teaching Hospital, PO Box 267, Bamako, Mali.
| | - Mohamed Albakaye
- Neurology Department, Gabriel Touré Teaching Hospital, PO Box 267, Bamako, Mali; Neurology Department, Ibn Tofail Hospital, BP 7010, Sidi Abbad, Marrakesh 40000, Morocco
| | | | - Broulaye Traoré
- Pediatrics Department, Gabriel Touré Teaching Hospital, PO Box 267, Bamako, Mali
| | - Yacouba Cissoko
- Pediatrics Department, Hospital of Gao, PO Box 107, Gao, Mali
| | - Seybou Hassane
- Neurology Department, Gabriel Touré Teaching Hospital, PO Box 267, Bamako, Mali
| | - Sara Diakite
- Neurology Department, Gabriel Touré Teaching Hospital, PO Box 267, Bamako, Mali
| | - K Clare McCaughey
- Neurology Department, Ibn Tofail Hospital, BP 7010, Sidi Abbad, Marrakesh 40000, Morocco
| | - Najib Kissani
- Neurology Department, Ibn Tofail Hospital, BP 7010, Sidi Abbad, Marrakesh 40000, Morocco
| | - Valeria Diaconu
- Department of Pediatrics, Sainte-Justine Hospital (CHU Sainte-Justine), University of Montreal, 3175 Cote Sainte-Catherine, Suite 5421, Montreal, QC H3T 1C5, Canada
| | - Danielle Buch
- Applied Clinical Research Unit, CHU Sainte-Justine Research Center, 3175 Cote Sainte-Catherine, Montreal, Quebec, Canada
| | - Kassim Kayentoa
- Malaria Research and Training Center (MRTC), Department of Epidemiology of Parasitic Disease, University of Bamako, Mali
| | - Lionel Carmant
- Department of Pediatrics, Sainte-Justine Hospital (CHU Sainte-Justine), University of Montreal, 3175 Cote Sainte-Catherine, Suite 5421, Montreal, QC H3T 1C5, Canada
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Ilangaratne NB, Mannakkara NN, Bell GS, Sander JW. Phenobarbital: missing in action. Bull World Health Organ 2013; 90:871-871A. [PMID: 23284189 DOI: 10.2471/blt.12.113183] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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