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Clinical features, proximate causes, and consequences of active convulsive epilepsy in Africa

Kariuki, Symon M. and Matuja, William and Akpalu, Albert and Kakooza-Mwesige, Angelina and Chabi, Martin and Wagner, Ryan G. and Connor, Myles and Chengo, Eddie and Ngugi, Anthony K. and Odhiambo, Rachael and Bottomley, Christian and White, Steven and Sander, Josemir W. and Neville, Brian G. R. and Newton, Charles R. J. C. and Seeds writing group, and Twine, Rhian and Gómez Olivé, F. Xavier and Collinson, Mark and Kahn, Kathleen and Tollman, Stephen and Masanja, Honratio and Mathew, Alexander and Pariyo, George and Peterson, Stefan and Ndyomughenyi, Donald and Bauni, Evasius and Kamuyu, Gathoni and Odera, Victor Mung'ala and Mageto, James O. and Ae-Ngibise, Ken and Akpalu, Bright and Agbokey, Francis and Adjei, Patrick and Owusu-Agyei, Seth and Kleinschmidt, Immo and Doku, Victor C. K. and Odermatt, Peter and Nutman, Thomas and Wilkins, Patricia and Noh, John. (2014) Clinical features, proximate causes, and consequences of active convulsive epilepsy in Africa. Epilepsia : journal of the International League against Epilepsy, Vol. 55, H. 1. pp. 76-85.

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Official URL: http://edoc.unibas.ch/dok/A6243458

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Abstract

Epilepsy is common in sub-Saharan Africa (SSA), but the clinical features and consequences are poorly characterized. Most studies are hospital-based, and few studies have compared different ecological sites in SSA. We described active convulsive epilepsy (ACE) identified in cross-sectional community-based surveys in SSA, to understand the proximate causes, features, and consequences.; We performed a detailed clinical and neurophysiologic description of ACE cases identified from a community survey of 584,586 people using medical history, neurologic examination, and electroencephalography (EEG) data from five sites in Africa: South Africa; Tanzania; Uganda; Kenya; and Ghana. The cases were examined by clinicians to discover risk factors, clinical features, and consequences of epilepsy. We used logistic regression to determine the epilepsy factors associated with medical comorbidities.; Half (51%) of the 2,170 people with ACE were children and 69% of seizures began in childhood. Focal features (EEG, seizure types, and neurologic deficits) were present in 58% of ACE cases, and these varied significantly with site. Status epilepticus occurred in 25% of people with ACE. Only 36% received antiepileptic drugs (phenobarbital was the most common drug [95%]), and the proportion varied significantly with the site. Proximate causes of ACE were adverse perinatal events (11%) for onset of seizures before 18 years; and acute encephalopathy (10%) and head injury prior to seizure onset (3%). Important comorbidities were malnutrition (15%), cognitive impairment (23%), and neurologic deficits (15%). The consequences of ACE were burns (16%), head injuries (postseizure) (1%), lack of education (43%), and being unmarried (67%) or unemployed (57%) in adults, all significantly more common than in those without epilepsy.; There were significant differences in the comorbidities across sites. Focal features are common in ACE, suggesting identifiable and preventable causes. Malnutrition cognitive and neurologic deficits are common in people with ACE and should be integrated into the management of epilepsy in this region. Consequences of epilepsy such as burns, lack of education, poor marriage prospects, and unemployment need to be addressed.
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Eco System Health Sciences > Helminths and Health (Odermatt)
UniBasel Contributors:Odermatt, Peter
Item Type:Article, refereed
Article Subtype:Research Article
Bibsysno:Link to catalogue
Publisher:Elsevier
ISSN:0013-9580
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:15 Aug 2014 07:16
Deposited On:15 Aug 2014 07:16

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