Self-Perceived Seizure Precipitants among Patients with Epilepsy in Middle-Belt of Nigeria

Aim: Patient's perception of seizure precipitant is crucial in epilepsy management; but it is often overlooked by physicians. This may be due to neglect and underestimation of its importance. This study looked at frequency and nature of self-perceived seizure precipitants among patients with epilepsy. Materials and Methods: A close-ended questionnaire-based study. Patients with active epilepsy (=2 attacks/year) were recruited from the neurology clinic of the University of Ilorin Teaching Hospital (UITH); Ilorin. Result: A total of 89 patients participated in the study and of these 41 (46.1) were males. Their median age was 30 (21-52) years and median age at seizure onset was 22 (15-46) years. The median seizure duration was five (2-14) years. More patients (46.1) had less than secondary school education and 12 (13.5) were uneducated. Generalized epilepsy was the predominant (68.6) seizure type. A total of 33 (37.1 subjects had =4 attacks/year; 29 (32.6) had 5-12 attacks/year; and 27 (30.3) 12 attacks/year. A total of 16 (18) subjects did not mention any seizure precipitant; whereas 73 (82.2) reported at least one specific seizure precipitant; of these; 62 (85) patients reported =2 precipitants. Stress (41); inadequate sleep (27); and head trauma (26) were the three leading seizure precipitants mentioned. Subject's age; sex; level of seizure control; and place of abode did not influence reported seizure precipitants. However; the more educated (12 years education) patients significantly reported stress as seizure precipitant (P 0.05). Most (80) patients rightly indicated that antiepileptic drug was the best treatment for their seizure control. Conclusion: The result of this study showed that the leading perceived seizure precipitants among epilepsy patients attending the neurology clinic of UITH were stress; inadequate sleep; head trauma; and demonic attacks and spells

The Role of Echocardiography in the Management of Stroke

BACKGROUND: Echocardiography is increasingly being used as a screening test to identify sources of cardiogenic embolism in patients with ischemic stroke or transient ischaemic attack (TIA). However; no consensus exists presently on the utilization of this imaging facility in individuals with stroke. OBJECTIVE: To evaluate the yield of transthoracic echocardiography in patients with ischaemic stroke with a view to providing guidance in its use in clinical management of stroke. METHODS: One hundred and twenty-six consecutive stroke patients with 90 controls were recruited prospectively. Patients were examined echocardiographically for evidence of intramural thrombus; congenital defects; valvular heart disease; wall motion abnormalities and intra-cardiac masses using twodimensional; m-Mode and Doppler facilities. RESULTS: Potential cardiac source of emboli (CSE) was identified in 23.0of the stroke patients. Those who had CSE identified aged 53.0(20.8) years were younger (p=0.0001) than those who did not have CSE; 57.2 (13.5) years. Five (4.0) patients had rheumatic valvular heart disease with demonstrable clots in the left atrium. On the other hand; four(3.2) patients had RHD without thrombi seen. Two patients had biventricular thrombi. One of these patients had giant clots within the ventricles and multiple freely mobile thrombi in right ventricle without obvious cardiac structural defect. CONCLUSION: Young stroke or transient ischaemic attacks patients who have clinical signs suggesting the heart as the potential CSE should have low threshold for echocardiography. However; there is a need for rationalisation of request for echocardiography where such clinical signs are absent