Management of acute seizures in children: a review with special consideration of care in resource-limited settings

Introduction:We sought to review recent evidence-based guidelines and where applicable, primary data to ex-trapolate insights into the appropriate management of acute seizures in children in resource-limited settings.Methods:PubMed and Google scholar searches were conducted with attention to publications from the last three to five years, including a focused search for acute seizure management guidelines relevant to resource limited settings. Since all guidelines to date, except the World Health Organization's, assume ready access to invasive ventilation and advanced diagnostic testing, guidelines and primary data were used to propose managementappropriate for resource-limited settings where respiratory suppression from treatment presents a major challenge in management.Results:Acute seizures are among the commonest medical emergencies encountered in the African settings.Seizure management must occur simultaneously with the diagnostic assessment, which should include addres-sing life threatening causes (e.g. hypoglycaemia, malaria) and with attention given to the most likely aetiology ina particular region or setting. For ongoing seizures, initial treatment with benzodiazepines is indicated. There is evidence of efficacy for several agents and delivery modes. Longer-acting antiepileptic drugs (AEDs) should beon hand if acute seizures fail to respond to two doses of benzodiazepines. There is little direct evidence comparing the relative efficacy of different long-acting AEDs for acute seizure management in African children.Findings suggest that generalising data from Western settings, where different aetiologies and risk factors for seizures prevail, may be inappropriate.Discussion: Though treatment options and diagnostics may be dictated by available medications andcapacity, it is possible for virtually any healthcare setting to develop a relevant and feasible local guideline for seizure management. Clear specifications on when to refer to a higher level of care should be part of the care plan

Seizure Variables and Cognitive Performance in Patients with Epilepsy

Background and Purpose Epilepsy is highly prevalent in developing African countries with significant morbidity; social stigmatization; poor quality of life and preventable mortality.There are scanty reports on the contributions of seizure variables like seizure types; frequency of seizures; duration of epilepsy; age at onset and anti-epileptic drugs to cognitive disturbances in Nigerian Africans. This study assessed the effects of seizure variables on the cognitive performances of patients with epilepsy. Methods The cognitive functions of 41 patients with epilepsy and 41 controls were assessed with a computer-assisted cognitive test battery; Iron Psychology (acronym - FePsy) using the simple and complex reaction time tasks for mental speed; recognition memory test (RMT) for memory and continuous performance test for attention. Results The cognitive performances of the patients using complex reaction time and the recognition memory tasks were worse than those of the controls (p0.05). The duration of treatment with anti-epileptic drugs negatively affected all cognitive domains assessed. The seizure frequency; duration of epilepsy and the use of phenytoin were associated with psychomotor retardation and impaired memory. Conclusions The seizure variables negatively affected cognitive performances of Nigerian patients with epilepsy. Cognitive assessment is recommended as part of regular evaluation of patients with epilepsy

Le traitement des crises epileptiques dans les tableaux neurologiques aigus

Les crises epileptiques sont frequentes dans les tableaux neurologiques aigus. Leur traitement dans ce contexte pathologique est sujet a caution et releve de la reanimation cerebrale qui n'est pas a la portee de tous les patients. Un prerequis de connaissance sur la physiopathologie de l'oedeme cerebral et le traitement de l'etat de mal epileptique peut permettre au praticien d'eviter de tomber facilement dans l'abus therapeutique

Epilepsy pattern and clinic compliance in Sierra Leonean epileptics

Two hundred and twenty patients with epilepsy attending the neurologic clinic at Connaught Hospital were reviewed. Male predominance; greater prevalence of primary generalised seizures and low family history are consistent with reports from other African countries. Similarly the majority of patients had idiopathic epilepsy. Only 35 per cent of patients attented clinic for six months and 12 per cent for two years. Cultural attitudes; cost of medication and distance from clinic may contribute to the low level of clinic attendance. It is suggested that integrating the follow up and treatment of epileptics into primary health care programmes will make a greater impact on epilepsy control