Epilepsie-absences de l'enfant et de l'adolescent au Sénégal aspects épidémiologiques, diagnostiques, thérapeutiques et pronostiques

Description: L'épilepsie-absence est un syndrome épileptique généralisé, fréquent, de cause présumée génétique, caractérisé par la survenue d'épisodes fréquents de rupture brutale et complète du contact sans perte de tonus. Objectif: L'objectif était de décrire l'épidémiologie et les caractéristiques cliniques de l'épilepsie-absence chez l'enfant et l'adolescent. Méthode: Nous avons mené une étude transversale longitudinale, portant sur 53 patients, de décembre 2003 à mars 2014 en colligeant les données épidémiologiques, diagnostiques, thérapeutiques et évolutives. L'analyse des données s'est faite avec le logiciel statistique CSPro 5.0 avec calcul de fréquences et moyennes. Résultats: Cinquante trois patients dont 42 enfants et 11 adolescents ont été colligé avec un âge moyen de 10 ans. L'âge moyen de début des crises était de 6,8 ans chez les enfants et 12,4 ans chez les adolescents. On notait une prédominance féminine à 52,4 % chez les enfants et masculine à 63,6 % chez les adolescents. Une consanguinité parentale était retrouvée dans 55,5 % chez l'enfant et 37,5 % chez l'adolescent. Quarante pourcent des enfants présentaient des antécédents familiaux d'épilepsie. Les crises survenaient spontanément dans 86,8 % des cas avec une durée moyenne de 10 secondes environ. Le Valproate de sodium a été utilisé chez tous nos patients avec une maitrise dans 81,6 % à trois mois. L'évolution de l'épilepsie-absence était globalement satisfaisante avec des difficultés d'apprentissage observées chez 22,6 % des patients. Conclusion: L'épilepsie-absence est fréquente, de causes multifactorielles et peut retentir sur le devenir psychosocial

Epilepsy seizure types, classification and treatment

Epilepsy is a chronic condition whose building blocks are recurrent seizures. It is this varied presentation that at times poses a challenge to making a diagnosis. The response to treatment is also not uniform, making it necessary to individualise. This article discusses the various seizure types, the latest classification by the International League against Epilepsy (ILAE), treatment and prognosis of the condition

A review of 'medical' knowledge of epilepsy amongst isiZulu-speaking patients at a regional hospital in KwaZulu-Natal

Background: Epilepsy is a common disorder in South Africa and the literature indicates that many patients do not access treatment. The reasons are complex and include a poor knowledge about causes; symptoms; diagnosis and treatment (medical knowledge). This study aimed to assess the medical knowledge of isiZulu-speaking people with epilepsy (PWE) who attend a combination regional and district hospital in the eThekwini district in KwaZulu-Natal Province.Method: This was a prospective; cross-sectional; descriptive study. Data were collected using a validated data collection tool for assessing the medical knowledge of PWE and analysed descriptively.Results: The questionnaires were completed by 199 PWE; with the general level of schooling being low and half being unemployed. Knowledge around causes; symptoms; diagnosis and treatments was good; but there were significant gaps in knowledge that may affect morbidity and mortality.Discussion: The findings will serve as a useful guide to develop both preventive and educational interventions to enhance knowledge around the causes and treatment of epilepsy in this population. It is important that such interventions also consider family and healthcare providers.Conclusion: There were considerable gaps in the medical knowledge of isiZulu-speaking PWE's; indicating the need for an educational intervention to improve their understanding of epilepsy. Further research is needed-using a range of tools to ensure that the data is reliable and valid-if the results are to be generalisable to the rest of the province and South Africa

Depression in Patients with Epilepsy: A Study from Enugu; South East Nigeria

Depression is a common psychiatric disorder in epilepsy patients. A bidirectional interaction is thought to be present between epilepsy and depression. There are few studies of this relationship in Nigerian Africans. Objectives: This was a cross-sectional study of the frequency and pattern of depression in a cohort of epilepsy patients in Enugu; South East Nigeria. Materials and Methods: Adult patients with epilepsy seen at the University of Nigeria Teaching Hospital; Enugu; from May to September 2009 were assessed for depression using the Becks Inventory for Depression. Informed consent was obtained from each patient. Clinical data obtained were analyzed using Statistical Package for the Social Sciences; version 15. The hospital's ethical review committee approved the study. Results: I0 n all; 83 subjects were studied (50 males and 33 females). They were aged from 18 to 75 years; with an average of 29.87 years. Most subjects were 25 years of age; single (53; 64) and had at least secondary school education (65; 78). Depression was present in 71 (85.5) subjects - minimal 57 (68.7); mild 10 (12); and moderate 4 (4.8). No case of severe depression was seen. Patients 25 years of age were the most affected. Depression was not significantly associated with age; gender; seizure type; or educational level. Conclusion: A significant proportion of Nigerian African epilepsy patients have depression; which may be easily overlooked; with far-reaching consequences on patients' quality of life; morbidity; and mortality rates. There is need to regularly assess for and manage epilepsy-related depression in this population

A review of traditional plants used in the treatment of epilepsy amongst the Hausa/Fulani Tribes of Northern Nigeria

Abstract: Five prescriptions used in the treatment of epilepsy amongst the Hausa/Fulani tribe of Northern Nigeria were collected from traditional healers. The five prescriptions containing eight plants were reviewed as in literature to ascertain scientific basis of their use in treatment of epilepsy. Securidaca longipedunculata (family Polygalaceace) was reported to have such property; Mitragyna inermis (family Rubiaceae) has alkaloids structurally similar to clinically useful anticonvulsant. Celtis integrefolia (family Ulmaceae) was reported to contain gamma amino butyric acid (GABA) that its deficiency may lead to convulsions. The remaining plants were basically helpful in alleviation of associated symptoms of epilepsy except Centaurea praecox (family Asteraceae) which was reported to have neurotoxic substances that may worsen the disease

Overcoming Barriers to Anti-Epileptic Treatment Life Sentence?

Epilepsy; like many other mental illnesses; is more prevalent than is commonly acknowledged.Moreover; its social and economic burden is excessive for the individual; family; health system and country at large. People with epilepsy have low quality of life and productivity. They and their families are stigmatized and discriminated against. Doctors with Africa - CUAMM; has operated aproject for epilepsy treatment together with the local health authorities in Nebbi and Arua districts since 2005; aimed at increasing access to free; effective anti-epileptic medicines. Despite the availability of the medicines; the attendance of many enrolled patients has been erratic. This study was done to document the level of adherence to treatment; the reasons for the observed healthseeking pattern and to assess the feasibility of sustainability of enhanced epilepsy treatment services once the project ended. Retrospective analysis of records of all patients registered in 2004 and 2005 was done in order to determine the level and pattern of adherence. A cross-sectional survey of 93 patients; selected according to the documented patterns of clinic attendance; was done to investigate the reasons for the observed pattern of healthcare use. Assessment of feasibility of sustainability was done by interviewing key informants and eviewing records of expenditures on anti-epileptic medicines for 2005.Conducted in 2006; the study shows that about 84.5of the enrolled patients missed at least one appointment over the two-year period of follow-up; with about one third missing all the clinics since enrolment. A typical patient missed about 60of all the appointments.The overall attendance level at any given time was at a low 40(30for those registered in 2005 and 50for those registered in 2004).There was wide variation in the magnitude and frequency of defaulting at the different sites.Younger and older patients defaulted more often than the middle-aged groups; just as female patients defaulted more frequently than the male counterparts.The reasons for the poor compliance were multiple; patient-specific and often acting simultaneously.The most critical and cross-cutting included distance from the health facility; family support; persistent health education and individual patient/family counseling.The mobilisers (often epilepsy patients themselves) were pivotal in patient/family education and counseling as well as reminding patients about clinic days.The most important adherence-promoting health systems factors were the regular availability of effective medicines and the vertical nature of the delivery system.There were several constraints working against sustainability of enhanced epilepsy care; including technical competence of the health workers; regulatory limitations that forbid the use of some anti-epileptic medicines at some levels of health care; negative staff attitude and high investment levels in ensuring constant availability of anti-epileptic medicines

Anticonvulsant Activity of Extracts of Epilepsy Fscheri Stem Bark

Evaluation of extracts of Diospyros fischeri Gurke (Ebenaceae); which is used traditionally for the treatment of epilepsy shows that the aqueous extract of the tem bark has no effect against picrotoxin induced convulsions in mice. However; an 80ethanol extract of the bark caused dose-dependent suppression of convulsions induced by 10 mg/kg body wt picrotoxin; at doses between 100-3200 mg/kg body wt. Petroleum ether; 1:1 dichloromethane:methanol; and methanol extracts also suppressed picrotoxin-induced convulsions; but had a slightly lower inhibitory effect. The petroleum ether extract was the most active; but all were less active than the ethanol extract. Unlike phenobarbitone; which at 50 mg/kg body wt completely suppressed convulsions induced by 10 mg/kg body wt picrotoxin; none of the plant extracts completely suppressed convulsions in the mice. These results support the traditional uses of D.fischeri for the treatment of epilepsy. Given the seemingly innocuous nature of the extracts more work is suggested to ascertain their clinical application

Prise en charge tradipraticienne de l'epileptique : besoin d'une education en sante mentale

L'evaluation des connaissances en matiere d'epilepsie(Ep) effectuee par le biais d'une enquete standardisee aupres de 68 tradipraticiens Kinois (TPK); a mis en evidence la contrainte conceptionnelle que le savoir socio-culturel traditionnel exerce encore sur l'approche tradiclinique de l'Ep et; par consequent; sur le traitement et la prise en charge du malade. Il en resulte une discordance entre les connaissances du TPK; son niveau general de scolarite et les connaissances medicales modernes etablies en cette matiere a ce jour. Cette discordance; prejudiciable a la prise en charge de l'epilepsie; est judiciable d'une action inculturee d'education en sante mentale (ESM) au benefice de ce groupe de professionnels de sante afin d'ameliorer la qualite de leur sevice