Phytochemical and anticonvulsant screening of three medicinal plants used in the treatment of epilepsy in the south-western part of Nigeria

The burden of epilepsy in developing countries made medicinal plants like Xylopia aethiopica fruit; Khaya grandifoliola, Alstonia boonei etc an alternative source in epilepsy management in the south-western part of Nigeria. The aim of the study was to provide pharmacological rationale for the ethnomedicinal use of the plants in epilepsy management. The oral medial lethal dose of methanol stem bark extracts of Alstonia boonei (MEAB) and Khaya grandifoliola (MEKG) and methanol fruit extract of Xylopia aethiopica (MEXAF) were done in accordance with the Organization for Economic Cooperation Development guideline. Quantitative and qualitative phytochemical profiling of the extracts was done. Anticonvulsant screening was carried out on the extracts (doses: 75, 150 and 300 mg/kg) using the pentylenetetrazole (PTZ)-induced seizure and maximum electroshock tests (MEST). Results showed that the MEXAF has the highest amount of phytochemicals except for saponins in MEKG; and MEAB with the least amount (but higher alkaloid) than MEKG. The TLC showed different bands of spots of the extracts. In the PTZ test, MEXAF showed 100 % protection against mortality at 300 mg/kg; MEAB with 66.67 % protection at 75 mg/kg and MEKG 0 % protection. MEAB, MEKG and MEXAF nonsignificantly increased the onset of seizure and latency to death. In the MEST, MEXAF, MEKG and MEAB at 75 mg/kg protected 50, 33.3 and 16.67% of the animals against tonic hind limb extension respectively and nonsignificantly (p˃0.05) decreased the recovery time at a dose of 75 mg/kg. It was concluded that the extracts possess anticonvulsant activities hence, the pharmacological credence for the ethnomedicinal use of these plants in treating epilepsy.

The utility of mobile telephone-recorded videos as adjuncts to the diagnosis of seizures and paroxysmal events in children with suspected epileptic seizures

Background. Epilepsy is often diagnosed through clinical description, but inter-observer interpretations can be diverse and misleading. Objective. To assess the utility of smartphone videos in the diagnosis of paediatric epilepsy.Methods. The literature was reviewed for evidence to support the use of smartphone videos, inclusive of advantages, ethical practice and potential disadvantages. An existing adult-based quality of video (QOV) scoring tool was adapted for use in children. A pilot study used convenience sampling of videos from 25 patients, which were reviewed to assess the viability of the adapted QOV tool against the subsequent diagnosis for the patients with videos. The referral mechanism of the videos was reviewed for the source and consent processes followed. Results. A total of 14 studies were identified. Methodologies varied; only three focused on videos of children, and QOV was formally scored in three. Studies found that smartphone videos of good quality assisted the differentiation of epilepsy from non-epileptic events, especially with accompanying history and with more experienced clinicians. The ethics and risks of circulation of smartphone videos were briefly considered in a minority of the reports. The pilot study found that the adapted QOV tool correlated with videos of moderate and high quality and subsequent diagnostic closure.Conclusions. Data relating to the role of smartphone video of events in children is lacking, especially from low- and middle-income settings. Guidelines for caregivers to acquire good-quality videos are not part of routine practice. The ethical implications of transfer of sensitive material have not been adequately addressed for this group. Prospective multicentre studies are needed to formally assess the viability of the adapted QOV tool for paediatric videos.

Childhood seizures: assessment of the knowledge, attitude and home interventions among patients attending a paediatric outpatient clinic in Nigeria

Most seizures in children occur outside the hospital and effective first aid would protect individuals from harm. Study assessed the knowledge, attitude and home-based interventions for childhood seizures.Methodology: This was a descriptive cross-sectional survey conducted from 1stJune to 31stDecember, 2021 among caregivers of patients in a Paediatric outpatient clinic. Interviewer-administered questionnaires were used to assess knowledge, attitude, and home intervention of childhood seizures. Data were analyzed using SPSS 24 and results presented as frequency tables, percentages and charts. P-values < 0.05 were considered significant.Results: Out of 218 respondents, the commonest source of information on childhood seizures was from friends and relatives 126(73.2%). Fever was the commonest known cause. Only 15(6.9%) recognized seizure as a neurological disorder. Jerking of the body and clenchingof the teeth were the commonest recognizable symptoms. The majority said seizures were contagious (176(80.7%) and children with seizures should not go to school 187(85.8%). The overall knowledge score was poor. Negative attitudes included avoidance 19(8.7%), isolation from playing with peers (15(6.9%) and from the public 17(7.8%). Common interventions during seizures were putting palm kernel oil in the mouth while only 25(29.4%) took the child to the hospital or laid him down away from harmful objects 25(29.4%). The practice of home intervention for seizures was good in only 11(5.0%) of respondents

Epilepsy classification (ILAE Classification 2017) in resource-limited countries: A cross-sectional study on epilepsy in pediatric patients from Sudan

Background: The objective of this study is to utilize the ILAE 2017 to classify epilepsy patients and determine its applicability in Sudan. Methods: This study is a prospective, descriptive, cross-sectional research conducted in two pediatric epilepsy clinics in Khartoum State, Sudan. Results: In this cross-sectional study, 350 pediatric patients with epilepsy were included, with a mean age of 8.4 ± 4.7 years and a mean illness duration of 4.71 ± 3.91 years. The ILAE classification was applied, showing that 71.11% of patients had generalized onset seizures, 27.7% had focal onset seizures, and only 1.1% had unknown onset seizures. Among patients with focal onset seizures, 56.4% had intact awareness, while 43.6% had impaired levels of awareness. The majority of patients who had generalized onset seizures experienced motor onset seizures, with tonicclonic seizures being the most common (44.2%). Nearly all patients with unknown onset seizures experienced tonic-clonic convulsions. These findings provide insights into the prevalence and types of seizures among pediatric epilepsy patients in Sudan and can guide clinicians in developing appropriate treatment plans. Conclusion: This study highlights the importance of utilizing the latest ILAE classification 2017 in epilepsy classification and its potential utilization in resource limited areas like Sudan.

An audit of CT brain findings in adults with new-onset seizures in a resource restricted setting in South Africa

Background: Globally, adults presenting with seizures account for 1% ­ 2% of visits to emergency departments (EDs), of which 25% are new-onset seizures. Neuroimaging is essential as part of the initial workup. Multiple studies have demonstrated abnormal CT brain (CTB) findings in these patients. Objectives: To review the CTB findings in adults presenting with new-onset seizures in a resource restricted setting. Method: A retrospective review of 531 CTBs was conducted at a tertiary hospital in Gauteng on adults presenting to the ED with new-onset seizures. Results: The mean age of the patients was 45.6 ± 17.1 years, and the male to female ratio was 1.2:1. Generalised and focal seizure types were almost equally represented. Of the total 531 patients, 168 (31.6%) were HIV positive. The CTB findings were abnormal in 257 (48.4%) patients, albeit vascular pathology accounted for 21.9%. Infective pathology accounted for 14.1% with a statistically significant association with HIV (p = 0.003). Trauma related pathology was 2.4%, whilst neoplastic pathology was seen in 3.0%. Other causes included congenital pathology, calcifications, atrophy and gliosis. Clinical factors associated with abnormal CTB findings were age ≥ 40 years, HIV infection, hypertension, focal seizures, low Glasgow Coma Scale (GCS), raised cerebrospinal fluid (CSF) protein and presence of lymphocytes. Conclusion: A high yield of abnormal CTB findings was noted in adult patients who presented with new-onset seizures, supporting the use of urgent CTB in patients with certain clinical risk factors. Patients without these risk factors can be scanned within 24­48 h in a resource restricted setting.

Pharmacological management of post-traumatic seizures in a South African paediatric intensive care unit

Background. Traumatic brain injury (TBI) is a common cause of paediatric intensive care unit (PICU) admissions in South Africa. Optimal care of these patients includes the prevention and control of post-traumatic seizures (PTS) in order to minimise secondary brain injury. Objectives. To describe the demographics of children admitted to a South African PICU, to describe the characteristics of PTS, and to describe the prophylactic and therapeutic management of PTS within the unit. Method. A 3-year retrospective chart review was conducted at the PICU of the Chris Hani Baragwanath Academic Hospital (CHBAH) in Soweto, Johannesburg, from 1 July 2015 to 30 June 2018. Results. Seventy-eight patients were admitted to the PICU, all with severe TBI. A total of 66 patient files were available for analysis. The median age of admission was 6 years (interquartile range (IQR) 4 - 9) with the majority of trauma secondary to mechanical injury (89%). Prophylactic anti-epileptic drugs (AEDs) were initiated in 44 (79%) patients. Early PTS occurred in 11 (25%) patients who received prophylaxis and 4 (33%) who did not. Three (5%) patients developed late PTS, resulting in an overall incidence of PTS of 43%. The most common seizure type was generalised tonic clonic (82%). Children diagnosed with PTS were a median of 2 years younger than those without PTS, with increased prevalence of seizures (83% v. 38%) in children below 2 years of age. Maintenance therapy was initiated in all patients consistent with recommended dosages. Of the total 167 anti-epileptic levels taken during maintenance, only 56% were within target range. Of the initial 78 patients, 8 died (10%). The median length of stay was 7 (IQR 5 - 12) and 8 (IQR 8 - 24) days longer in ICU and hospital respectively, in children with PTS. Conclusion. PTS is a frequent complication of severe TBI in children. There was considerable variation in the approach to both prophylaxis and maintenance therapy of PTS in terms of choice of agent, dosage, frequency of drug monitoring and approach to subtherapeutic levels. It is clear that more high-level studies are required in order to better inform these practices

Current norms and practices in using a seizure diary for managing epilepsy: A scoping review

Epilepsy is a chronic and debilitating condition affecting people of all ages in many nations. Healthcare practitioners look for effective ways to track patients' seizures, and a seizure diary is one of the methods used. This scoping review sought to identify current norms and practices for using seizure diaries to manage epilepsy. Method: A scoping review was performed by screening relevant studies and identifying themes, categories and subcategories. Results: A total of 1125 articles were identified from the database; 46 full-text articles were assessed for eligibility, of which 23 articles were selected. The majority (48%) of the studies were prospective studies. The majority (65%) of the articles were studies conducted in the United States. The themes identified were types of seizure diaries used in clinical practice, contents and structure of a standardized seizure diary, the use and efficacy of seizure diaries in medicine and challenges relating to using a seizure diary for patient management. Conclusion: The study revealed that a seizure diary remains a relevant tool in managing epilepsy. The two forms of diaries in use are electronic and paper-based diaries. The high cost of data and the expensive devices required to access electronic diaries make it unsuitable in a resource-limited setting. Despite its disadvantages, imperfections and inadequacies, the paper-based diary is still relevant for managing patients with epilepsy in resource-limited settings. Contribution: This study reviewed the literature to find the current norms and practices in using seizure diaries. The benefits of the different formats were emphasized

La lissencéphalie : à propos de deux cas

Introduction : La lissencéphalie est une malformation grave du cortex cérébral, définie par une absence totale ou partielle de circonvolutions à la surface du cerveau. C'est une pathologie rare et handicapante. Non connue dans les pays en développement, sa prise en charge est lourde et difficile. Observations : Nous rapportons 2 patients suivis dans le service de pédiatrie du Centre Hospitalier Universitaire Joseph Raseta de Befelatanana (CHUJRB),Antananarivo, admis pour crise convulsive évoluant depuis l'âge de 6 mois, un retard de développement psychomoteur et une microcé¬phalie, chez qui le diagnostic de lissencéphalie a été porté ultérieurement après la réalisation de l'IRM cérébrale. Sans incident pendant la grossesse, le premier est né à terme avec une bonne adaptation néonatale. On notait un faciès particulier avec un diamètre bitemporal étroit et un hypotélo-risme, une microcéphalie et des crises hypertoniques. Le second est né asphyxié, il présentait des crises sous forme de spasme en flexion confirmant le syndrome de West à l'EEG. A noter l'absence d'antécédent familial particulier chez les 2 patients. Conclusion : Bien que rare, la lissencéphalie existe bien dans les pays en développement. Il faut y penser devant une épilepsie de l'enfant associée à une microcephalie et un retard de dévelop¬pement psychomoteur. Son diagnostic reste iconographique. Sa prise en charge est lourde et difficile par son coût. Donc la prévention est impor¬tante. Mais la consultation génétique n'est pas encore accessible dans les pays en développement

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

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

Role of Genetics in the Etiopathogenesis of Genetic Generalized Epilepsy: A Review of Current Literature

"Until recently; genetic generalized epilepsy (GGE) was believed to be of presumed genetic etiology with no identifiable genetic mutation or demonstrable epigenetic abnormality. A wide range of epileptic disorders has clue for an inherited susceptibility. Monogenic disorders associated with epilepsy mental retardation and structural brain lesion typified by heterotopias; tuberous sclerosis; and progressive myoclonus epilepsies account for about 1 of epilepsies. This review focuses on the role of genetic mutations and epigenetic rearrangements in the pathophysiologic mechanism of GGE. To achieve this; PubMed; EMBASE; and Google Scholar were systematically and comprehensively searched using keywords (""epilepsy"" ""juvenile myoclonic epilepsy (JME);"" ""typical absences;"" ""idiopathic generalized epilepsy;"" ""JME;"" ""juvenile absence epilepsy;"" ""childhood absence epilepsy"" ""generalized tonic-clonic seizure"" ""GTCS""). Most GGE has evidence of underlying genetic inheritance. Recent animal studies have shown that early detection and treatment of genetic generalized epilepsies can alter the phenotypic presentation in rodents. These findings suggest a critical period in epileptogenesis; during which spike-and-wave seizures can be suppressed; leading to chronic changes in the brain (epileptogenesis) and the preceding dysfunctions may; therefore; be targeted using therapeutic approaches that may either delay or inhibit the transition to active epileptic attack. The interplay between genetic mutations and epigenetic rearrangements play important roles in the development of GCE and that this process; especially at crucial developmental periods; is very susceptible to environmental modulations"

Seizure-related death in children with epilepsy

Children with epilepsy have a significantly higher rate of death than the general population. The cause of premature death among epileptics is contributed by the underlying cause, coexisting neurologic compromise and the epilepsy itself. Mortality directly related to seizures in paediatric epilepsy is the subject of this review. Seizure-related deaths in epileptics arise from status epilepticus, aspiration pneumonia, as well as sudden and unexpected death in epilepsy (SUDEP). Epilepsy per se enhances the risks of accidents and suicide. Children with epilepsy who are otherwise neurologically intact and with normal neuroimaging findings have an exceedingly low risk of seizure-related death. Poor compliance to antiepileptic drugs (AED) , poor ly co nt rol led (intractable and refractory) seizures, impaired cognition, structural/ metabolic aetiology and antiepileptic drug polypharmacy tend to carry poor prognosis. Therefore, parents need to be appropriately advised about the risk of seizurerelated premature death. Early identification, compliance with AED prescription, and treatment of comorbid conditions can reduce mortality risk and improve health outcomes in children with epilepsy. Children with intractable types of epilepsy may benefit from medical marijuana and neurosurgery

GC­MS Profile, Anti-Seizure and Anti-Pyretic Activities of Palm Kernel Nut Oil and its Isolate, N-Octanoic Acid from Specially Breed Palm Kernel Elaeis Guineensis

PURPOSE: Palm kernel nut oil(PKNO) from palm fruit of a rare breed of Elaeis guineensis (virescens), and one of the species belonging to the Elaeis genre of arecaceae family was subjected to Gas chromatography - Mass spectroscopic studies as well as anti-seizure and anti-pyretic studies. It is used in South-Eastern part of Nigeria as antipyretic and anti-seizure agents especially in children. The aim of this study was to evaluate the chemical contents of PKNO using GC-MS and to investigate the antiseizure and antipyretic properties of PKNO using animal model.METHOD: 1500 g Palm Kernels (PK) of the rare breed collected from Abia State were cracked open and the nuts (1000 g) poured into steel vessel and heated until oil was produced after charring the nuts. The oil (PKNO) was analyzed using GC-MS to determine its chemical composition. Yeast induced hyperthermia method was used for anti-pyretic studies while strychnine sulphate induced method was used for anti-seizure studies. PKNO and Octanoic acid (0.5 mg/kg ,1 mg/kg, 2 mg/kg) were administered intraperitoneally (IP).Paracetamol (0.15mg/kg) was used as reference standard for anti-pyretic assay while epilim and tegretol (0.14mg/kg, resp.) were used as reference standards for anti-seizure assay.RESULTS: The major component identified in the extract include: Dodecanoic acid,2,3-dihydroxypropyl ester(19.36 %),n-Hexadecanoic acid(15.49 %),Dodecanoic acid( 12.51 %),Myristic acid ( 6.47 %), Dodecanedioic acid (3.93 %),n-Acetylpyrrolidone (3.67 %) , Thiazole (0.98 %) and Octanoic acid, OA( 3.19 %).The anti-seizure results showed that doses of PKNO and OA used had Significant (p<0.02) anti-seizure activities by delaying the on-set of seizure from time of induction to time of first seizure observed. In yeast induced hyperthermia model, PKNO exhibited good level of anti-pyretic activities by direct reduction of pyrexia with the highest dose, 2.0 mg/kg. The PKNO and OA are proven to be safe till 3000 µl/kg as indicated by LD50 results.CONCLUSION: PKNO and its components mainly fatty acids, thiazole, and n- acetylpyrrolidone are potent and promising agents with anti-pyretic and antiseizure activities

People with psychogenic non-epileptic seizures: a South African perspective

Background: Psychogenic non-epileptic seizures (PNES) is a disabling disorder which has a negative effect on the quality of life of individuals with PNES. A clear understanding of the disorder is necessary; however, to date, research about PNES in South Africa is limited. Objectives: The aims of this study were to explore the demographic variables of individuals with PNES in South Africa, to review the available body of research on PNES, and to compare it with our results. Method: Twenty-two people with PNES, with confirmed video EEG, were recruited by means of convenience sampling from two hospitals. Descriptive statistics were used to describe the demographic variables of the participants. Results: Internationally comparable results revealed misdiagnoses and low treatment delivery amongst a primarily female population.Conclusion: This study provided greater insight into individuals with PNES in South Africa, highlighting the need for more information, support, effective treatment and accurate diagnosis of PNES

Electroencephalographic Findings in Patients Referred for Electroencephalogram in a University Teaching Hospital in Northern Nigeria

Background: Electroencephalogram (EEG) is a valuable investigation for the assessment of patients with seizures and some other neuropsychiatric disorders. The literature is scanty of reports describing its application and usefulness in Nigerian patients. In this study we analyzed the EEG records of a series of patients who were referred with various provisional diagnoses. Materials and Methods: EEG records of the entire 200 consecutive cases referred from various clinics within and outside a tertiary hospital in Northern Nigeria during a 1 year period were analyzed. Information on biodemographic data; clinical description of symptoms and provisional diagnosis made by referring physicians and the EEG diagnosis were obtained from the records. Results: Most of the attendees were aged between 10 years and 29 years (59.5) and mostly males (63.5). About 80 of the attendees had received a provisional diagnosis of seizure disorder (generalized and partial). The EEG diagnosis of seizure disorder accounted for 75; normal EEG record accounted for 21 and organic brain disorder accounted for 4 of all EEG diagnosis. Generalized seizure disorder was the commonest seizure type by EEG diagnosis (50). There was a significant association between the provisional diagnosis and EEG diagnosis (P 0.05). Conclusion: Most of the patients referred for the EEG had their reports consistent with clinical suspicion. EEG was found to be a useful tool in the evaluation of seizures and organic brain disorder in our study

Knowledge of Caregivers of Febrile Children about Fever; Paracetamol Use and Paracetamol Induced Hepatic Toxicity in Lagos Nigeria

Background: Fever is as a result of immune response to many pathogens. Paracetamol is widely and irrationally used at home for treatment of fever in children before presentation at the health facility but it is not clear whether caregivers are aware of the toxicity that can result from non-rational use of paracetamol.Objectives: The aim of this study was to evaluate the knowledge of fever; the use of paracetamol; and paracetamol induced hepatic toxicity amongst caregivers of febrile children. Methods: This was a prospective descriptive study in which we interviewed two hundred and ten caregivers who brought febrile children to Onwusikawa Children's Medical Center Okota Lagos over a period of one year (Jan 2013- Dec 2013). A pretested closed ended questionnaire was used to collect data on the use of paracetamol; knowledge about fever; and toxicity of paracetamol during routine clerking.Result: Paracetamol in both syrup and tablet formulations was administered by the study population to febrile children before presentation in hospital . Majority of the respondents (61%) knew fever as an increase in body temperature. About 8% of those interviewed gave paracetamol to their children including neonates almost on a daily basis to prevent fever or because they felt the baby especially the head was hot. Ninety five percent of all respondents were not aware that paracetamol could cause adverse effects while 98% did not know that paracetamol could cause hepatic toxicity. Conclusion: The knowledge regarding toxicity of paracetamol was poor. It is proposed that education of caregivers by health workers on dangers of paracetamol misuse should be routine. Pharmaceutical companies that manufacture paracetamol for children must provide a risk management plan

Factors associated with clinical seizures in high-risk neonates at the Wesley Guild hospital, Ilesa, Nigeria

The occurrence of seizures among ill newborns has been reported to increase morbidity and mortality. Recognition and prompt management/avoidance of risk factors associated with the occurrence of seizures in the newborn may improve survival. This study aims to determine the risk factors for seizures among admitted babies at the Wesley Guild hospital, Ilesa. Consecutive neonatal admissions over a 9 month period were prospectively observed for clinical seizures. Perinatal and neonatal factors were compared between babies with and without seizures. Multiple logistic regression analysis was used to determine the independent predictors of the occurrence of seizures among the babies. Fifty-five (16.2%) of the 340 neonates admitted during the study period had clinical seizures. Male to female ratio of babies with seizures was 2.9:1, and 67.2% were admitted within 72 h of birth. Male sex (odds ratio [OR] 2.256; 95% confidence interval [CI] 1.146­7.167; P=0.024), parental low socioeconomic class (OR=2.211; 95% CI=1.427­9.281; P=0.007), delivery outside the hospital, particularly in mission homes (OR=4.173; 95% CI=1.590­14.040; P=0.005), and maternity homes (OR=2.005; 95% CI=1.183­9.692; P=0.003) were the independent risk factors associated with seizures among the babies. Delivery in private maternity and mission homes coupled with parental low socioeconomic class are major risk factors for seizures among admitted sick babies at the Wesley Guild hospital, Ilesa. Making delivery in standard health centers easily accessible and affordable may help reduce this burden

Crises epileptiques au cours de la toxoplasmose cerebrale chez les patients immunodeprimes au V IH

Décrire les caractéristiques des crises épileptiques au cours de la toxoplasmose cérébrale (TC) chez les patients immunodéprimés au VIH à l'Hôpital Général de Douala (HGD).Matériel méthodes Il s'agissait d'une étude descriptive rétrospective des cas de TC diagnostiquée entre janvier 2000 et décembre 2012. La prévalence, le type, la fréquence des crises épileptiques et les thérapeutiques antiépileptiques ont été étudiées. Les patients avec un antécédent de crises épileptiques étaient exclus. Le test de Khi-2 a été utilisé pour rechercher les facteurs associés à la survenue des crises épileptiques tandis que le test de Student a été utilisé pour comparer les moyennes. P < 0,05 était considéré comme statistiquement significatif. Résultats 146 patients étaient inclus avec 78 femmes pour un sex-ratio de 0,87 en faveur des femmes. L'âge moyen était de 39,38 ± 9,88 ans. Le taux de CD4 moyen était de 115,63 ± 142,70 éléments/ml. La prévalence des crises épileptiques était de 45,2% et 61% des épileptiques étaient répétées. Les crises épileptiques généralisées prédominaient avec 75,8%. Seuls la fièvre (p < 0,012), les céphalées (p < 0,004), le syndrome d'hypertension intracrânienne (p < 0,038), un taux de CD4 < 50/ mm3 (p < 0,02) et un taux d'hémoglobine <10g/dl (p < 0,017) étaient statistiquement associés à la survenue des crises épileptiques. Un traitement antiépileptique était prescrit chez 43,2% des patients. Conclusion Les crises épileptiques sont fréquentes au cours de la toxoplasmose cérébrale. Elles peuvent se répéter et justifier d'un traitement antiépileptique

Early post-acute stroke seizures: clinical profile and outcome in a Nigerian stroke unit

Aim: To describe the basic clinico-demographic profile and outcome of Early Post-Acute Stroke Seizures (EPASS). Materials and Methods: Two-hundred and fifty one patients admitted within 24 h of onset of stroke symptoms into the stroke unit of a tertiary care hospital were followed up for convulsive seizure(s) within 7 days of admission and for disease outcome in 42 days. Stroke subtype was defined by cranial computed tomography and ictal phenomenon was as described by the stroke unit doctors. Stroke severity was by the Canadian Neurological Scale (CNS) and Glasgow Coma Scale (GCS). Seizures were characterized as partial; generalized; or status. Stroke outcome was defined as discharge from inpatient care to follow-up or still in care and all cause in-hospital death. Data was compared between the group with and without seizures. The effect of age; sex; blood sugar; GCS; CNS; and seizure type on stroke outcome and time to in-hospital death in EPASS was tested on logistic regression and Cox proportional hazard regression. Result: EPASS occurred in 9.96 of subjects and intracerebral infarct was more associated with EPASS; a finding different from what is dominant in western literature. Conclusion: Profile of EPASS may appear different in terms of stroke subtype in Sub-Saharan African populations. Larger prospective studies may clarify the position better