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.

Caractéristiques de l'épilepsie chez les sujets âgés de 65 ans et plus / Characteristics of epilepsy in subjects aged 65 and over

Introduction. L'épilepsie du sujet âgé de 65 ans et plus est une pathologie plus fréquente que chez l'adulte jeune. L'objectif principal de ce travail était de faire la description clinique, étiologique et thérapeutique de l'épilepsie débutante et de l'épilepsie ancienne dans cette population. Méthodes. Il s'agissait d'une étude rétrospective et descriptive. Tout patient de 65 ans et plus, hospitalisé en neurologie ou vu en consultation d'épileptologie au CHU Pontchaillou de Rennes (France), présentant une épilepsie débutante ou une épilepsie ancienne a été inclus du 01 novembre 2018 au 30 avril 2019. Résultats. Nous avons retenu 95 patients. Quatorze patients ont été inclus pour une épilepsie débutante. Les crises focales prédominaient (50%) suivies des crises d'emblée généralisées (28,57%). L'étiologie la plus fréquente était d'origine structurelle dans 57,14% des cas avec 75 % de lésions tumorales et 25 % de lésions neuro-vasculaires. Quatre-vingt et un patients ont été retenus pour une épilepsie ancienne. Les crises focales prédominaient (41,98%) suivies des crises d'emblée généralisées (35,80%). L'étiologie la plus importante était d'origine structurelle (54,78%) avec 38,10% de lésions neuro-vasculaires suivies de lésions tumorales dans 16,68% des cas. Le lé vé tiracé tam était plus utilisé chez les patients ayant une épilepsie débutante et la lamotrigine chez les patients connus épileptiques. Conclusion. L'épilepsie chez le sujet âgé est de diagnostic diffi cile en raison d'un grand polymorphisme des crises et de l'origine souvent plurifactorielle. L'étiologie neuro-vasculaire est dominante dans cette population.

Introduction. Epilepsy in subjects aged 65 and over is a more frequent pathology than in young adults. The main objective of this work was to make the clinical, etiological, and therapeutic description of early epilepsy and old epilepsy in this population. Methods. This was a retrospective and descriptive study. Any patient aged 65 and over, hospitalized in neurology or seen in an epileptology consultation at the CHU Pontchaillou in Rennes (France), presenting with early epilepsy or old epilepsy was included from November 01, 2018, to April 30, 2019. Results. We retained 95 patients. Fourteen patients were included for early epilepsy. Focal seizures predominated (50%) followed by generalized seizures (28.57%). The most common etiology was of structural origin in 57.14% of cases with 75% tumor lesions and 25% neurovascular lesions. Eighty-one patients were selected for old epilepsy. Focal seizures predominated (41.98%) followed by generalized seizures (35.80%). The most important etiology was of structural origin (54.78%) with 38.10% of neurovascular lesions followed by tumor lesions in 16.68% of cases. Levetiracetam was used more in patients with early epilepsy and lamotrigine in patients with known epilepsy. Conclusion. Epilepsy in the elderly is difficult to diagnose due to a large polymorphism of seizures and often multifactorial origin. The neurovascular etiology is dominant in this population.

A mixed-methods, cross-sectional study of perceived stigma among Ugandans with epilepsy

Background: Epilepsy is associated with stigma and negatively impacts the lives of people living with epilepsy (PLWE) and their immediate families. More understanding of the stigma and discrimination experienced by PLWE in sub-Saharan Africa is needed. Methods: In a cross-sectional, mixed methods study, forty- eight PLWE who met the study inclusion criteria were enrolled. In depth interviews and focus group discussions were conducted and were audiotaped and transcribed verbatim. Analysis was conducted using a thematic, constant comparative approach with an emphasis on dominant themes. Perceived stigma was measured using the Kilifi epilepsy stigma score. Associations between socio-demographic factors and Kilifi epilepsy stigma score were assessed. Results: The median age of the study participants was 25 years, with median age (IQR) of epilepsy onset of 12 (6-18) years. The prevalence of high-perceived stigma was 31.9% (15/48). Seizure frequency was associated with high levels of perceived stigma (p-value of 0.038). Psychological abuse, rejections at home, places of employment and schools, poor relationships and intimacy and unmet engagements in social activities were cited as the perceived stigmatizing aspects among PLWE. Conclusion: In this Ugandan sample perceived stigma remains unacceptably high and interventions to address it are urgently needed in our settings.

Ivermectin treatment response in two rural villages with a high prevalence of onchocerciasis and epilepsy, Mahenge Tanzania

Background: Despite 20 years of ivermectin mass distribution in the Mahenge area, Tanzania, the prevalence of onchocerciasis and epilepsy has remained high in rural villages. Objectives: We investigated the efficacy of ivermectin in reducing Onchocerca volvulus microfilariae and predictors for parasitic load following ivermectin treatment in persons with (PWE) and without epilepsy (PWOE). Methods: Between April and September 2019, 50 PWE and 160 randomly selected PWOE from Msogezi and Mdindo villages participated in a follow-up study. Skin snips were obtained pre (baseline) and three months post-ivermectin treatment. Results: The overall prevalence of O. volvulus positive skin snips at baseline was 49% (103/210), with no significant difference between PWE (58.0%) and PWOE (46.3%); p=0.197. The overall mean micro filarial density was significantly higher at baseline 1.45(95%CI:0.98-2.04)) than three-month post-ivermectin treatment (0.23(95%CI:0.11-0.37), p<0.001. Three months after ivermectin, the micro filarial density had decreased by ≥80% in 54 (81.8%, 95%CI: 72.3-91.4) of the 66 individuals with positive skin snips at baseline. High micro filarial density at baseline was the only significant predictor associated with higher micro filarial density in the post-ivermectin skin snips. Conclusion: Our study reports a decrease in micro filarial density following ivermectin treatment in most individuals. Optimizing ivermectin coverage will address the ongoing onchocerciasis transmission in Mahenge

A description of sodium valproate, lamotrigine and levetiracetam consumption in the Western Cape public sector

The rational use of medicine is fundamental to ensure effective and safe patient medicine treatment, and hence, should be monitored. Undisputable evidence exists for the teratogenic risk factors associated with sodium valproate. Consequently, the Western Cape Department of Health introduced a policy (2019) recommending alternatives for valproate in women of childbearing age, including lamotrigine or levetiracetam as alternatives for patients on antiretrovirals. This study aimed to describe the change in the consumption of valproate, lamotrigine and levetiracetam after a policy implementation in public sector health facilities of the Western Cape, South Africa. Methods: This observational study followed a quasi-experimental design. Consumption data from the Cape Medical Depot over the period 01 April 2018 to 31 March 2020 were analysed retrospectively. Consumption was presented as a defined daily dose (DDD) per 1000 population per quarter for sodium valproate, levetiracetam and lamotrigine for the Western Cape province, urban and rural areas. Consumption 12 months before was compared with consumption 12 months after policy implementation. Results: Post-policy implementation, valproate consumption remained unchanged provincially (3.3%; p = 0.255), in urban (7.8%; p = 0.255) and rural (1.5%; p = 0.701) areas. Lamotrigine consumption increased significantly provincially (30.7%; p = 0.020) and in urban areas (54.5%; p = 0.002); however, rural (26.1%; p = 0.108) areas did not show significant change. Provincially, valproate consumption remained substantially higher (209 DDDs/1000 population per quarter) compared with lamotrigine consumption (32.22 DDDs/1000 population per quarter). Conclusion: In the Western Cape public sector, the consumption of sodium valproate remained unchanged 12 months after policy implementation. Although there were significant increases in lamotrigine and levetiracetam consumption, the consumption was considerably less compared with sodium valproate consumption.

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

Electroencephalographic Findings, Antiepileptic Drugs and Risk Factors of 433 Individuals Referred to a Tertiary Care Hospital in Ethiopia

Little is known about the characteristics of electroencephalogram (EEG) findings in epileptic patients in Ethiopia. The objective of this study was to characterize the EEG patterns, indications, antiepileptic drugs (AEDs), and epilepsy risk factors. METHODS: A retrospective observational review of EEG test records of 433 patients referred to our electrophysiology unit between July 01, 2020, and December 31, 2021. Results: The age distribution in the study participants was right skewed unipolar age distribution for both sexes and the mean age of 33.8 (SD=15.7) years. Male accounted for 51.7%. Generalized tonic clonic seizure was the most common seizure type. The commonest indication for EEG was abnormal body movement with loss of consciousness (35.2%). Abnormal EEG findings were observed in 55.2%; more than half of them were Interictal epileptiform discharges, followed by focal/or generalized slowing. Phenobarbitone was the commonest AEDs. A quarter (20.1%) of the patients were getting a combination of two AEDs and 5.2% were on 3 different AEDs. Individuals taking the older AEDs and those on 2 or more AEDs tended to have abnormal EEG findings. A cerebrovascular disorder (27.4%) is the prevalent risk factor identified followed by brain tumor, HIV infection, and traumatic head injury respectively. CONCLUSION: High burden of abnormal EEG findings among epileptic patients referred to our unit. The proportion of abnormal EEG patterns was higher in patients taking older generation AEDs and in those on 2 or more AEDs. Stroke, brain tumor, HIV infection and traumatic head injury were the commonest identified epilepsy risk factors

Antiepileptic Drug Adherence and Its Associated Factors among Epilepsy Patients on Follow-ups at Emanuel Mental Specialized Hospital, Ethiopia

Medication adherence is a fundamental determinant of effective treatment. However, people with epilepsy have poor compliance with their treatment because of the chronic nature of the disease. Limited studies have been conducted to address antiepileptic medication adherence in Africa, including Ethiopia. Thus, the aim of this study was to assess antiepileptic drug adherence and its asociated factors among patients with epilepsy attending outpatient department of Amanuel Mental Specialized Hospital. METHODS: A cross-sectional study design was conducted on 439 patients with epilepsy in Amanuel Mental Specialized Hospital. Medication adherence reporting scale-5 (MARS-5) was used to assess adherence to antiepileptic drugs. The Oslo social support, Jacob perceived stigma scale, and hospital anxiety and depression scale (HADS) were the instruments used to assess associated factors. Simple and multiple linear regression analysis models were fitted. Then, the adjusted unstandardized beta (ß) coefficient at a 95% confidence level was used. RESULTS: The mean (SD) score of antiepileptic medication adherence was 16.38(±3.76) with 95%CI:(16.03, 16.72). Depressive symptoms (ß= -1.35, 95% CI: (-2.04, -0.65)), anxiety symptoms (ß=-1.12,95%CI:(-1,79, -0.44), perceived stigma (ß= -1.64, 95% CI: -2.16, -1.12), being single (ß=-0.67, 95%CI: -1.20, -0.14), presence of seizure per month (ß=-2.11,95% CI: (-2.81, -1.41) and antiepileptic drug adverse effect (ß=-0.07,95%CI: -0.11, -0.03) were factors associated with anti-epileptic medication adherence. CONCLUSION: The results suggest that the mean score of adherences to antiepileptic drugs was poor as compared to other settings. Antiepileptic medication adherence screening tool should be included in the patient's treatment protocol

Hematological consequences of antiepileptic drug therapy among children with epilepsy

Epilepsy is a chronic neurologic disease that comes third after cerebrovascular and Alzheimer's disease. Anti-epileptic drugs may affect certain hematological parameters of epileptic patients. Few researches investigated hematological adverse effects of antiepileptic drugs in Libya. Thus, the aim was to evaluate hematological parameters in epileptic children who are on antiepileptic drugs. This retrospective study included 83 pediatric patients with epilepsy recruited from Benghazi Children Hospital, Department of Neurology, from December 2017 to April 2018. Data collected included demographic characteristics, types of epilepsy, anti-epileptic drugs and serum hematological parameters. Hematological parameters recorded included: hemoglobin, hematocrit, platelet, mean cell volume, mean cell hemoglobin, mean cell hemoglobin concentration and white blood cell count. In all treated patients, regardless of the number of antiepileptic drugs therapy used, the average levels of hematological parameters were significantly lower in treated group compared to control group (11.64 gm per dl, 34.53%, 27.74 pg and 33.13 gm per dl, respectively). A significant increase (12.12109 per l) in white blood cell counts in treated group was found. Average hemoglobin, hematocrit and mean cell hemoglobin concentration levels were significantly lower in patients on poly-therapy compared to mono-therapy and control groups. Average white blood cell counts were significantly increased in patients on anti-epileptic drugs. In sodium valproate users, levels of hematological parameters were significantly decreased but significantly increased in white blood cell counts. In diazepam users, significant increases in white blood cells and platelet but no difference in other parameters observed. There were no differences in all hematological parameters among patients using carbamazepine except for platelet counts (significantly decreased). In conclusion, there is substantial effect of the anti-epileptic drugs, especially sodium valproate, on hematological parameters of children despite the effects were not critical as the changes were still in the normal range.

Prise en charge de la femme épileptique pendant la grossesse

La grossesse est envisageable chez la plupart des femmes épileptiques mais nécessite une surveillance particulière et une prise en charge multidisciplinaire impliquant le neurologue, l'obstétricien, l'anesthésiste et le pédiatre. La question de la grossesse devrait être abordée de façon systématique avec toute patiente épileptique en âge de procréer. Le projet de grossesse devrait être planifié et programmé afin d'adapter le traitement avant la conception ; le but ultime étant de réduire le risque de complications fœto-maternelles. A travers cet article, nous rapportons les données les plus récentes émanant des trois principaux registres de grossesse chez la femme épileptique : le registre européen (EURAP : The European Register of Antiepileptic Drugs ans Pregnancy), le registre nord-américain (North American Antiepileptic Drug Pregnancy Registry : NAAPR), et le registre anglo-saxon (UK and Ireland Register). En nous appuyant sur ces données, nous proposons des recommandations pour une prise en charge optimale de la femme épileptique durant la grossesse

Poor adherence to antiepileptic drugs and associated factors in a sample of Cameroon epilepsy patients

Objectives:The aim of the study was to determine the prevalence and factors associated to poor adherence to antiepileptic drugs in a referral hospital of Douala, Cameroon.Method:This was a cross-sectional and descriptive study of antiepileptic drugs (AED) adherence carried out in a group of selected patients with epilepsy. Patients were recruited from January to June 2018 at the Neurology Department of the Douala Laquintinie Hospital. Non-adherence to antiepileptic drugs was measured by the 8-item Morisky Medication Adherence Scale and logistic regression was used to look for significant associations.Results:Participants (n=102) were of mean age 28.39 ± 19.74 years-old with 55% of male sex. Non-adherence was observed in 84 patients giving a prevalence rate of 82.35%. The factors associated to poor adherence to AEDs were forgetfulness (p<0.0001), lack of financial resources (p<0.0001), not having medication on hand, shortage of drugs at the pharmacy (p<0.0001) and lack of information on the disease (p<0.0001).Conclusion:Non-adherence to AEDs is common in Cameroon. Targeted management programs and communication strategies as well as health workers training are necessary to improve adherence to AED treatment in patients with epilepsy and avoid consequences such as seizure recurrence, status epilepticus and poor quality of life

Impact of caregiver burden on health-related quality of life and family functioning of carers of children with epilepsy at the Charlotte Maxeke Johannesburg Academic Hospital, South Africa

Background. The impact of caring for a child with a chronic disease on caregivers and their family functioning contributes to the child's adaptation to the disease.Objectives. To determine the impact of caregiver burden on the health-related quality of life (HRQOL) and family functioning of carers of children with epilepsy (CWE), and to determine factors associated with a high impact of caregiver burden.Method. A cross-sectional study was conducted among primary caregivers of CWE attending the Charlotte Maxeke Johannesburg Academic Hospital, South Africa. Participants had been involved in childcare for at least 6 months before study enrolment and all gave informed consent. Data regarding sociodemographic and epilepsy-related variables were obtained from questionnaires, including the 36-item family impact module of the Pediatric Quality of Life assessment tool. Scores in the lower quartile were considered indicative of a negative impact on HRQOL and poor family functioning.Results. Participants identified as experiencing a high impact of paediatric epilepsy care reported raw scores ≤31.3 for both caregiver burden and family functioning. The family functioning score correlated strongly with the caregivers' HRQOL score (p=0.78; p<0.001). Multivariate analysis identified a low level of education among caregivers and a high seizure frequency in patients as independent predictors of caregiver burden associated with a negative impact.Conclusion. Our findings suggest that the burden of caregiving in paediatric epilepsy among our study population impacts negatively on family functioning. The burden of care was associated with a low level of caregiver education and a high seizure frequency in their children

Role of electroencephalogram in diagnosis of attention deficit hyper activity disorder

Introduction: Attention deficit hyper activity disorder (ADHD), is the most prevalent neurodevelopmental disorder of childhood, which is characterized by the presence of inattention, hyperactivity, and/or impulsivity, EEG is the substrate of brain activity underlying cognition and behavior.Objective: To detect the abnormalities in the electroencephalogram (EEG) in patients with ADHD also to find the relation between attention deficit hyperactivity disorder symptom severity and results of EEG. Method: sixty patients of ADHD and 60 age and sex matched control were evaluated with EEG to detect abnormal waves. Results: Patients with ADHD show abnormal EEG results in the form of background slowing in3 patients (5%) and epileptiform discharge in 19 patients (32%) frontal slowing in 13 patients(22%) normal EEG in 25 patients (42%).Conclusion: There is increased low frequency activity and decreased high frequency activity in children with ADHD, this may aid as an indicator in the diagnosis of ADHD

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

Errance diagnostique des épilepsies symptomatiques en Afrique : Cas de la sclérose mésio-temporale chez une fille gabonaise

Nous rapportons le cas d'une fille gabonaise, âgé de 12 ans, sans antécédent particulier, ayant présenté une sclérose mésio-temporale droite dans les suites de crise épileptique plusieurs épisodes non contrôlées par les antiépileptiques. Cas clinique : Hospitalisée en neurologie au centre hospitalier universitaire(CHU) de Libreville, pour crise épileptique partielle à type de mouvements stéréotypés et répétitifs de mâchonnements et parfois de crise tonicoclonique généralisée, avec morsure latérale de la langue, perte d'urine et amnésie postcritique. L'imagerie par résonance magnétique(IRM) cérébrale en coupe coronale était constituée d'un hypersignal en T2 et T2 FLAIR de la région hippocampique droite témoignant une sclérose mésio-temporale droite. L'électro-encéphalogramme(EEG) était constitué de grapho éléments en fronto-pariétale bilatérale et en temporale droite. Le diagnostic d'épilepsie sur sclérose mésio-temporale était retenu en tenant compte d'un faisceau d'arguments cliniques et paracliniques. Mise sous Lamotrigine et phénobarbital après trois (3) semaines de traitement, l'évolution était stationnaire marquée par la persistance des crises épileptiques. Conclusion : La sclérose mésio-temporale est une cause sous-estimée d'épilepsie temporale chez l'enfant. Notre observation souligne le fait qu'elle est rare dans les hospitalisations de neurologie et qu'il s'agit d'une épilepsie pharmaco-résistante

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

Suivi thérapeutique des personnes souffrant d'épilepsie par le dosage plasmatique des médicaments antiépileptiques au CNHU-HKM de Cotonou

RESUME: L'épilepsie est une affection neurologique chronique qui constitue de par sa prise en charge un problème de santé publique. L'objectif principal était d'étudier le suivi thérapeutique des personnes souffrant d'épilepsie (PSE) par le dosage plasmatique des médicaments anti épileptiques (MAE) au CNHU-HKM de Cotonou. Il s'agissait d'une étude transversale descriptive et analytique qui s'était déroulée au CNHU-HKM de Cotonou du 1er mars au 31 décembre 2013 et portant sur les PSE traitées par le phénobarbital, la carbamazépine ou l'acide valproïque en monothérapie ou en association et qui ont atteint l'état d'équilibre pharmaco-cinétique pour chaque médicament. 70 PSE étaient recrutés dont 36 de sexe masculin et 34 de sexe féminin. Le phénobarbital en monothérapie est le MAE le plus employé dans une proportion de 55,7%. La concentration thérapeutique était observée chez 30% des sujets pour le phénobarbital, 48% pour la carbamazépine et 45 % pour l'acide valproïque. 20% des PSE ont une mauvaise observance du traitement et les raisons évoquées étaient entre autres l'indisponibilité et les effets indésirables des médicaments. Ce travail a permis de connaître les caractéristiques thérapeutiques et biologiques des PSE étudiées et surtout de contrôler leur observance thérapeutique

Prévalence et profil clinique de l'épilepsie de novo chez l'adulte au Bénin

L'épilepsie est une maladie neurologique chronique qui prédomine dans l'enfance et à l'âge adulte. Les objectifs étaient d'étudier la prévalence et les aspects cliniques de l'épilepsie de novo chez les adultes à la Clinique Universitaire de Neurologie (CUN) du Centre National Hospitalier et Universitaire Hubert K. Maga (CNHU-HKM) de Cotonou. Il s'agissait d'une étude rétrospective qui a porté sur des adultes âgés de 18 ans et plus, et ayant consulté à la CUN du CNHU-HKM de Cotonou pendant une période de 5 ans, du 1er janvier 2011 au 31 Décembre 2015. L'épilepsie de novo est toute épilepsie nouvellement diagnostiquée. La prévalence hospitalière de l'épilepsie de novo chez l'adulte à ladite clinique était de 67%, IC95% [60,5% - 73,5%]. Les crises tonico-cloniques généralisées étaient les plus fréquentes (72,8%). L'épilepsie de novo était fortement associée aux antécédents d'HTA (p=0,00) et d'AVC (p=0,010)

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