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

Ischemic Stroke and Neuroprotection

Stroke is a major cause of morbidity and mortality in both developed and developing countries of the world. Greater understanding of the pathophysiology of neuronal damage in ischemic stroke has generated interest in neuroprotection as a management strategy. This paper aims to review the current concept and place of neuroprotection in ischemic stroke. An extensive search of all materials related to the topic was made using library sources including Pubmed and Medline searches. Current research findings were also included. The findings are as presented. Neuroprotection is an increasingly recognized management strategy in ischemic stroke that promises to assist clinicians in reducing stroke mortality rates and improving the quality of life of survivors

Assessment of Mild Cognitive Impairment with Mini Mental State Examination among Adults in Southeast Nigeria

Mild cognitive impairment is a recently described neuropsychiatric entity with the possibility of evolving into overt dementia. It has been found to respond to therapeutic intervention; thus halting or significantly retarding the progression to dementia. Resource-poor countries like Nigeria can hardly afford to provide optimal care for dementia patients. Knowledge about mild cognitive impairment in Nigeria is limited. An appreciation of the probable burden may help stimulate and galvanize appropriate public health policies in response. Aim: This cross-sectional; descriptive study sought to determine the frequency of subclinical mental state abnormalities in a cohort of apparently normal adult Nigerians. Subjects and Methods: One hundred and thirty-five apparently normal adult Nigerians of both sexes seen at the University of Nigeria Teaching Hospital; Enugu; were interviewed. The Mini Mental State Examination (MMSE) of Folstein; Folstein; and McHugh was used to assess cognitive function in each subject at a single instance. The results obtained were analyzed using SPSS version 11.3 (Chicago; IL). Consent was obtained from each person and approval obtained from the hospital's ethics review board. Results: A cut-off score of ?17 was obtained for normal cognitive function in this population using the MMSE. Minimum score obtained was 12; while the maximum score was 30. A mean (2SD) of 24.84 (7.94) was obtained on analysis of the overall MMSE scores of the 135 individuals. Cognitive impairment was identified in 5.93 (8/135) of the subjects examined. These persons thus represent otherwise normal functional individuals with unrecognized mild cognitive impairment who may be at risk of developing overt dementia in future. Conclusion: The concept of mild cognitive impairment needs further large-scale studies in Nigerians with possible multi-centre participation to fully elucidate the scope of the problem. Strategies for the appropriate management of dementia need to be strengthened

Multiple Sclerosis in a Nigerian Alcoholic Male: A Case Report from Enugu; South East Nigeria

Background: Multiple sclerosis is a rare neurological disorder in black Africans. In Nigeria it had been difficult to confirm suspected cases due to the paucity of diagnostic facilities. The availability of magnetic resonance imaging has enabled an increased confidence in making the diagnosis. Method: This is a case report of a 40- year old Nigerian farmer of the Igbo ethnic group living in a rural community in Enugu who presented with clinical features suggestive of multiple sclerosis. Though the patient had a significant history of alcohol consumption; he had clinical and magnetic resonance imaging features diagnostic of multiple sclerosis. Results: A 40-year old male farmer presented to the Neurology Clinic of the University of Nigeria Teaching Hospital Enugu in January 2010 with a 10-year history of recurrent episodes of weakness of the legs. Each episode was sudden; affected either limb alternately; was associated with paraesthesiae and would resolve spontaneously after a few days or weeks without any intervention. Over the years he became unable to walk. The sphincters and vision were unaffected. A week prior to presentation he developed tremors of the hands with disorientation. The patient exhibited confabulation and had flaccid quadriparesis with glove and stocking sensory loss. Spinal fluid protein was raised and there were classic periventricular and intracerebral white matter hyper-intensities on magnetic resonance imaging. Conclusion: This report of a case of multiple sclerosis suggests a need for clinicians in Africa to increase their index of suspicion in probable clinical scenario especially where magnetic resonance imaging exists

Profile of Neurological Admissions at the University of Nigeria Teaching Hospital Enugu

The burden of Neurological diseases may be on the increase especially in developing countries. Improved outcome in these settings may require appreciation of the spectrum of Neurological diseases and the impediments to their management. We aim to determine the profile of neurological admissions and the challenges of managing these diseases at the University of Nigeria Teaching Hospital Enugu South East Nigeria. Methods: Analysis of Neurological admissions into the medical wards of the University of Nigeria Teaching Hospital Enugu from January 2003 to December 2007. Results: Neurological admissions comprise about 14.8of medical admissions. There were 640 (51) males and 609 (49) females. The spectrum of neurological diseases were stroke 64.9; central nervous system infections (21.8); HIVrelated neurological diseases 3.5; hypertensive encephalopathy (3.4); dementia (3); subarachnoid haemorrhage (2.2); Guillian Barre syndrome (1.2); Parkinson's disease (1.1); myasthenia gravis (1.0); motor neurone disease and peripheral neuropathy and accounted for 0.8and 0.6respectively. Overall; non infectious disease accounted for 78.2of neurological admissions while infectious diseases accounted for 21.8. Conclusion: A wide spectrum of neurological diseases occurs in our setting. The high incidence of CNS infections indicates that efforts should be geared towards preventive measures. A major challenge to be addressed in the management of neurological diseases in our setting is the lack of specialized facilities

Experience with Tetanus in a Tertiary Hospital in South East Nigeria

Background: Tetanus has for long been an avoidable source of morbidity and mortality particularly in developing countries. The aim of this study was to review the experience with managing tetanus in a regional tertiary hospital in Nigeria. Methods: A retrospective study of patients who were admitted with a clinical diagnosis of tetanus between January 1999 and December 2003 was done. Relevant data were extracted from the patients' case records. Results: A total of 12 patients were identified within the time frame with a diagnosis of tetanus. There were more male than female patients (ratio 1.4:1) with city dwellers constituting a small majority. The mean age of the patients was 29.8 years. Lower limb injuries accounted for the portal of entry in 75of cases while one case followed a practice of oral sex. All patients were managed in the general ward and no mortality was recorded despite the presence of dysautonomia in some patients. Conclusion: Despite the high rate of morbidity and mortality associated with tetanus in developing countries and despite some regional differences in presentation; careful clinical management even in resource poor countries can result in very good outcomes