Cognitive function in Nigerian children with newly diagnosed epilepsy: a preliminary report.

INTRODUCTION: Epilepsy has long been associated with cognitive dysfunction and educational underachievement. The purpose of the study was to describe the baseline findings from a larger prospective study. METHODS: New cases of epilepsy aged 6-16 years seen at a paediatric neurology clinic in Ibadan, Nigeria were evaluated for any evidence of cognitive impairment. Intelligence quotient (IQ) of the participants was measured using the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV). Scores on cognitive subtests and Full Scale IQ (FSIQ) were computed and association between the subsets scores and seizure variables were calculated. RESULTS: 40 children, 24 males and 16 females were studied and their ages ranged from 6 to 16 years with a mean of 10.8 (SD=3.0) years. Global intellectual functioning as measured by the WISC-IV was in the normal range (FSIQ scores <85) for 52.5% (n = 21) of the participants and the remaining participants (47.5%) scored between the borderline and severe category for intellectual disability. The strongest correlation was between 'caregiver's assessment of school performance' and FSIQ, (r = 0.70; p< 0.001). Age at onset of epilepsy and seizure type had no significant association with scores on the WISC-IV composite scores. CONCLUSION: There is a high prevalence of significant cognitive dysfunction in Nigerian children with epilepsy, even in the absence of any known brain insult. All children with epilepsy should have routine IQ assessment following diagnosis, in order to allow for early intervention when indicated, and thus, improved outcomes.

Feasibility of parent-mediated behavioural intervention for behavioural problems in children with Autism Spectrum Disorder in Nigeria: a pilot study.

BACKGROUND: Autism Spectrum Disorders (ASD) is a disabling and lifelong neuro-developmental disorder. Challenging behaviours such as aggression and self injury are common maladaptive behaviours in ASD which adversely affect the mental health of both the affected children and their caregivers. Although there is evidence-base for parent-delivered behavioural intervention for children with ASD and challenging behaviours, there is no published research on the feasibility of such an intervention in sub-Saharan Africa. This study assessed the feasibility of parent-mediated behavioural intervention for challenging behaviour in children with ASD in Nigeria. METHODS: This was a pre-post intervention pilot study involving 20 mothers of children with DSM-5 diagnosis of ASD recruited from a Child and Adolescent Mental Health Service out-patient Unit. All the mothers completed five sessions of weekly manualised group-based intervention from March to April, 2015. The intervention included Functional Behavioural Analysis for each child followed by an individualised behaviour management plan. The primary outcome measure was the Aggression and Self Injury Questionnaire, which assessed both Aggression towards a Person and Property (APP) and Self Injurious Behaviour (SIB). The mothers' knowledge of the intervention content was the secondary outcome. All outcome measures were completed at baseline and after the intervention. The mothers' level of satisfaction with the programme was also assessed. Treatment effect was evaluated with Wilcoxon Signed Rank Tests of baseline and post-intervention scores on outcome measures. RESULTS: The children were aged 3-17 years (mean = 10.7 years, SD 4.6 years), while their mothers' ages ranged from 32 to 52 years (mean 42.8 years, SD 6.4 years). The post intervention scores in all four domains of the APP and SIB were significantly reduced compared with pre-intervention scores. The mothers' knowledge of the intervention content significantly increased post-intervention. The intervention was well received with the vast majority (75 %) of participants being very satisfied and all (100 %) were willing to recommend the programme to a friend whose child has similar difficulties. CONCLUSIONS: Parent-mediated behavioural intervention is a feasible and promising treatment for challenging behaviour in children with ASD in Nigeria. Behavioural intervention should be an integral component in scaling up services for children with ASD in Nigeria.

Electroencephalography as a tool for evidence-based diagnosis and improved outcomes in children with epilepsy in a resource-poor setting.

INTRODUCTION: Electroencephalography (EEG) remains the most important investigative modality in the diagnostic evaluation of individuals with epilepsy. Children living with epilepsy in the developing world are faced with challenges of lack of access to appropriate diagnostic evaluation and a high risk of misdiagnosis and inappropriate therapy. We appraised EEG studies in a cohort of Nigerian children with epilepsy seen in a tertiary center in order to evaluate access to and the impact of EEG in the diagnostic evaluation of the cases. METHODS: Inter-ictal EEG was requested in all cases of pediatric epilepsy seen at the pediatric neurology clinic of the University College Hospital, Ibadan, Nigeria over a period of 18 months. Clinical diagnosis without EEG evaluation was compared with the final diagnosis post- EEG evaluation. RESULTS: A total of 329 EEGs were recorded in 329 children, aged 3 months to 16 years, median 61.0 months. Clinical evaluation pre-EEG classified 69.3% of the epilepsies as generalized. The a posteriori EEG evaluations showed a considerably higher proportion of localization-related epilepsies (33.6%). The final evaluation post EEG showed a 21% reduction in the proportion of cases labeled as generalized epilepsy and a 55% increase in cases of localization-related epilepsy(p<0.001). CONCLUSION: Here we show that there is a high risk of misdiagnosis and therefore the use of inappropriate therapies in children with epilepsy in the absence of EEG evaluation. The implications of our findings in the resource-poor country scenario are key for reducing the burden of care and cost of epilepsy treatment on both the caregivers and the already overloaded tertiary care services.

Health-Related Quality of Life of Nigerian Children with Epilepsy

Background Epilepsy is a leading neurological disorder in childhood with the greatest burden in developing countries. The scope of management of epilepsy includes optimal seizure control as well as improvement of the health related quality of life (HRQOL) of affected children. Objectives The study was undertaken to assess the HRQOL of Nigerian children with epilepsy and the psychosocial impact of the disease on the parents of affected children. Methods A standardized questionnaire adapted from the PedsQL Questionnaire was applied to evaluate the HRQOL in 66 consecutive children with epilepsy; aged ?5 years seen at the University College Hospital; Ibadan during a 3 month period. Results Twenty children (30.3) showed significant impairment in the HRQOL with the major impact found in the areas of general health; family life; school activity and self esteem. There was a statistically significant association between seizure severity; parental emotional impact; maternal level of education and impaired HRQOL. Conclusion Impaired HRQOL is a major issue in Nigerian children with epilepsy. The extended family support system does not appear to have any ameliorating effect on the stress experienced by the affected families. This study suggests the need for psychosocial support to achieve optimal care for children on antiepileptic drugs

Nevus sebaceous syndrome with facial hemihypertrophy.

Nevus sebaceous syndrome is a member of the epidermal nevus syndromes group, and is characterized by extensive nevus sebaceous, seizures, and mental retardation. We present an affected 5-month-old boy who had facial hemi-hypertrophy and recurrent seizures.