ABSTRACT
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.
Subject(s)
Cognition Disorders/epidemiology , Cognition/physiology , Epilepsy/complications , Adolescent , Age of Onset , Child , Cognition Disorders/etiology , Female , Humans , Longitudinal Studies , Male , Nigeria/epidemiology , Prevalence , Prospective Studies , Wechsler ScalesABSTRACT
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.
Subject(s)
Electroencephalography , Epilepsy/diagnosis , Adolescent , Child , Child, Preschool , Evidence-Based Medicine , Female , Health Resources , Humans , Infant , Male , PovertyABSTRACT
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
