Knowledge, Attitudes, and Practices with Respect to Epilepsy among Nurses in the City of Niamey, Niger.

Objective The aim of this study is to evaluate knowledge, attitudes, and practices about epilepsy among nurses in the city of Niamey, Niger, to identify existing gaps in their knowledge concerning epilepsy to formulate recommendations to improve the quality of care for people with epilepsy. Materials and Methods We conducted a descriptive cross-sectional survey on epilepsy knowledge among nurses in the city of Niamey, using a self-administered questionnaire including questions related to knowledge about epilepsy. Results A total of 98 nurses (29 men and 69 women) were included in the survey. The mean age of the participants was of 32.88 ± 10.87 years (range: 17-58 years). The sample consisted of 10.2% of student nurses, 64.3% of college patent, and 25.5% of bachelor nurses. Only 22.4% of participants reported having heard about epilepsy during their training programs. Among the respondents, 43.9% of them had already attended at least one epileptic seizure. Epilepsy is considered as a psychiatric illness and contagious disease by 11.2 and 19.4% of respondents, respectively. The main transmission routes reported were physical contact with an epileptic person (14.3%) and contact with saliva (4.1%). Epilepsy was considered as an incurable disease by 5.1% of respondents. When someone has an epileptic seizure, 10.2% of respondents think that physical contact with this person should be avoided to prevent from contamination. Only 6.1% of respondents had appropriate attitudes when someone has an epileptic seizure such as lying the patient on his side, clearing the airway if necessary, and diazepam injection. Conclusion Considering that people with epilepsy are largely cared out by nurses in Niger, the results of the study justify the need to train nurses with respect to epilepsy to improve their knowledge about epilepsy and the care of people with epilepsy.

Knowledge, attitudes, and practices with respect to epilepsy among primary and secondary school teachers in the city of Niamey, Niger.

OBJECTIVE: We aimed firstly to evaluate knowledge, attitudes, and practices about epilepsy among primary and secondary school teachers in the city of Niamey and secondly to formulate targeted sensitization messages for these teachers. MATERIALS AND METHODS: A descriptive cross-sectional survey was carried out among primary and secondary school teachers in the city of Niamey, capital of Niger, using a self-administered questionnaire including questions related to knowledge, attitudes, and practices about epilepsy. RESULTS: One hundred and forty-five (145) teachers aged 27-69 (mean age: 39.57 ± 8.304 years) had answered the questionnaire (52 men and 93 women). In 62.1% of cases, respondents had a bachelor degree in education signifying a high level of education. Sixty-one respondents (42.1%) considered epilepsy as a brain disease, whereas it was considered as a psychiatric illness by 15.9% of respondents and as an impurity by 38.9%. Sixteen respondents (11%) considered it as a hereditary disease. Epilepsy was considered as a contagious disease by 46.2% of teachers, and the main transmission routes reported were contact with places of crisis (26.2%), physical contact with an epileptic person (16.6%), and contact with saliva (6.9%). It was considered as an incurable disease by 6.9% of teachers. Of the 115 respondents (79.3%) who considered epilepsy as a treatable condition, 46 of them believe that epilepsy is treated by traditional medicine. When someone has an epileptic seizure, 28.3% of respondents think that physical contact with him should be avoided and that the places of the crisis should be avoided. CONCLUSION: Considering that epilepsy is common in school-age, the study results suggest the need to train teachers with respect to epilepsy to change misconceptions about epilepsy and to promote positive attitudes toward epileptic people to avoid the rejection of these people by the society responsible for problems of social integration.

Clinical and Etiological Characteristics of Epilepsy in the Elderly: A Hospital-Based Study from a Tertiary Care Referral Center of Niamey, Niger.

Objectives The aim of this study is to evaluate the management of epilepsy in the elderly at a tertiary referral center in Niger to obtain a comprehensive understanding to determine the intrahospital deficiencies to improve and to make recommendations in terms to improve the management of epilepsy in the elderly in Niger. Materials and Methods We conducted a retrospective study at the Neurology Outpatient Clinic of the National Hospital of Niamey (Niger) over a period of 5 years from May 2013 to May 2018, collecting all cases of patients aged 60 years or over diagnosed with epilepsy by neurologists. From the registers of consultation, we collected and analyzed for each patient the demographic, clinical, etiological, and therapeutic data, as well as the outcomes during follow-up visits. Results Of the 4,576 patients of all ages seen during the period of our study, we included 62 patients aged 60 years or over diagnosed with epilepsy with a hospital frequency of 1.35%. The mean age of patients was 65.82 ± 5.72 years (range: 60 and 83 years) with a predominance of the male sex (sex ratio at 1.6). Patients aged 60 to 64 years were the most represented (43.5%). Generalized tonic-clonic seizures were the most frequent (41.9%), followed by focal to bilateral tonic-clonic seizures (25.8%). All patients underwent electroencephalogram. Only 30 patients (48.4%) underwent brain imaging, and mainly brain computed tomography scan. The etiologies included poststroke epilepsy (25.8%), brain tumors (3.2%), cerebral toxoplasmosis (3.2%), and cerebral meningioma (1.6%). We found 41 cases (66.1%) of epilepsy without definite etiology and with an incomplete workup. Carbamazepine and phenobarbital were the only two antiepileptic drugs (AEDs) used. Conclusion The present study shows limited access to newer generation AEDs and diagnostic tests of epilepsy in Niger. Considerable efforts should be made to facilitate for people living with epilepsy the accessibility to diagnostic tests and the newer generation AEDs to improve the quality of epilepsy management in Niger.

Clinical and etiological characteristics of epilepsy in people from Niger: a hospital-based study from a tertiary care referral center of Niamey, Niger.

OBJECTIVES: Epilepsy constitutes a major public health concern in the world particularly in developing countries, especially in sub-Saharan African countries. We designed this study to evaluate epilepsy management at a tertiary referral center in Niger to obtain a comprehensive understanding to determine the intrahospital deficiencies to improve and to make recommendations in terms to improve epilepsy management in Niger. METHODS: We conducted a retrospective study at the Neurology Outpatient Clinic of the National Hospital of Niamey (Niger) between May 2013 and May 2018 (5 years), collecting all cases of patients diagnosed with epilepsy by the neurologists. From the registers of consultation, we collected for each patient the demographic, clinical, etiological, and therapeutic data, as well as the outcomes during follow-up visits. RESULTS: Of the 4576 patients seen during the period of the study, 1350 patients consulted for epilepsy with a hospital frequency of 29.5%. The mean age of the patients was 18.55 ± 17.15 years (range: 3 months to 83 years) with a predominance of the male sex (sex ratio at 1.5). Patients younger than 20 years were the most represented (61.6%). All patients underwent EEG. Only 463 patients (35.2%) underwent brain imaging. Generalized tonic-clonic seizures were the most frequent (50%) followed by typical absences seizures (11.8%). Cerebrovascular disease, central nervous system infections, and head injuries were the main etiologies. First-generation AEDs were the most prescribed (99%). The proportion of patients with drug-resistance was 9.6%. SIGNIFICANCE: Our study shows limited access to newer generation AEDs and diagnostic tests of epilepsy in Niger. Considerable efforts should be made to facilitate for people living with epilepsy the accessibility to diagnostic tests and newer generation AEDs in order to improve the quality of epilepsy management in Niger.

Hurler-Scheie syndrome in Niger: a case series.

BACKGROUND: Hurler-Scheie syndrome is an intermediate form of mucopolysaccharidosis type I which is a rare lysosomal storage disorder caused by the deficiency or complete absence of enzyme alpha-L-iduronidase activity. We report the first documented cases of Hurler-Scheie syndrome observed in Niger in a Touareg family. CASE PRESENTATION: We studied the case of two 12-year-old twin Touareg boys and their 10-year-old Touareg sister whose parents are first-degree cousins, and there was no history of similar cases in their previous generations. The diagnosis of Hurler-Scheie syndrome was considered in these patients on the basis of clinical and radiological arguments, with the highlighting of a deficiency of enzyme alpha-L-iduronidase in serum and leukocytes. The twins had presented the first symptoms at the age of 24 months and the diagnosis of Hurler-Scheie syndrome was made at the age of 12 years. In their younger sister, the first symptoms were observed at the age of 3 years and the diagnosis was made at the age of 10 years. The three probands were born after a normal full-term pregnancy and a spontaneous vaginal delivery according to their parents. Their birth weight, height, and head circumference were within normal limits according to their parents. The three probands were brought in for consultation for stunted growth, joint stiffness with gait disorders, deformities of the thoracolumbar spine, recurrent otitis media, decreased hearing, increased abdominal volume, snoring during sleep, and facial dysmorphism. CONCLUSIONS: Even in countries with limited access to diagnostic means, a good knowledge of the clinical manifestations of the disease can help to guide the diagnosis of mucopolysaccharidosis type I.

Hemiconvulsion-hemiplegia-epilepsy syndrome in Niger: A retrospective case series.

OBJECTIVE: To report the demographic, clinical and paraclinical characteristics as well as the outcomes during follow-up visits of HHE syndrome in Niger. PATIENTS AND METHODS: It was a retrospective study conducted at the Neurology Outpatient Clinic of the National Hospital of Niamey (Niger) between May 2003 and May 2018. RESULTS: During the period of study, 882 patients with epilepsy aged 20 years or less were seen in consultation among whom we collected 22 cases of HHE syndrome with a hospital prevalence of 2.5%. They were 14 men and 8 women (sex ratio = 1.75) with a mean age of 3.76 years (range: 1 and 20 years). At the time of diagnosis, 81.8% of patients were aged under 6 years. The antecedent of febrile convulsions in childhood was found in only 31.8% of cases. The mean age of onset of hemiplegia was 1.9 years (range: 9 months and 5 years). The mean age of onset of epileptic seizures was 2.94 years (range: 1 and 8 years). The mean interval between the onset of hemiplegia and onset of epileptic seizures was 9 months (range: 1 month and 4 years). 31.8% of patients had a delay of acquisitions at the time of diagnosis. 95.5% of patients had drug-resistant epilepsy. CONCLUSION: HHE syndrome is still seen in the countries of Sub-Saharan Africa. The high morbidity and mortality in children with HHE syndrome highlight the need to improve emergency care for febrile clonic seizures in childhood and the early and adequate management of infectious diseases in the child.

Clinical Profile of Parkinson's Disease: Experience of Niger.

BACKGROUND: Parkinson's disease (PD) is a chronic neurodegenerative pathology with unknown etiology. It is characterized clinically by the classic triad that associated tremors, bradykinesia, and rigidity. In Niger, there are no data on PD. AIMS: We aimed to provide the demographic and clinical profile of PD in patients from Niger to create a database on PD in Niger. PATIENTS AND METHODS: We conducted a retrospective study at the Neurology Outpatient Clinic of the Hôpital National de Niamey (HNN, Niger) over a period of 4.42 years from February 2009 to July 2013 collecting all cases of PD. The demographic and clinical features of all patients were collected and analyzed. RESULTS: During the period of the study, 1695 patients consulted at the Neurology Outpatient Clinic of the HNN, among which 76 patients (4.48%) had secondary parkinsonism and 25 patients (1.47%) had features compatible with PD. Only patients with PD were included in this study. The mean age at onset of symptoms was 58 years (range: 42-74 years). The male sex was predominant (60%) with a sex ratio of 1.5. The mean time interval from the onset of symptoms to diagnosis of PD was 1.8 years (range: 1-5 years). The tremor was the most common symptom (84%). Bradykinesia represented 64% of the symptoms and rigidity 20%. At the time of the diagnosis of PD, 8 patients (32%) were in Stage I of the classification of Hoehn and Yahr, 16 patients (64%) in Stage II, and 1 patient (4%) in Stage III. The levodopa/carbidopa combination was the most used antiparkinsonian drug in our patients (88%). The mean time of follow-up of the patients was 2.5 years (range: 1-4.42 years). During the course of the disease, 9 patients (36%) were in Stage II of the classification of Hoehn and Yahr, 13 patients (52%) in Stage III, and 3 patients (12%) in Stage IV. CONCLUSION: Our study provides demographic and clinical data of PD in patients from Niger and shows that the hospital frequency of this disease is low (1.47%). The demographic and clinical features of our patients are similar to those of the patients of the prior studies reported in sub-Saharan Africa.

Prevalence and characteristics of chronic pain: Experience of Niger.

INTRODUCTION: Chronic pain is a major health problem, considered as a disease in its own right. The prevalence of chronic pain is estimated to be between 2% and 40% in adult populations. In Niger, there are no data on chronic pain. AIMS: This study was designed to provide the demographic, clinical and etiological profile of chronic pain in patients from Niger in order to create a database on chronic pain in Niger. PATIENTS AND METHODS: Our study is prospectively conducted at the department of external consultation of the Hôpital National de Niamey over a period of 10 months from 31 May 2016 to 30 January 2017 collecting all cases of chronic pain. The demographic, clinical and etiological characteristics of all patients were collected and analyzed. RESULTS: During the period of the study, 1927 patients consulted at the department of external consultation of the Hôpital National de Niamey, among which 411 patients had chronic pain (21.33% [95% CI: 19.53% and 23.13%]). The average age was 48.28 years (±12.84) with 51.6% of patients aged over 50 years. The male sex was predominant (61.8%). The most common sites of chronic pain were legs (25.5%), back (14.4%), neck (13.6%), knees (13.4%) and feet (13.1%). Osteoarthritis was the most common cause of chronic pain (35.5%), followed by herniated disc (22.2%), spondylodiscitis (14.6%) and migraine (4.1%). Significantly patients aged 50-59 years suffered from neck and legs pain (p value<0.001). Significantly chronic headaches and rheumatoid arthritis were more common in women while osteoarthritis, herniated disc and spondylodiscite were more common in men (p value=0.001). Significantly osteoarthritis and herniated disc were more common in patients older than 40 years (p value<0.001). CONCLUSION: Our study provides demographic, clinical and etiological data of chronic pain in patients from Niger, and shows that chronic pain is a common reason for consultation in Niger concerning 1 in 5 patients with a high prevalence among men and patients aged over 40 years.

[A treatment of neuromyelitis optica (Devic's disease) during pregnancy]. / Traitement de la neuromyélite optique de Devic durant de la grossesse.

Neuromyelitis optica (Devic's disease) is an inflammatory demyelinating disease of the central nervous system that mainly affects spinal cord, optic nerve and brain regions with high aquaporin 4 antigen expression. This is a severe autoimmune disease caused by autoantibodies directed against aquaporin 4 and associated with high morbidity and mortality. Unlike other inflammatory conditions such as multiple sclerosis or rheumatoid polyarthritis, pregnancy does not seem to influence the activity of neuromyelitis optica, hence the need for a thorough treatment during pregnancy. Corticosteroid therapy is the treatment of choice for neuromyelitis optica during pregnancy. Other treatments may also be used including rituximab, some immunosuppressive agents and immunoglobulins. Immunosuppressive treatment or rituximab is recommended when the long-term corticosteroid treatment is contraindicated, in case of inefficiency or if side effects are intolerable. Immunoglobulins are administered to patients with serious outbreaks of neuromyelitis optica which do not respond to bolus methylprednisolone. Immunoglobulins alone can also be continued at a dose of 0.4 g/kg/day for 6-8 weeks until delivery. Plasmapheresis is also a good alternative to bolus methylprednisolone when outbreaks are extremely severe.