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Characteristics of people with epilepsy in three Eastern African countries - a pooled analysis

Epilepsy is one of the most common neurological disorders worldwide. Yet, its treatment gap is large in some areas and especially in sub-Saharan Africa data on clinical, radiological and semiological characteristics, as well as on treatment of persons with epilepsy (PWE) are still scarce. We pooled...

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Published in:BMC neurology 2022-08, Vol.22 (1), p.321-12, Article 321
Main Authors: Stelzle, Dominik, Kaducu, Joyce, Schmidt, Veronika, Welte, Tamara M, Ngowi, Bernard J, Matuja, William, Escheu, Gabrielle, Hauke, Peter, Richter, Vivien, Ovuga, Emilio, Pfausler, Bettina, Schmutzhard, Erich, Amos, Action, Harrison, Wendy, Keller, Luise, Winkler, Andrea S
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creator Stelzle, Dominik
Kaducu, Joyce
Schmidt, Veronika
Welte, Tamara M
Ngowi, Bernard J
Matuja, William
Escheu, Gabrielle
Hauke, Peter
Richter, Vivien
Ovuga, Emilio
Pfausler, Bettina
Schmutzhard, Erich
Amos, Action
Harrison, Wendy
Keller, Luise
Winkler, Andrea S
description Epilepsy is one of the most common neurological disorders worldwide. Yet, its treatment gap is large in some areas and especially in sub-Saharan Africa data on clinical, radiological and semiological characteristics, as well as on treatment of persons with epilepsy (PWE) are still scarce. We pooled data from four cross-sectional studies on epilepsy in eastern Africa. Two studies from Malawi and Uganda were community-based; two studies in Tanzania (urban Dar es Salaam and rural Haydom) were hospital-based. Clinical characteristics of PWE were assessed by the same questionnaire. Additionally, data on treatment were collected and computed tomography (CT) scans were performed. Overall, 1179 PWE were included in our analysis (581 (49.3%) female, median age 22 years (IQR 15-32 years)). Up to 25% of the patients had focal onset seizures. Those showed a higher rate of remarkable CT scan findings, with especially post-ischaemic and neurocysticercosis-associated lesions, compared to PWE with generalized onset seizures (35.1% vs. 20%). The majority of the patients experienced tonic-clonic seizures (70-85%). Only 67-78% of PWE received anti-seizure medication (ASM) treatment in the community-based studies, mostly monotherapy with phenobarbital, phenytoin or carbamazepine. Yet, underdosage was frequent and a large proportion of PWE received alternative non-ASM treatment consisting of herbal treatment (up to 83%) and/or scarification (up to 20%). Epilepsy is common in sub-Saharan Africa, often caused by neurocysticercosis or ischaemic strokes. PWE suffer from high seizure rates and subsequent injuries, as well as from socio-economic consequences due to insufficient ASM treatment. This pooled analysis illustrates the need for structural programmes for adequate identification, education, assessment and treatment of PWE in sub-Saharan Africa.
doi_str_mv 10.1186/s12883-022-02813-z
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Yet, its treatment gap is large in some areas and especially in sub-Saharan Africa data on clinical, radiological and semiological characteristics, as well as on treatment of persons with epilepsy (PWE) are still scarce. We pooled data from four cross-sectional studies on epilepsy in eastern Africa. Two studies from Malawi and Uganda were community-based; two studies in Tanzania (urban Dar es Salaam and rural Haydom) were hospital-based. Clinical characteristics of PWE were assessed by the same questionnaire. Additionally, data on treatment were collected and computed tomography (CT) scans were performed. Overall, 1179 PWE were included in our analysis (581 (49.3%) female, median age 22 years (IQR 15-32 years)). Up to 25% of the patients had focal onset seizures. Those showed a higher rate of remarkable CT scan findings, with especially post-ischaemic and neurocysticercosis-associated lesions, compared to PWE with generalized onset seizures (35.1% vs. 20%). The majority of the patients experienced tonic-clonic seizures (70-85%). Only 67-78% of PWE received anti-seizure medication (ASM) treatment in the community-based studies, mostly monotherapy with phenobarbital, phenytoin or carbamazepine. Yet, underdosage was frequent and a large proportion of PWE received alternative non-ASM treatment consisting of herbal treatment (up to 83%) and/or scarification (up to 20%). Epilepsy is common in sub-Saharan Africa, often caused by neurocysticercosis or ischaemic strokes. PWE suffer from high seizure rates and subsequent injuries, as well as from socio-economic consequences due to insufficient ASM treatment. 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1471-2377
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source Publicly Available Content Database; PubMed Central
subjects Adult
Anticonvulsants
Carbamazepine
Classification
Computed tomography
Convulsions & seizures
Cross-Sectional Studies
Cysticercosis
Demographic aspects
Demography
Development and progression
Epidemiology
Epilepsy
Female
Global health
Humans
Ischemia
Low income groups
Male
Medical imaging
Mental disorders
Methods
Neurocysticercosis
Neurological diseases
Patients
Phenobarbital
Phenytoin
Rural areas
Seizures
Semiotics
Sub-Saharan Africa
Tanzania
Treatment gap
Young Adult
title Characteristics of people with epilepsy in three Eastern African countries - a pooled analysis
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