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Abstract
Background
Most children with epilepsy reside in resource-limited regions such as sub-Saharan Africa, where the majority of studies have been conducted in rural areas with limited investigations. Medical records from children with epilepsy seen at an urban hospital in Kenya were examined to provide a comprehensive description of epilepsy in children from this hospital.
Methods
A retrospective observational study was conducted which involved reviewing medical records of 426 epilepsy patients (260 males and 166 females) aged 0 - 18 years, seen at Aga Khan University Hospital, Nairobi, Kenya between February 2011 and December 2014.
Results
The most frequent age at presentation; documented in 29% was in infancy. Generalized seizures due to structural brain abnormalities were the most common form of epilepsy (28%). Lennox-Gastaut Syndrome was the most common electroclinical syndrome (7%). Focal seizures and focal seizures with loss of awareness were identified in 12% of the population. There were no cases of childhood absence epilepsy in this group. Brain atrophy was the most common MRI finding, occurring in a fifth of the population (20%), while cystic encephalomalacia occurred in 13%. Half (50%) of all EEG recordings performed for this cohort were abnormal. Generalized seizures due to structural brain abnormalities and Lennox-Gastaut Syndrome (LGS) were significant predictors of a treatment history of three or more AEDs. At the conclusion of the review period, 16% of the patients had not visited the clinic for more than 12 months and were considered to be lost to follow-up.
Conclusion
The highest frequency of epilepsy cases was documented in children less than one year of age. Generalized seizures due to structural abnormalities and Lennox-Gastaut syndrome were the most common seizure type and syndrome. Improvement of public awareness of different types of seizures in children may increase identification of children with childhood absence epilepsy.
Article Details
Copyright (c) 2019 Pauline Samia, Arwen Barr, Subira B Levi, Kirsten A Donald, Jo M Wilmshurst, Charles R. Newton
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References
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- Dekker, P. A. (2002). World Health Organization: Epilepsy, A manual for medical and clinical officers in Africa. World Health Organisation.
- Meinardi, H., Scott, R. A., Reis, R., Sander, J. W., & ILAE Commission on the Developing World. (2001). The treatment gap in epilepsy: the current situation and ways forward. Epilepsia, 42(1), 136–149. https://doi.org/10.1046/j.1528-1157.2001.32800.x
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- Kanu, I., Anyanwu, E. C., Nwachukwu, N. C., Ehiri, J. E., & Merrick, J. (2005). Clinical Microbiological Aspects of Epileptic Seizures in the Tropical Countries with Specific Focus on Nigeria. The Scientific World JOURNAL, 5, 401–409. https://doi.org/10.1100/tsw.2005.51
- Munyoki, G., Edwards, T., White, S., Kwasa, T., Chengo, E., Kokwaro, G., … Newton, C. R. (2010). Clinical and neurophysiologic features of active convulsive epilepsy in rural Kenya: a population-based study. Epilepsia, 51(12), 2370–2376. https://doi.org/10.1111/j.1528-1167.2010.02653.x
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- Ogunlesi, T., Ogundeyi, M., & Olowu, A. (2009). Pattern of childhood epilepsies in Sagumu, Nigeria. Indian Journal of Pediatrics, 76(4), 385–389. https://doi.org/10.1007/s12098-009-0022-4
- Ogunrin, O. A., & Adeyekun, A. A. (n.d.). Profile of post-traumatic epilepsy in Benin City, Nigeria. West African Journal of Medicine, 29(3), 153–157. https://doi.org/10.4314/wajm.v29i3.68212
- Berhanu, S., Alemu, S., Prevett, M., & Parry, E. H. O. (2009). Primary care treatment of epilepsy in rural Ethiopia: causes of default from follow-up. Seizure, 18(2), 100–103. https://doi.org/10.1016/j.seizure.2008.07.002
- Coleman, R., Gill, G., & Wilkinson, D. (1998). Noncommunicable disease management in resource-poor settings: a primary care model from rural South Africa. Bulletin of the World Health Organization, 76(6), 633–640. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10191559
- Diop, A. G., Hesdorffer, D. C., Logroscino, G., & Hauser, W. A. (2005). Epilepsy and mortality in Africa: a review of the literature. Epilepsia, 46 Suppl 1, 33–35. https://doi.org/10.1111/j.1528-1167.2005.00405.x
- Elechi, C. A. (n.d.). Default and non-compliance among adult epileptics in Zaria, Nigeria. The need to restructure continued care. Tropical and Geographical Medicine, 43(1–2), 242–245. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/1750124
- Kaiser, C., Asaba, G., Mugisa, C., Kipp, W., Kasoro, S., Rubaale, T., & Kabagambe, G. (1998). Antiepileptic drug treatment in rural Africa: involving the community. Tropical Doctor, 28(2), 73–77. https://doi.org/10.1177/004947559802800206
- Kalk, W. J., Veriawa, Y., & Osler, C. (2000). A survey of hospital outpatient services for chronic diseases in Gauteng. South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde, 90(1), 57–61. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10721395
- Nimaga, K., Desplats, D., Doumbo, O., & Farnarier, G. (2002). Treatment with phenobarbital and monitoring of epileptic patients in rural Mali. Bulletin of the World Health Organization, 80(7), 532–537. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12163916
- Sanya, E. O., Wahab, K. W., Desalu, O. O., Bello, H. A., Ademiluyi, B. A., Alaofin, W. A., & Busari, K. (n.d.). A 3 year audit of adult epilepsy care in a Nigerian tertiary hospital (2011-2013). Annals of African Medicine, 14(2), 97–102. https://doi.org/10.4103/1596-3519.149878
- Burton, K., Rogathe, J., Whittaker, R. G., Mankad, K., Hunter, E., Burton, M. J., … Newton, C. R. J. C. (2012). Co-morbidity of epilepsy in Tanzanian children: a community-based case-control study. Seizure, 21(3), 169–174. https://doi.org/10.1016/j.seizure.2011.10.011
- Duggan, M. B. (2013). Epilepsy and its effects on children and families in rural Uganda. African Health Sciences, 13(3), 613–623. https://doi.org/10.4314/ahs.v13i3.14
- Elafros, M. A., Sakubita-Simasiku, C., Atadzhanov, M., Haworth, A., Chomba, E., & Birbeck, G. L. (2013). Stigma and psychiatric morbidity among mothers of children with epilepsy in Zambia. International Health, 5(4), 288–294. https://doi.org/10.1093/inthealth/iht028
- Koba Bora, B., Lez, D. M., Luwa, D. O., Baguma, M. B., Katumbay, D. T., Kalula, T. K., & Mesu’a Kabwa, P. L. (2015). Living with epilepsy in Lubumbashi (Democratic Republic of Congo): epidemiology, risk factors and treatment gap. The Pan African Medical Journal, 21, 303. https://doi.org/10.11604/pamj.2015.21.303.5580
- Sebera, F., Munyandamutsa, N., Teuwen, D. E., Ndiaye, I. P., Diop, A. G., Tofighy, A., … Dedeken, P. (2015). Addressing the treatment gap and societal impact of epilepsy in Rwanda--Results of a survey conducted in 2005 and subsequent actions. Epilepsy & Behavior : E&B, 46, 126–132. https://doi.org/10.1016/j.yebeh.2015.03.028
- Ellenberg, J. H., Hirtz, D. G., & Nelson, K. B. (1984). Age at onset of seizures in young children. Annals of Neurology, 15(2), 127–134. https://doi.org/10.1002/ana.410150204
- Feksi, A. T., Kaamugisha, J., Gatiti, S., Sander, J. W., & Shorvon, S. D. (1991). A comprehensive community epilepsy programme: the Nakuru project. Epilepsy Research, 8(3), 252–259. https://doi.org/10.1016/0920-1211(91)90072-n
- Carter, J. A., Neville, B. G. R., White, S., Ross, A. J., Otieno, G., Mturi, N., … Newton, C. R. J. C. (2004). Increased prevalence of epilepsy associated with severe falciparum malaria in children. Epilepsia, 45(8), 978–981. https://doi.org/10.1111/j.0013-9580.2004.65103.x
- Kind, C. J., Newton, C. R. J. C., Kariuki, S. M., & Neurodevelopment Disorders study group. (2017). Prevalence, risk factors, and neurobehavioral comorbidities of epilepsy in Kenyan children. Epilepsia Open, 2(4), 388–399. https://doi.org/10.1002/epi4.12069
- Lagunju, I. A., Oyinlade, A. O., & Babatunde, O. D. (2016). Seizure-related injuries in children and adolescents with epilepsy. Epilepsy & Behavior : E&B, 54, 131–134. https://doi.org/10.1016/j.yebeh.2015.11.019
- Mung’ala-Odera, V., White, S., Meehan, R., Otieno, G. O., Njuguna, P., Mturi, N., … Newton, C. R. J. C. (2008). Prevalence, incidence and risk factors of epilepsy in older children in rural Kenya. Seizure, 17(5), 396–404. https://doi.org/10.1016/j.seizure.2007.11.028
- Ogunrin, O. A., Adeyekun, A., & Adudu, P. (2013). Etiologies of epilepsy and health-seeking itinerary of patients with epilepsy in a resource poor setting: analysis of 342 Nigerian Africans. Seizure, 22(7), 572–576. https://doi.org/10.1016/j.seizure.2013.04.012
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References
World Health Organization. (n.d.). World Health Organization: Global Health Estimates 2015: DALYs by Cause, Age, Sex, by Country and by Region, 2000-2015. Retrieved from https://www.who.int/healthinfo/global_burden_disease/estimates/en/index2.html
World Health Organization. (n.d.). World Health Organization Fact sheet on Epilepsy. Retrieved from https://www.who.int/en/news-room/fact-sheets/detail/epilepsy
Mbuba, C. K., Ngugi, A. K., Newton, C. R., & Carter, J. A. (2008). The epilepsy treatment gap in developing countries: a systematic review of the magnitude, causes, and intervention strategies. Epilepsia, 49(9), 1491–1503. https://doi.org/10.1111/j.1528-1167.2008.01693.x
Meyer, A.-C., Dua, T., Ma, J., Saxena, S., & Birbeck, G. (2010). Global disparities in the epilepsy treatment gap: a systematic review. Bulletin of the World Health Organization, 88(4), 260–266. https://doi.org/10.2471/BLT.09.064147
Ngugi, A. K., Bottomley, C., Kleinschmidt, I., Wagner, R. G., Kakooza-Mwesige, A., Ae-Ngibise, K., … SEEDS group. (2013). Prevalence of active convulsive epilepsy in sub-Saharan Africa and associated risk factors: cross-sectional and case-control studies. The Lancet. Neurology, 12(3), 253–263. https://doi.org/10.1016/S1474-4422(13)70003-6
Wilmshurst, J. M., Kakooza-Mwesige, A., & Newton, C. R. (2014). The challenges of managing children with epilepsy in Africa. Seminars in Pediatric Neurology, 21(1), 36–41. https://doi.org/10.1016/j.spen.2014.01.005
Dekker, P. A. (2002). World Health Organization: Epilepsy, A manual for medical and clinical officers in Africa. World Health Organisation.
Meinardi, H., Scott, R. A., Reis, R., Sander, J. W., & ILAE Commission on the Developing World. (2001). The treatment gap in epilepsy: the current situation and ways forward. Epilepsia, 42(1), 136–149. https://doi.org/10.1046/j.1528-1157.2001.32800.x
Berg, A. T., Berkovic, S. F., Brodie, M. J., Buchhalter, J., Cross, J. H., van Emde Boas, W., … Scheffer, I. E. (2010). Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia, 51(4), 676–685. https://doi.org/10.1111/j.1528-1167.2010.02522.x
Scheffer, I. E., Berkovic, S., Capovilla, G., Connolly, M. B., French, J., Guilhoto, L., … Zuberi, S. M. (2017). ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia, 58(4), 512–521. https://doi.org/10.1111/epi.13709
Birbeck, G. L. (2012). Revising and refining the epilepsy classification system: priorities from a developing world perspective. Epilepsia, 53 Suppl 2, 18–21. https://doi.org/10.1111/j.1528-1167.2012.03554.x
Kariuki, S. M., Matuja, W., Akpalu, A., Kakooza-Mwesige, A., Chabi, M., Wagner, R. G., … Noh, J. (2014). Clinical features, proximate causes, and consequences of active convulsive epilepsy in Africa. Epilepsia, 55(1), 76–85. https://doi.org/10.1111/epi.12392
Fisher, R. S., Acevedo, C., Arzimanoglou, A., Bogacz, A., Cross, J. H., Elger, C. E., … Wiebe, S. (2014). ILAE official report: a practical clinical definition of epilepsy. Epilepsia, 55(4), 475–482. https://doi.org/10.1111/epi.12550
World Health Organization. (2013). HIV/AIDS Definition of key terms. Retrieved from https://www.who.int/hiv/pub/guidelines/arv2013/intro/keyterms/en/
World Health Organization. (n.d.). Infant, Newborn. Retrieved December 27, 2019, from https://www.who.int/infant-newborn/en/
Burton, K. J., Rogathe, J., Whittaker, R., Mankad, K., Hunter, E., Burton, M. J., … Newton, C. R. J. C. (2012). Epilepsy in Tanzanian children: association with perinatal events and other risk factors. Epilepsia, 53(4), 752–760. https://doi.org/10.1111/j.1528-1167.2011.03395.x
Gebremariam, A., Gutema, Y., Leuel, A., & Fekadu, H. (2006). Early-onset neonatal seizures: types, risk factors and short-term outcome. Annals of Tropical Paediatrics, 26(2), 127–131. https://doi.org/10.1179/146532806X107476
Kanu, I., Anyanwu, E. C., Nwachukwu, N. C., Ehiri, J. E., & Merrick, J. (2005). Clinical Microbiological Aspects of Epileptic Seizures in the Tropical Countries with Specific Focus on Nigeria. The Scientific World JOURNAL, 5, 401–409. https://doi.org/10.1100/tsw.2005.51
Munyoki, G., Edwards, T., White, S., Kwasa, T., Chengo, E., Kokwaro, G., … Newton, C. R. (2010). Clinical and neurophysiologic features of active convulsive epilepsy in rural Kenya: a population-based study. Epilepsia, 51(12), 2370–2376. https://doi.org/10.1111/j.1528-1167.2010.02653.x
Nicoletti, A., Bartoloni, A., Sofia, V., Mantella, A., Nsengiyumva, G., Frescaline, G., & Preux, P.-M. (2007). Epilepsy and toxocariasis: a case-control study in Burundi. Epilepsia, 48(5), 894–899. https://doi.org/10.1111/j.1528-1167.2007.01104.x
Ogunlesi, T., Ogundeyi, M., & Olowu, A. (2009). Pattern of childhood epilepsies in Sagumu, Nigeria. Indian Journal of Pediatrics, 76(4), 385–389. https://doi.org/10.1007/s12098-009-0022-4
Ogunrin, O. A., & Adeyekun, A. A. (n.d.). Profile of post-traumatic epilepsy in Benin City, Nigeria. West African Journal of Medicine, 29(3), 153–157. https://doi.org/10.4314/wajm.v29i3.68212
Berhanu, S., Alemu, S., Prevett, M., & Parry, E. H. O. (2009). Primary care treatment of epilepsy in rural Ethiopia: causes of default from follow-up. Seizure, 18(2), 100–103. https://doi.org/10.1016/j.seizure.2008.07.002
Coleman, R., Gill, G., & Wilkinson, D. (1998). Noncommunicable disease management in resource-poor settings: a primary care model from rural South Africa. Bulletin of the World Health Organization, 76(6), 633–640. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10191559
Diop, A. G., Hesdorffer, D. C., Logroscino, G., & Hauser, W. A. (2005). Epilepsy and mortality in Africa: a review of the literature. Epilepsia, 46 Suppl 1, 33–35. https://doi.org/10.1111/j.1528-1167.2005.00405.x
Elechi, C. A. (n.d.). Default and non-compliance among adult epileptics in Zaria, Nigeria. The need to restructure continued care. Tropical and Geographical Medicine, 43(1–2), 242–245. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/1750124
Kaiser, C., Asaba, G., Mugisa, C., Kipp, W., Kasoro, S., Rubaale, T., & Kabagambe, G. (1998). Antiepileptic drug treatment in rural Africa: involving the community. Tropical Doctor, 28(2), 73–77. https://doi.org/10.1177/004947559802800206
Kalk, W. J., Veriawa, Y., & Osler, C. (2000). A survey of hospital outpatient services for chronic diseases in Gauteng. South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde, 90(1), 57–61. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10721395
Nimaga, K., Desplats, D., Doumbo, O., & Farnarier, G. (2002). Treatment with phenobarbital and monitoring of epileptic patients in rural Mali. Bulletin of the World Health Organization, 80(7), 532–537. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12163916
Sanya, E. O., Wahab, K. W., Desalu, O. O., Bello, H. A., Ademiluyi, B. A., Alaofin, W. A., & Busari, K. (n.d.). A 3 year audit of adult epilepsy care in a Nigerian tertiary hospital (2011-2013). Annals of African Medicine, 14(2), 97–102. https://doi.org/10.4103/1596-3519.149878
Burton, K., Rogathe, J., Whittaker, R. G., Mankad, K., Hunter, E., Burton, M. J., … Newton, C. R. J. C. (2012). Co-morbidity of epilepsy in Tanzanian children: a community-based case-control study. Seizure, 21(3), 169–174. https://doi.org/10.1016/j.seizure.2011.10.011
Duggan, M. B. (2013). Epilepsy and its effects on children and families in rural Uganda. African Health Sciences, 13(3), 613–623. https://doi.org/10.4314/ahs.v13i3.14
Elafros, M. A., Sakubita-Simasiku, C., Atadzhanov, M., Haworth, A., Chomba, E., & Birbeck, G. L. (2013). Stigma and psychiatric morbidity among mothers of children with epilepsy in Zambia. International Health, 5(4), 288–294. https://doi.org/10.1093/inthealth/iht028
Koba Bora, B., Lez, D. M., Luwa, D. O., Baguma, M. B., Katumbay, D. T., Kalula, T. K., & Mesu’a Kabwa, P. L. (2015). Living with epilepsy in Lubumbashi (Democratic Republic of Congo): epidemiology, risk factors and treatment gap. The Pan African Medical Journal, 21, 303. https://doi.org/10.11604/pamj.2015.21.303.5580
Sebera, F., Munyandamutsa, N., Teuwen, D. E., Ndiaye, I. P., Diop, A. G., Tofighy, A., … Dedeken, P. (2015). Addressing the treatment gap and societal impact of epilepsy in Rwanda--Results of a survey conducted in 2005 and subsequent actions. Epilepsy & Behavior : E&B, 46, 126–132. https://doi.org/10.1016/j.yebeh.2015.03.028
Ellenberg, J. H., Hirtz, D. G., & Nelson, K. B. (1984). Age at onset of seizures in young children. Annals of Neurology, 15(2), 127–134. https://doi.org/10.1002/ana.410150204
Feksi, A. T., Kaamugisha, J., Gatiti, S., Sander, J. W., & Shorvon, S. D. (1991). A comprehensive community epilepsy programme: the Nakuru project. Epilepsy Research, 8(3), 252–259. https://doi.org/10.1016/0920-1211(91)90072-n
Carter, J. A., Neville, B. G. R., White, S., Ross, A. J., Otieno, G., Mturi, N., … Newton, C. R. J. C. (2004). Increased prevalence of epilepsy associated with severe falciparum malaria in children. Epilepsia, 45(8), 978–981. https://doi.org/10.1111/j.0013-9580.2004.65103.x
Kind, C. J., Newton, C. R. J. C., Kariuki, S. M., & Neurodevelopment Disorders study group. (2017). Prevalence, risk factors, and neurobehavioral comorbidities of epilepsy in Kenyan children. Epilepsia Open, 2(4), 388–399. https://doi.org/10.1002/epi4.12069
Lagunju, I. A., Oyinlade, A. O., & Babatunde, O. D. (2016). Seizure-related injuries in children and adolescents with epilepsy. Epilepsy & Behavior : E&B, 54, 131–134. https://doi.org/10.1016/j.yebeh.2015.11.019
Mung’ala-Odera, V., White, S., Meehan, R., Otieno, G. O., Njuguna, P., Mturi, N., … Newton, C. R. J. C. (2008). Prevalence, incidence and risk factors of epilepsy in older children in rural Kenya. Seizure, 17(5), 396–404. https://doi.org/10.1016/j.seizure.2007.11.028
Ogunrin, O. A., Adeyekun, A., & Adudu, P. (2013). Etiologies of epilepsy and health-seeking itinerary of patients with epilepsy in a resource poor setting: analysis of 342 Nigerian Africans. Seizure, 22(7), 572–576. https://doi.org/10.1016/j.seizure.2013.04.012
The World Bank. (n.d.). GDP per capita (current US$) - Kenya. Retrieved December 27, 2019, from https://data.worldbank.org/indicator/NY.GDP.PCAP.CD?locations=KE
Buchhalter, J. (2011). Treatment of childhood absence epilepsy-an evidence-based answer at last! Epilepsy Currents, 11(1), 12–15. https://doi.org/10.5698/1535-7511-11.1.12