Clinical profile of childhood epilepsy in Nigerian children seen in a tertiary hospital

Abstract

Background: Epilepsies are the most common conditions encountered in most paediatric neurology clinics in many parts of the developing world. In sub-Saharan Africa epilepsies are secondary, reflecting persistently high risks at birth, and the adverse neurological sequelae of CNS infections during and beyond childhood. The study was designed to determine the clinical pattern of childhood epilepsies, probable aetiologies and associated comorbidities of the disease children.Methods: The study was conducted within an 18 months period among children having established epilepsy attending the Neurology Clinic of University of Calabar Teaching Hospital (UCTH). The children and or care givers were interviewed by the authors and the following data were obtained and recorded in a questionnaire; bio data, age at onset of seizure. History was obtained to determine the possible cause of the seizure, type of epilepsy and associated comorbidities. The data obtained was analysed with SPSS version 20. P-value <0.05 was considered significant.Results: Of the one hundred eighty children seen with various neurological morbidities during the study period, one hundred and seven had epilepsy which constitutes 59.4%. Generalized tonic clonic epilepsy was the commonest type of epilepsy found in 66 (61.1%) of the children with epilepsy, followed by simple partial and myoclonic epilepsy in 18.5% and 6.5% respectively. Severe birth asphyxia was responsible was the commonest identifiable cause of epilepsy in 19 (17.8%) of cases while central nervous system infection accounted for 14 (13.1%). Cerebral palsy was the commonest comorbidity in 20 (18.6%) followed by mental retardation in 17 (15.9%) of the children.Conclusions: The study showed epilepsy to be the commonest neurological presentation among children presenting at the paediatric neurology clinic of our facility. Primary generalised tonic clonic epilepsy was the commonest type of epilepsy seen, followed by simple partial seizures. Cerebral palsy and mental retardation were the main associated comorbidities. Birth injuries mainly severe birth asphyxia and CNS infection were the major causes of epilepsy in our study. In conclusion, epilepsy is the commonest neurological morbidity in our environment, limited facilities and resources still militate against identifying the actual aetiology in most children with the disease. Effort should be intensifying to eradicate the preventable causes of the disease.

Profile of Childhood Epilepsies and Syndromes Seen in an Electrophysiology Laboratory in Southeast Nigeria

“…Similar findings have been reported from other parts of Africa [10,11] and Europe [12,13]. However, Eyong et al [14] in their study in South Nigeria reported generalized epilepsy as the commonest epilepsy type seen. The perceived difference is most likely due to the incorporation of EEG findings in diagnosis in our study since the study by Eyong et al [14] was based solely on history obtained from parents/caregivers (eye witness account).…”

“…However, Eyong et al [14] in their study in South Nigeria reported generalized epilepsy as the commonest epilepsy type seen. The perceived difference is most likely due to the incorporation of EEG findings in diagnosis in our study since the study by Eyong et al [14] was based solely on history obtained from parents/caregivers (eye witness account). Additionally, it may be because some of the focal seizures or focal to bilateral tonic-clonic seizures were wrongly classified as generalized seizures.…”

Management of epilepsies at the community cottage hospital level in a developing environment

“…Eyong et al .,12 in a tertiary health facility in southern Nigeria, saw 107 children with epilepsy in a 1-year period. The large proportion of patients in this study who had no form of treatment for long periods is not surprising and reflects the general belief in Africa that epilepsies are not treatable with orthodox medication 4567121314. This also most probably informed the choice of traditional herbalists by some of our patients prior to presentation to us.…”

Panayiotopoulos syndrome: a clinico-electroencephalographic presentation of three cases from Nigeria

“…While Rolandic epilepsy is well recognized and appears in studies on epilepsies in Nigeria, PS is underdiagnosed and escaping recognition. [6][7][8][9] The three cases reported all had at the onset unusual autonomic (focal, nonmotor) symptoms such as vomiting, ictal syncope ("lifeless and floppy body"), behavior change and cyanosis/ palor ("colour change", "dark lips and palms"). These initial symptoms are difficult for the General practitioner or even Paediatricians to recognize as ictal events and failure to do so is a major reason for misdiagnosis of PS.…”

“…2 However, this common childhood epileptic syndrome remains under diagnosed in Nigeria as there are no reports or mention of it in studies on epilepsy in Nigeria. [5][6][7][8] The three cases reported here all manifested the unusual constellation of autonomic symptoms in addition to the conventional seizure symptoms. One of the cases had visual hallucinations which are rare in PS while another had adverse natal, perinatal and early postnatal events that suggested a symptomatic aetiology for the autonomic seizures.…”