Epidemiology, causes, and treatment of epilepsy in sub-Saharan Africa

Ba-Diop, Awa; Marin, Benoît; Druet‐Cabanac, Michel; Ngoungou, Edgard Brice; Newton, Charles R.; Preux, Pierre‐Marie

doi:10.1016/s1474-4422(14)70114-0

Cited by 231 publications

(266 citation statements)

References 123 publications

(141 reference statements)

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“…Adjusting for nonfebrile risk factors of epilepsy such as low birth weight, prematurity, cerebral palsy, and injuries, which are usually in the causal pathway for epilepsy,2 but not for acute seizures,3 would provide a parsimonious validation for the role of infectious causes of acute seizures in the pathogenesis of epilepsy. Additionally, the significantly greater risk for epilepsy after acute symptomatic seizures than after febrile seizures suggests that underlying neurological damage probably from intracranial infections such as falciparum malaria or bacterial meningitis is perhaps linked to epilepsy.…”

Section: Discussionmentioning

confidence: 99%

“…Epilepsy is common in low‐ and middle‐income countries, with the prevalence of epilepsy in Africa ranging from 7 to 15 per 1,000,1, 2 about twice that of high‐income countries. Acute seizures (febrile and acute symptomatic seizures) are common and are associated with the development of epilepsy.…”

mentioning

confidence: 99%

“…The incidence of acute seizures in children admitted to a Kenyan hospital was about 600 per 100,000/year,3, 4 but because many children are not admitted, this may be an inaccurate estimate of true incidence. Acute seizures and epilepsy may have shared risk factors, including genetic susceptibility,5 central nervous system (CNS) infections such as cerebral malaria and meningitis,2 a family history of seizures, and perinatal complications 1. However, the contribution of acute seizures to the development of epilepsy is unclear in Africa.…”

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confidence: 99%

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Risk of convulsive epilepsy following acute seizures in Kenyan children

2016

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SummaryObjectiveThe prevalence of epilepsy is high in Africa, and people with epilepsy often have a history of acute seizures. We determined whether acute seizures are associated with risk for epilepsy in rural Africa, where both conditions are common and may have shared risk factors.MethodsA total of 16,438 children (2,991 with acute seizures and 13,447 without seizures) admitted to Kilifi County Hospital from 2002 to 2008 were followed up with epidemiological surveys conducted in 2003 and 2008 to assess the prevalence of epilepsy and the associated risk factors. Cox proportional hazards regression models were used to identify the risk factors. Prevalence ratios were computed using log binomial regression models.ResultsThe prevalence of epilepsy was higher in admissions with acute seizures (5.0% [95% confidence interval (CI), 4.3–5.9%]) than in those without seizures (0.7% [95% CI, 0.5–0.8%]), p < 0.0001). Acute seizures were associated with epilepsy after accounting for potential confounders in a Cox regression model (hazard ratio [HR] = 1.53 [95% CI, 1.10–2.14]). Prevalence was greater in complex acute seizures (5.9%; prevalence ratio [PR] = 1.58 [95% CI, 1.13–2.20]) or status epilepticus (7.5%; PR = 1.96 [95% CI, 1.32–2.91]) than in simple acute seizures (3.7%). Factors independently associated with epilepsy following acute seizures in Cox regression models were perinatal complications (HR = 3.60 [95% CI, 1.89–6.87]), cerebral palsy (HR = 1491.51 [95% CI, 144.30–15,416.21]), duration of follow‐up (HR = 1.21 [95% CI, 1.09–1.35]), and malnutrition (relative risk [RR] = 0.24 [95% CI, 0.08–0.69]).SignificanceAcute seizures in children are associated with subsequent risk for epilepsy that is greater than in the general population. The burden of epilepsy may be reduced by control of causes of acute seizures.

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Section: Discussionmentioning

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Risk of convulsive epilepsy following acute seizures in Kenyan children

2016

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“…Previous research has focused largely upon its epidemiology, aetiology and management [94]. The annual incidence of epilepsy in Africa ranges between 64 and 187 per 100,000 person-years while prevalence rates are as high as 105 per 1000 persons [94]. Its most common risk factors include febrile convulsions, birth trauma, CNS infections, and traumatic brain injury.…”

Section: Perspectives On What Is Knownmentioning

confidence: 99%

Neurogenomics in Africa: Perspectives, progress, possibilities and priorities

Akinyemi

Owolabi

Oyeniyi

et al. 2016

Journal of the Neurological Sciences

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The understanding of the genetic basis of neurological disorders has grown rapidly in the last two decades. Despite the genomic heterogeneity within African populations, large-scale candidate gene or linkage and exome studies are lacking. However, current knowledge on neurogenetics in African populations is limited and geographically very uneven. Isolated reports indicate the existence of autosomal dominant or recessive conditions incorporating cerebrovascular, movement, neuromuscular, seizure and motor neuron disorders in Africans. In addition, few African families with neurodegenerative disorders associated with dementia have been characterized in North, West and South Africa. The current insurgency in genomic research triggered by among others the Human Health and Heredity (H3) Africa Initiative indicates that there are unique opportunities to advance our knowledge and understanding of the influence of genomic variation on the pattern, presentations and prognosis of neurological disorders in Africa. These have enormous potential to unmask novel genes and molecular pathways germane to the neurobiology of brain disorders. It would facilitate the development of novel diagnostics, preventative and targeted treatments in the new paradigm of precision medicine. Nevertheless, it is crucial to strike a balance between effective traditional public health strategies and personalized genome based care. The translational barriers can be overcome through robust stakeholder engagement and sustainable multilevel, multigenerational and multidisciplinary capacity building and infrastructural development for genomic medicine in Africa.

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“…The same issues were raised in a sub-Saharan Africa conducted by Preux and Druet-Cabanac, published in 2005, 12 as well as in a review and update by Ba-Diop et al in 2014. 13 The main risk factors for epilepsy in that area of the world were family history of seizures, previous febrile seizures, perinatal trauma, head injury, and CNS infections, such as NCC. They confirmed that febrile seizures were commonly associated with epileptic seizures among the pediatric population (6---38% of patients with epilepsy had a history of febrile seizures).…”

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Epidemiology of febrile seizures and epilepsy: a call for action

Preux

Ratsimbazafy

Jost

2015

Jornal de Pediatria

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Seizures triggered by fever, qualified as febrile seizures, have been for decades a major issue for children in developed countries and more so in resource-limited settings. Approximately 2---5% of children are affected by this kind of seizure. Many studies aimed to describe, measure, and analyze several hypotheses, including the assessment of the physiopathological mechanisms, epidemiological indicators, care management, and their impact on their later neurological impairments, such as epilepsy, but many unknowns remain.In this issue of Jornal de Pediatria, Dalbem et al. 1 report a population-based cross-sectional study conducted in the city of Barra do Bugres in Brazil to assess the prevalence of benign febrile seizures during childhood. The main outcome was a prevalence of 6.4/1000 habitants (95% confidence interval [CI], 3.8---10.1), which is much lower than the results reported in two studies also performed in Brazil, ranging from 13.9 to 16.0/1000, 2,3 but within the literature range, from 3.5/1000 in an Arab population 4 to 17.0/1000 in a rural north American population. 5 One of the strengths of their study was that almost all the pediatric population in ଝ Please cite this article as: Preux P-M, Ratsimbazafy V, Jost J. Epidemiology of febrile seizures and epilepsy: a call for action. J Pediatr (Rio J). 2015. http://dx.

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Epidemiology, causes, and treatment of epilepsy in sub-Saharan Africa

Cited by 231 publications

References 123 publications

Risk of convulsive epilepsy following acute seizures in Kenyan children

Risk of convulsive epilepsy following acute seizures in Kenyan children

Neurogenomics in Africa: Perspectives, progress, possibilities and priorities

Epidemiology of febrile seizures and epilepsy: a call for action

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