Clinical and etiological profile of epilepsy at the regional hospital center of Tahoua (Niger): A 4‐year retrospective study

Abstract

Objective: We aimed to evaluate epilepsy management at the regional hospital center (RHC) of Tahoua (Niger) to determine the intrahospital deficiencies to optimize to improve the management of people with epilepsy.Methods: A descriptive retrospective study was carried out at the Psychiatric Unit of the RHC of Tahoua between January 1, 2016 and December 31, 2019. We collected from the registers of consultation all patients followed by nurse technicians in mental health for epilepsy whose diagnosis was made by nonspecialist physicians or internists. The study included patients with epilepsy who had a medical follow-up at least 6 months.Results: Of the 2022 patients seen during the period of the study, 246 patients were consulted for epilepsy with a hospital frequency of 12.2%. The mean age was 22.38 years, with a slight predominance of men (57.7%). Only generalized tonic-clonic seizures (95.1%) and focal-aware seizures (4.9%) were reported. The main etiologies were cerebral malaria (18.7%), bacterial meningitis (8.1%), and head trauma (4.9%). In 60.2% of cases, the etiology was undetermined, but the etiological diagnosis investigation was incomplete (CT scan not done). Only the first-generation antiepileptic drugs were used. Only 2.8% of the patients had drug-resistant epilepsy, and 97.2% of the patients had controlled seizures. Conclusion:The study shows a predominance of infectious causes, particularly cerebral malaria. We found a high proportion of epilepsies with unknown etiologies with incomplete workup. The RHC of Tahoua should facilitate access to the CT scan for people with epilepsy to improve etiological diagnosis investigation. K E Y W O R D Sepilepsy, hospital-based study, Niger, sub-Saharan Africa, Tahoua INTRODUCTIONEpilepsy is one of the most common chronic neurological diseases that affects more than 50 million people worldwide, and almost 80% of them live in developing countries (Ngugi et al., 2010). In developingThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Epilepsy in Niger: An overview of the current situation

“…However, two hospital-based studies on epilepsy have been published. 4,5 The first study was conducted in Niamey in a tertiary care center in a neurological unit and reported a hospital prevalence of 29.5%. 4 In the above study, the diagnosis of epilepsy was considered in case of at least two unprovoked (or reflex) seizures occurring more than 24 h apart or one unprovoked (or reflex) seizure in individuals who have risk factors such as cerebrovascular disease, central nervous system infection, and traumatic brain injury according to the 2014 revised definition of epilepsy of ILAE Official report.…”

“…7 The second study was conducted in Tahoua in a secondary care center in a psychiatric unit and reported a hospital prevalence of 12.2%. 5 The diagnosis of epilepsy was considered in the case of repetition of epileptic seizures over time in this study. The mean hospital prevalence was estimated to be 24.2% (95% CI: 23.2-25.2) (Table 1).…”

“…The age of the first epileptic seizure was less than 20 years in about 60% of patients. 5 Patients aged ≥60 years, considered elderly in a hospital-based study conducted in Niger in 2019, 8 representing 4.1% (95% CI: 3.1-5.1). This prevalence of epilepsy among people aged 60 years and older in Niger seemed near to that reported in a systematic review among people aged 60 years or older in sub-Saharan Africa, which ranged from 0.02% to 3.2%.…”

“…However, two hospital-based studies on epilepsy have been published. 4,5 To date in Niger, PWEs are usually cared for by non-physician healthcare workers (mainly nurse technicians in mental health), general medical doctors (non-specialist physician), and nonneurologist physicians. In routine practice, these health workers make the diagnosis of epilepsy essentially based on the clinic, that is, the repetition of epileptic seizures over time (mainly generalized tonic-clonic seizures) because most of them practiced in health centers or district hospitals or regional hospital centers in which electroencephalogram and neuroradiological explorations are of limited access or unavailable as well as a referral neurologist.…”

“…There is no door‐to‐door survey on epilepsy to estimate the prevalence of this condition in the general population in Niger. However, two hospital‐based studies on epilepsy have been published 4,5 . To date in Niger, PWEs are usually cared for by non‐physician healthcare workers (mainly nurse technicians in mental health), general medical doctors (non‐specialist physician), and non‐neurologist physicians.…”