Patterns of diagnosis and therapeutic care of epilepsy at a tertiary referral center in Nigeria

Abstract

SUMMARYObjective: Epilepsy care in developing countries is challenged by the paucity of trained specialists, diagnostic tools, and antiepileptic drugs (AEDs). We retrospectively evaluated how epilepsy was managed in a Nigerian tertiary referral center, with the goals of determining diagnostic accuracy by comparing clinical and electroencephalography (EEG) diagnoses, the appropriateness of prescribed therapy by clinician specialization, and the association between therapy and patient outcomes. Methods: We examined the medical records of 372 patients diagnosed with epilepsy in the center over a 6-month period from 2011 to 2012. Data were obtained on methods of diagnosis, clinician specialization, therapeutic care, and patient self-or caregiverreported outcome on follow-up visits. Interrater agreement was assessed using Cohen's j coefficient, and the diagnoses made by nonspecialist and specialist clinicians compared using the chi-square test. Results: Of 372 patients diagnosed with epilepsy, only one had a brain computerized tomography (CT) scan. Seventy-six were differentially diagnosed for generalized or partial epilepsy by both clinical presentation and EEG. Low interrater agreement (j = 0.05) was found between these methods of diagnosis. Of the 76 patients, 53 (69.7%) received therapies judged as appropriate, with no significant difference in prescription rates for appropriate therapy between nonspecialists and specialists (p = 0.536). Specific syndromic diagnoses were made only in 4% of patients, and only in patients who underwent EEG. Only three first-generation AEDs were prescribed, with 97.6% of patients receiving carbamazepine. Significance: The discrepancy between diagnoses made on clinical features alone versus EEG diagnosis suggests that in many patients without concomitant EEG, the epileptic syndrome might have been erroneously classified, with increased risk of inappropriate treatment. Resources should be more properly directed toward increasing access to diagnostic facilities and newer generation AEDs.

Clinical and etiological characteristics of epilepsy in people from Niger: a hospital‐based study from a tertiary care referral center of Niamey, Niger

“…The mean age of our patients was 18.55 years, demonstrating the young age of the majority of patients in the study sample. The study also showed a predominance of the male sex (sex ratio at 1.5), as previously reported in many studies in sub‐Saharan Africa . However, the predominance of female sex has been reported in some studies in Nigeria, Rwanda, and Tanzanie .…”

“…A study from Togo reported a high proportion of patients with infectious and structural etiologies (69.4%) . A Nigerian study reported a proportion of idiopathic generalized epilepsies of 17.1% . Despite the means to carry out additional examinations (such as laboratory tests, brain CT scan, or/and MRI), which is not always possible in studies conducted in some sub‐Saharan African countries, we found a high proportion of idiopathic generalized epilepsies in our study than those so far reported.…”

“…13 A Nigerian study reported a proportion of idiopathic generalized epilepsies of 17.1%. 11 Despite the means to carry out additional examinations (such as laboratory tests, brain CT scan, or/and MRI), which is not always possible in studies conducted in some sub-Saharan African countries, we found a high proportion of idiopathic generalized epilepsies in our study than those so far reported. These findings reflect the interest of pursuing descriptive and analytical epidemiological studies in Niger to confirm or invalidate this abnormally high proportion of idiopathic generalized epilepsies.…”

“…Lamotrigine (LTG) was the sole newer generation AED prescribed in our study and only in 1% of patients. In Nigeria, a study reported only the prescription of first‐generation AEDs (VPA, CBZ, and PB) . Similar findings were also reported in a study from Togo with PB as the first choice molecule .…”

“…The study also showed a predominance of the male sex (sex ratio at 1.5), as previously reported in many studies in sub-Saharan Africa. [8][9][10][11][12][13][14] However, the predominance of female sex has been reported in some studies in Nigeria, 15,16 Rwanda, 17 and Tanzanie. 18 In our study, patients younger than 20 years were the most affected (61.6%).…”