Prevalence, causes, and behavioral and emotional comorbidities of acute symptomatic seizures in Africa: A critical review

Abstract

SummarySeizures with fever includes both febrile seizures (due to nonneurological febrile infections) and acute symptomatic seizures (due to neurological febrile infections). The cumulative incidence (lifetime prevalence) of febrile seizures in children aged ≤6 years is 2–5% in American and European studies, but there are no community‐based data on acute symptomatic seizures in Africa. The incidence of acute symptomatic seizures in sub‐Saharan Africa is more than twice that in high‐income countries. However, most studies of acute symptomatic seizures from Africa are based on hospital samples or do not conduct surveys in demographic surveillance systems, which underestimates the burden. It is difficult to differentiate between febrile seizures and acute symptomatic seizures in Africa, especially in malaria‐endemic areas where malaria parasites can sequester in the brain microvasculature; but this challenge can be addressed by robust identification of underlying causes. The proportion of complex acute symptomatic seizures (i.e., seizures that are focal, repetitive, or prolonged) in Africa are twice that reported in other parts of the world (>60% vs. ∼30%), which is often attributed to falciparum malaria. These complex phenotypes of acute symptomatic seizures can be associated with behavioral and emotional problems in high‐income countries, and outcomes may be even worse in Africa. One Kenyan study reported behavioral and emotional problems in approximately 10% of children admitted with acute symptomatic seizures, but it is not clear whether the behavioral and emotional problems were due to the seizures, shared genetic susceptibility, etiology, or underlying neurological damage. The underlying neurological damage in acute symptomatic seizures can lead not only to behavioral and emotional problems but also to neurocognitive impairment and epilepsy. Electroencephalography may have a prognostic role in African children with acute symptomatic seizures. There are significant knowledge gaps regarding acute symptomatic seizures in Africa, which results in lack of reliable estimates for planning interventions. Future epidemiological studies of acute symptomatic seizures should be set up in Africa.

Anxiety: An overlooked confounder in the characterisation of chronic stress-related conditions?

“…Lower socioeconomic standing increases the likelihood of experiencing negative life events and children and young adults in particular are at risk of experiencing early life trauma and poorer health outcomes [1,2]. [3,4] Similarly, behavioural and emotional problems are now common in young children globally [5]. The onset of an anxiety disorder is typically in childhood or early adolescence [6].…”

Prevalence, risk factors and behavioural and emotional comorbidity of acute seizures in young Kenyan children: a population-based study

“…The two studies did not investigate the risk factors for behavioural and emotional comorbidities of acute seizures, while some febrile seizures could have been acute symptomatic seizures since malaria was associated with over half of these seizures. Acute seizures in Africa increase the future risk for epilepsy [ 9 ] and mental health problems [ 10 ], so their early identification and prevention is of public health importance.…”

“…In sub-Saharan Africa, a greater proportion of acute seizures are complex (i.e. prolonged, repetitive or focal) (60–70%) [ 12 , 13 ], which may increase the risk of behavioural and emotional problems in affected children [ 10 ]. Behavioural and emotional problems in children with seizures may be related to (i) the seizures, especially possible damage from complex seizures, (ii) a shared neurological damage that leads to both seizures and behavioural and emotional problems or (iii) an underlying genetic susceptibility that may interact with other environmental factors to lead to seizures, behavioural and emotional problems or both [ 10 ].…”

“…prolonged, repetitive or focal) (60–70%) [ 12 , 13 ], which may increase the risk of behavioural and emotional problems in affected children [ 10 ]. Behavioural and emotional problems in children with seizures may be related to (i) the seizures, especially possible damage from complex seizures, (ii) a shared neurological damage that leads to both seizures and behavioural and emotional problems or (iii) an underlying genetic susceptibility that may interact with other environmental factors to lead to seizures, behavioural and emotional problems or both [ 10 ]. Behavioural and emotional problems occurred in approximately 10% of Kenyan children discharged from hospital with acute symptomatic seizures (a relative risk of 1.8 compared to controls) [ 10 ], but hospital estimates are biased towards more severe seizure disorders and it is unclear if behavioural and emotional problems were related to the seizures, malarial disease, shared genetic susceptibility or underlying neurological impairment.…”

“…Behavioural and emotional problems in children with seizures may be related to (i) the seizures, especially possible damage from complex seizures, (ii) a shared neurological damage that leads to both seizures and behavioural and emotional problems or (iii) an underlying genetic susceptibility that may interact with other environmental factors to lead to seizures, behavioural and emotional problems or both [ 10 ]. Behavioural and emotional problems occurred in approximately 10% of Kenyan children discharged from hospital with acute symptomatic seizures (a relative risk of 1.8 compared to controls) [ 10 ], but hospital estimates are biased towards more severe seizure disorders and it is unclear if behavioural and emotional problems were related to the seizures, malarial disease, shared genetic susceptibility or underlying neurological impairment. Since both acute seizures and behavioural and emotional problems are common on the Kenyan coast [ 5 , 14 ], we examined their independent association, particularly in preschool children in whom mortality is high, and early initiation of interventions before they enrol school may be beneficial.…”