THE CAUSE AND MANAGEMENT OF EPILEPSY IN NIGERIA


THE CAUSE AND MANAGEMENT OF EPILEPSY IN NIGERIA  

TABLE OF CONTENTS

CHAPTER ONE

⦁ Introduction

⦁ Background to the study

⦁ Statement of the problem

⦁ Justification for the study

⦁ Objectives of the study

CHAPTER TWO

⦁ Concept of epilepsy

⦁ Types of epilepsy

⦁ Effects of epilepsy

⦁ Causes of epilepsy

⦁ Signs and symptoms of epilepsy

⦁ Diagnosis

⦁ Management

⦁ Complication

⦁ Prevention of epilepsy

CHAPTER THREE

⦁ Methodology

CHAPTER FOUR

⦁ Discussion

⦁ Summary

CHAPTER FIVE

⦁ Conclusion 

⦁ Recommendation

⦁ References

CHAPTER ONE

INTRODUCTION

1.0 Background of the study;

 Epilepsy is the most common non-infectious neurologic disease in developing African countries, including Nigeria and it remains a major medical and social problem. Historically, epilepsy was believed to be a sacred disease that is the result of the invasion of the body by a god. It was thought that only a god could deprive a healthy man of his senses, throw him to the ground, convulse him and then rapidly restore him to his former self again. The word `lunatic' was first applied to sufferers of epilepsy as gods were thought to occupy heavenly spheres, one of which was the moon. In contrast, mad people were referred to as maniacs' whose madness was a result of invasion of the body by devils or evil spirits. The ‘Dictator Perpetuus’ of the Roman Empire, the great Julius Caesar likely had epilepsy on the basis of documented four attacks that were probably complex partial seizures. Also, it is possible that he had absence attacks as a child and as a teenager. His son, Caesarion, and his great-great-great grandnephews Caligula and Britannicus also had seizures. The etiology of epilepsy in this Julio-Claudia family is probably linked to inheritance. [1]

This historical legacy has continued to influence public attitude to epilepsy making it a dreaded disease. These beliefs have resulted in patients with epilepsy (PWE) being ostracized, stigmatized and misunderstood. The social implications are serious. For instance, in Madagascar, patients with epilepsy are refused burial in the family grave. In many African countries, the PWE is an out-cast 6 as Africans believe that the disease results from visitation of the devil, effect of witch-craft, the revenge of an aggrieved ancestral spirit or consumption of something harmful in uterus. Suicide or attempted suicide is not uncommon among Nigerians who suffer from epilepsy. The patient with epilepsy is likely to drop out of school, lose his job, finds it Benin Journal of Postgraduate Medicine A. OgunrinOlubunmi 28 impossible to marry, loses his wife or her husband, and be tormented to the extent of becoming a vagrant vagabond. The remarkable issue raised by Hippocrates' famous treatise on the `Sacred Disease' was his belief that epilepsy was not sacred, that the brain was the seat of the disease. In the latter half of the nineteenth century, Hughlings Jackson defined epilepsy on the basis of a neuronal theory. About three decades later, William Gowers observed a link between epilepsy and cognitive deterioration. He noted that defective memory, especially for recent acquisitions and weakened capacity for attention are frequently encountered cognitive impairments in epileptic patients. This observation was not novel as Tissot in 1770 in his `Traite' de L`Epileptic' wrote that he had never seen a patient with epilepsy whose fits were not very rare not complaining about a weakening of memory.[1][2]

1.1 Statement of the problem;

 Definition According to the World Health Organization dictionary of Epilepsy, epilepsy is defined as a `chronic disorder of the central nervous system of various etiologies characterized by recurrent seizures due to excessive discharge of cerebral neurones. Single or occasional seizures as well as those occurring during an acute illness should not be classified as epilepsy. Epidemiology At a conservative estimate, 50 million people worldwide have epilepsy with an annual incidence ranging from 20 to 70 cases per 100,000 15 and the point prevalence of 0.4 to 0.8 percent16. The incidence rates are highest in childhood, plateaus from the age of 15 to 65 years, and rise again among the elderly. Most patients suffering from epilepsy in African countries prefer anonymity and are reluctant to disclose their condition because of the stigma attached to the disease. This factor affects the prevalence rates hence there is likelihood that most of the reported prevalence rates represent a `tip of the ice-berg' as the chances of under-reporting are high. The prevalence rates of epilepsy reported in Africa are based on surveys of defined communities and hospital admissions. The prevalence of epilepsy is particularly high in developing countries especially in Latin America and several African countries, notably Liberia, Nigeria and United Republic of Tanzania 1 compare with the prevalence rates of between 4 and 6 per 1000 which have been reported among Caucasians16. In Nigeria, its prevalence, based on defined communities, varies from 15 to 37 per 1000. However one of the early publications17 on the prevalence of epilepsy in Nigeria reported a prevalence of between 8 and 13 per 1000 inhabitants in the urban communities of Lagos, but with a computed rate of 3.1 per 1000. Osuntokun et al18 reported a prevalence rate of 5.3 per 1000 among the inhabitants of Igbo-ora, a community with comprehensive health facilities, with the highest age-specific prevalence ratio occurring below the age of 20 years i.e. within 5 to 14 years age group. This prevalence rate is lower than what obtains in most rural African communities and similar to that of Western countries. The lower prevalence rate is probably due to the improved health facilities in this community.[1][2]

1.2 Justification of the study;

Etiology Idiopathic epilepsy still remains the commonest in all age groups, though the frequency of symptomatic epilepsy progressively rises with age. Idiopathic epilepsy constitutes 55 - 60% of epilepsy reported in Nigerians. In other parts of the world, about 30% Benin Journal of Postgraduate Medicine A. OgunrinOlubunmi 30 of patients with seizure have an identifiable neurological or systemic disorder, and the remainders have either idiopathic or cryptogenic epilepsy 29. Genetics several studies conducted in recent times showed that inherited forms of epilepsy account for about 20% of all patients with epilepsy, particularly in children 30. Although the premise that heredity plays an important role in epilepsy was first noted by Hippocrates in 450 B.C. in his treatise on `The Sacred Disease' where he stated that, `It is thus with regard to the disease called Sacred; it appears to me no more divine nor more Sacred than other diseases. Its origin is hereditary, like that of other diseases'. Now we know that epilepsy is a component of the phenotype in over 100 mendelian disorders, but the most common genetic epilepsies display a ‘complex’ non-mendelian pattern of inheritance. These include several well-defined syndromes such as juvenile myoclonic epilepsy (JME), absence epilepsy and benign childhood epilepsy with Centro temporal spikes. [2][3]

1.3 Objectives of the study;

i. To review the prevalence of epilepsy in Nigeria

ii. To reveal the possible causes of epilepsy 

iii. To highlight the complications of epilepsy

iv. To review management of epilepsy 

CHAPTER TWO

2.0 LITERATURE REVIEW

Epilepsy in Nigeria - a review of etiology, epidemiology Although there is general agreement that genetic factors are important in generalized seizure disorders, partial seizures have been attributable mainly to acquired causes such as asphyxia, infection, trauma, tumor and haemorrhage1,18,36. Some workers had, however, reported the interaction of environmental and hereditary influences in partial seizures. Rimoin and Metrakos reported that patients who suffered brain insults and did not have seizures had a lower familial predisposition to seizures than those who did have seizures. Furthermore, 15% of siblings of children with complex partial seizures were reported to have had seizures. The literature concerning the genetics of febrile seizures is voluminous and controversial. It is however generally agreed that there is an increased incidence of febrile seizures among the relatives of children with febrile seizures. A positive family history for febrile seizures can be elicited in 25 to 40% of patients with afebrile seizures 16. There is scanty information available on genetic epidemiology of epilepsy in Nigerians, but there are reports of tuberous sclerosis among Nigerians with epilepsy. Infections the commonest cause of symptomatic epilepsy remains central nervous system infections, mainly bacterial and viral meningitis, encephalitis, neurosyphilis, brain abscess and tuberculosis. These infections accounted for 10% to 20% of cases of epilepsy reported in Africa. Most of the acute presentations of seizures in the tropics, where health facilities are lacking, especially in the rural and suburban communities, are due to CNS infections. Incidentally, Human immunodeficiency virus infection (HIV) is increasing steadily in Africa, with the recent WHO report stating that `11.3 million cases out of 17 million worldwide are found in Africa with South Africa, Uganda, Kenya and Nigeria leading other African Countries'38. It is now clear that HIV infection will be, or already is, a much greater problem in developing tropical countries. It may lead to epilepsy by direct invasion of the brain, as in HIV encephalopathy, or as a consequence of opportunistic infections, as in toxoplasmosis. Although there is a high incidence of parasitic infections in Nigeria, there is little evidence that these parasites commonly cause epilepsy locally. [1][2][3]

.

THE CAUSE AND MANAGEMENT OF EPILEPSY IN NIGERIA



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