Abstract
Introduction: The epilepsy classification in under developed countries faces many difficulties in reporting, work-up and management strategies. Exploring local practice in general hospitals will positively add to the welfare of patients with epilepsy. The objectives of this study were to assess the current medical practice in epilepsy work up and to study the selection of AEDs as per ILAE guidelines. Methods: This was a cross sectional-retrospective hospital based study, conducted between April and September 2016 in Omdurman Teaching Hospital, Khartoum, Sudan. Patients aged 18 years old and above were enrolled. Epilepsy was defined as having at least two non-provoked seizures in the least 6 months in a patient who was assessed by clinical review and electroencephalogram (EEG). Epilepsy was classified as generalized, focal or unclassified. Medications refer to all internationally licensed antiepileptic medications (AEDs) in 2016. Results: One hundred adult Sudanese patients were enrolled for this study. The most common event described during the ictal phase was tongue biting in 50% of participants followed by body stiffness in 46%. Epilepsy was classified as generalized in 84%, focal in 11% and unclassified in 5% patients. In generalized epilepsy, the MRI detected 23.3% abnormal findings higher than the CT which detected 14.8% (4/27), p value = 0.032. In focal epilepsy, the CT detected 75% abnormal findings higher than the MRI which detected 33.3%, p value = 0.02. The AEDs used were as follows: Carbamazepine (CBZ) 48%, Na valproate (VP) 33%, Lamotrigine (LMT) 2%, Levetricetan (LVT) 1%, CBZ + VP 14% and CBZ + Oxcarbazepine (OXC) 2%. Conclusion: The current medical practice in Omdurman teaching hospital should be modified to match the international league against epilepsy (ILAE) guidelines in workup, management, AEDs selection and classification of epilepsy.
Highlights
The epilepsy classification in under developed countries faces many difficulties in reporting, work-up and management strategies
The most common event described during the ictal phase was tongue biting in 50% of participants followed by body stiffness in 46%
The most common events described during the ictal phase was tongue biting in 50% of participants followed by body stiffness in 46%
Summary
The epilepsy classification in under developed countries faces many difficulties in reporting, work-up and management strategies. Epilepsy was classified as generalized in 84%, focal in 11% and unclassified in 5% patients. The MRI detected 23.3% abnormal findings higher than the CT which detected 14.8% (4/27), p value = 0.032. The CT detected 75% abnormal findings higher than the MRI which detected 33.3%, p value = 0.02. In Sudan, the prevalence of generalized epilepsy was estimated to be 56% followed by focal epilepsy 36% and 8% for unclassified epilepsy [9]. The electroencephalography (EEG) is the main tool for potentiating the diagnosis, classification and prognostic criteria for epilepsy. It has a moderate sensitivity and a high specificity [10]. A large study across 14 countries concluded that the MRI was the preferred imaging tool to detect cortical and subcortical changes in epilepsy [13]
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