Abstract
ObjectiveWe investigated the prevalence and pattern of electroencephalographic (EEG) features of epilepsy and the associated factors in Africans with active convulsive epilepsy (ACE). MethodsWe characterized electroencephalographic features and determined associated factors in a sample of people with ACE in five African sites. Mixed-effects modified Poisson regression model was used to determine factors associated with abnormal EEGs. ResultsRecordings were performed on 1426 people of whom 751 (53%) had abnormal EEGs, being an adjusted prevalence of 2.7 (95% confidence interval (95% CI), 2.5–2.9) per 1000. 52% of the abnormal EEG had focal features (75% with temporal lobe involvement). The frequency and pattern of changes differed with site. Abnormal EEGs were associated with adverse perinatal events (risk ratio (RR)=1.19 (95% CI, 1.07–1.33)), cognitive impairments (RR=1.50 (95% CI, 1.30–1.73)), use of anti-epileptic drugs (RR=1.25 (95% CI, 1.05–1.49)), focal seizures (RR=1.09 (95% CI, 1.00–1.19)) and seizure frequency (RR=1.18 (95% CI, 1.10–1.26) for daily seizures; RR=1.22 (95% CI, 1.10–1.35) for weekly seizures and RR=1.15 (95% CI, 1.03–1.28) for monthly seizures)). ConclusionsEEG abnormalities are common in Africans with epilepsy and are associated with preventable risk factors. SignificanceEEG is helpful in identifying focal epilepsy in Africa, where timing of focal aetiologies is problematic and there is a lack of neuroimaging services.
Highlights
Epilepsy in Africa is associated with significant morbidity and mortality and a large treatment gap (Newton and Garcia, 2012)
Focal features defined by seizure semiology and neurological deficits are common in people with epilepsy from Africa and may be related to perinatal complications, head injuries, and central nervous system infections (Kariuki et al, 2014)
Active convulsive epilepsy (ACE) in Africa is associated with childhood onset in 60% of cases, convulsive status epilepticus in about 30%, non-adherence to treatment in 60% and psychosocial problems such as being single in over 60% (Mbuba et al, 2012; Kariuki et al, 2015b)
Summary
Epilepsy in Africa is associated with significant morbidity and mortality and a large treatment gap (Newton and Garcia, 2012). Active convulsive epilepsy (ACE) in Africa is associated with childhood onset in 60% of cases, convulsive status epilepticus in about 30%, non-adherence to treatment in 60% and psychosocial problems such as being single in over 60% (Mbuba et al, 2012; Kariuki et al, 2015b). The proportion of abnormal EEGs varies between epilepsy syndromes and may differ between hospital- and community-based samples (Binnie and Stefan, 2003). In a broad sample of people with different types of epilepsy, the yield of interictal epileptiform activity in a single 30-min awake EEG recording is up to 50%, there is substantial variability between individuals (Cockerell et al, 1996; Binnie and Stefan, 2003). The diagnostic yield of EEG can be improved through increased recording time, serial recordings, sleep and activation procedures such as hyperventilation and photic stimulation (Nuwer, 2012)
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