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African Journal of Neurological Sciences
Pan African Association of Neurological Sciences
ISSN: 1015-8618
Vol. 14, Num. 2, 1995
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The African Journal of Neurological Sciences
Vol 14 No.2, 1995
CLINICAL ASPECTS OF SEIZURE DISORDERS AT OUAGADOUGOU BURKINA FASO
RETROSPECTIVE STUDY OF 532 CASES.
J. Kabore, A. Lengani, Y.J. Drabo - Ouagadougou - Burkina Faso
Z. Melaku, P.M. Preux, M. Dumas - Limoges - France
I.P. Ndiaye - Dakar - Senegal
Code Number: NS95006
Size of Files:
Text: 12K
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SUMMARY
A retrospective analysis of 532 patients with seizure disorders seen in
the Internal Medicine department of Yalgado OUEDRAOGO hospital,
Ouagadougou, over a seven years period is presented. The commonest type of
epileptic seizure encountered was generalized epilepsy of the tonic-clonic
type (61.5%), 35.5% had partial seizures, petit-mal type was seen in only
3%. Possible etiologies has been identified in 29.7% of the cases. Aspects
of treatment are briefly discussed. These results are compared with the
experiences in other African countries.
RESUME
A partir d'une serie de 532 observations de patients colligees dans le
service de Medicine Interne du CHU de Ougadougou, pendant une periode de 7
ans, les Auteurs decrivent les aspects cliniques des crises epileptiques
rencontrees; il s'agit de 108 patients hospitalises (dont 44% d'etat de mal
epileptique), et de 424 patients ambulatoires. La repartition des types
cliniques de crises. montre une predominance des crises generalisees
tonico-cloniques (61,5%); les crises partielles suivent avec 35,5%. Les
absences de 1 'enfant ne font que 3%.
Des etiologies possibles sont identifiees dans 29,7% des cas, dominees par
les causes traumatiques et les sequelles d'infection du systeme nerveux
central. Le traitement medicamenteux utilise plus souvent le phenobarbital
a cause de son cout peu eleve.
Key Words: Epilepsy - Burkina Faso
INTRODUCTION
Epilepsy is one of the commonest neurological disorders world-wide, and
it is more common in developing countries than in developed countries.
Epilepsy is not well studied in Africa. Most studies on epilepsy in Africa
have been based on hospital attending patients. In Burkina Faso, there is
no hospital-based study concerning epilepsy up to now.
This study was carried out to describe the different clinical aspects of
seizure disorders in Burkina Faso.
PATIENTS AND METHODS
It is a retrospective study in which the medical records of all
patients with seizure disorder seen on out-patient and/or in-patient basis,
in the department of Internal Medicine of Yalgado OUEDRAOGO Hospital,
between October 1, 1987 and December 31, 1994 were reviewed. All the
children included in this study were seen on consultation, and subsequently
followed in the paediatrics department. A total of 532 patients has been
identified. From the medical records of these patients all the available
clinical, laboratory, and other informations have been collected and
analysed. The classification of seizures was done on the basis of history
using the International League Against Epilepsy (ILAE) classification
(1981) (10). Electroencephalography results were not available.
RESULTS
Of the five hundred thirty two patients who have been included in this
study: 108 were in-patients and 424 were out-patients. Of these, 87 were
children between the age of 0-14 years (46 boys, 41 girls). Of the total
number of patients, 68.4% were males and 31.6% were females. The
distribution according to the age and sex is presented in Table 1.
TABLE 1 Age and Sex distribution of patients.
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AGE GROUP MALE FEMALE TOTAL
(YEARS) ----------- ----------- -------------
No. % No. % No. %
--------------------------------------------------
0 - 9 27 7.4 26 15.5 53 10
10 - 19 49 13.5 46 27.4 95 17.8
20 - 29 92 25.3 31 18.4 123 23.1
30 - 39 84 23.2 31 18.4 115 21.6
40 - 49 62 17.1 14 8.3 76 14.3
50 - 59 25 6.9 9 5.4 34 6.4
60 - 69 19 5.2 7 4.2 26 4.9
70 & above 5 1.4 5 3.0 10 1.9
--------------------------------------------------
TOTAL 363 100 169 100 532 100
The distribution according to the clinical type of seizure is presented in
Table 2. Generalized seizures of the tonic-clonic type was the commonest
type seen (61.5%), followed by secondary generalized seizures (18.8%), and
partial complex seizures (10.3%). Petit-mal seizure type was rarely
encountered (3%).
TABLE 2 Clinical types of seizures
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TYPE OF EPILEPSY NUMBER OF CASES %
---------------------------------------------
Generalized seizures 343 64.5
* Tonico-clonic 327 61.5
* Petit-mal (Absence) 16 3.0
Partial seizures 189 35.5
* Simple 34 6.4
* Complex 55 10.3
* Secondary generalization 100 18.8
---------------------------------------------
Probable etiologies have been identified in 158 patients. The list of
identified etiologies is shown in Table 3. History of the head injury and
chronic alcoholism were obtained in 28.5% and 17.7% cases respectively. A
history suggestive of central nervous system infection was obtained in
20.2% cases. 9.8% of the patients had antecedent of cerebrovascular
accidents. 6.3% of the patients had intracranial space-occupying
lesions.
TABLE 3 Probable etiologies of seizures in 158 patients.
---------------------------------------------------
ETIOLOGY No cases %
---------------------------------------------------
Head injury 45 28.5
Chronic alcoholism 28 17.7
CNS infections 32 20.3
Cerebrovascular accident 17 10.7
HIV infection (AIDS) 14 8.9
Intracranial-space occupying lesion 10 6.3
Cysticercosis 10 6.3
Hypoglycemia 2 1.3
---------------------------------------------------
TOTAL 158 100
---------------------------------------------------
8.9% had advanced HIV infection (AIDS); 6.3% had neurocysticercosis.
Besides, past history of febrile convulsions has been noted in 21
patients.
Among the 108 hospitalised patients, 48(44.4%) had status epilepticus. In
five of these patients this was the initial presenting manifestation.
329 of the patients have been taking their treatment regularly. The drugs
prescribed were the following: phenobarbitone, 250 patients (76%), sodium
valporate, 42 patients (12.8%); carbamazepine, 32 patients (9.7%);
phenytoin, 5 patients (1.5%). Patients with status epilepticus had been
treated with diazepam or clonazepam in perfusion.
DISCUSSION
Apart from the 5 patients with inaugural status epilepticus, the other
patients could be considered epileptic patients.
In this series a male predominance has been observed with sex ratio 2.6.
This is similar to the findings of other studies from Africa (1, 2, 5, 11,
13). The degree of male predominance is less marked in developed countries
(10). The possible explanations for this male over representation are the
tendency in Africa for males to seek medical attention more readily than
females and the migration of men to cities due to economic and social
reasons (6, 12).
As in other hospital series in Africa (1, 11, 12), in our series the
majority of the patients were young. 82.1% of the patients being below 40
years of age and only 6.8% of the patients were above 60 years of age.
The pattern of the epilepsy found in this study is similar to what has been
reported in the literature from other African countries (4, 5, 11, 12, 13)
generalized seizures of the tonic-clonic type being the most frequent type
of seizures seen. On the other hand petit-mal epilepsy was rare. The
relative rarity of absence seizures in our study and other studies from
Africa (5, 13) could be due to under-diagnosis of the disorder because of
its relatively subtle clinical features.
In this series possible etiologies has been identified in 158 cases. Past
history of head injury was the commonest disorder identified accounting for
28.5 % of these cases, followed by sequalae of cerebral infection in 20.2%,
and chronic alcoholism (17.7%). It is important to note that 10 patients
had clinical evidence of cysticercosis, and their seizures were probably
consequences of central nervous system involvement of the cysts.
Among the 48 patients with status epilepticus, in 44%, the precipitating
factor was cerebral malaria; in the others, the discontinuation of the
antiepileptic drugs was the precipitating factor identified. The attitude
of the population towards epilepsy and epileptics make treatment and
follow-up of the patients difficult. Among the antiepileptic drugs,
phenobarbitone is the one which is widely used, because of its reasonable
price.
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Copyright 1995 Pan African Association of Neurological Sciences
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