Incidence and Risk Factors of Early Post-traumatic Seizures in Nigerians
Neurology Unit College of Medicine, University of Ibadan , Ibadan , Nigeria. Brain Injury
(Impact Factor: 1.81).
09/2011; 25(10):980-8. DOI: 10.3109/02699052.2011.589798
To determine the incidence and risk factors of early post-traumatic seizures (PTS) in Nigerian subjects.
Subjects were recruited consecutively, classified as mild, moderate or severe traumatic brain injury (TBI), and followed for 168 hrs for development of seizures.
There were 266 subjects, 213 (80%) males and 53 (20%) females, with mean age 31 years (sd 18, range 1-80, median 30). Causes of TBI were motor traffic accident (MTA) related in 217 (82%), falls in 25 (9%), struck by objects in 15 (5%), firearms in 4 (2%), sports and recreation in 3 (1%), and failed suicide in 2 (1%). Cumulative incidence of early PTS was 119‰ (95% CI 80-156). Risk factors were age ≤12 years, severity of TBI, history of seizures, and TBI at weekend, but gender and GCS were not. Skeletomotor palsy was independently associated with early PTS.
Incidence of early PTS is high in this population, probably due to the relatively high proportion of severe TBI. Risk factors are TBI severity, young age, history of seizures, and TBI at weekends. The best preventive strategy is reduction of MTA, which causes over 80% of TBI. Prophylactic anti-seizure therapy may benefit subjects with severe TBI and skeletomotor deficits.
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ABSTRACT: This review discusses recent literature relevant to the diagnosis and treatment of epilepsy in developing countries with particular attention to underlying causes, natural history, and advances made toward optimizing systems of care and bridging the treatment gap.
Prospective data suggest that cerebral malaria-induced brain injury may explain the high prevalence of epilepsy in malaria-endemic regions. Population-based mortality studies support the long proposed hypothesis that seizure-related deaths contribute to excessive premature mortality. WHO guidelines have the potential to improve care, but macrolevel barriers related to pharmaceutical regulation and distribution continue to contribute to the treatment gap. Evidence-based guidelines endorsed by the WHO and American Academy of Neurology regarding the optimal management of comorbid epilepsy and HIV may raise awareness regarding critical drug interactions between antiepileptic drugs and antiretrovirals, but are also problematic as the treatment regimen and diagnostic facilities routinely available in developing countries will prevent most healthcare providers from following the recommendations.
New insights into the causes, natural history and best care practices for epilepsy in developing countries are available but without prioritization and action from policy makers, the present treatment gap will likely to persist.
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