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Review
. 2014 Oct;13(10):1029-44.
doi: 10.1016/S1474-4422(14)70114-0.

Epidemiology, causes, and treatment of epilepsy in sub-Saharan Africa

Awa Ba-Diop  1 , Benoît Marin  2 , Michel Druet-Cabanac  1 , Edgard B Ngoungou  3 , Charles R Newton  4 , Pierre-Marie Preux  5
Affiliations
Review

Epidemiology, causes, and treatment of epilepsy in sub-Saharan Africa

Awa Ba-Diop et al. Lancet Neurol. 2014 Oct.

Abstract

Epilepsy is a common neurological disease in tropical countries, particularly in sub-Saharan Africa. Previous work on epilepsy in sub-Saharan Africa has shown that many cases are severe, partly a result of some specific causes, that it carries a stigma, and that it is not adequately treated in many cases. Many studies on the epidemiology, aetiology, and management of epilepsy in sub-Saharan Africa have been reported in the past 10 years. The prevalence estimated from door-to-door studies is almost double that in Asia, Europe, and North America. The most commonly implicated risk factors are birth trauma, CNS infections, and traumatic brain injury. About 60% of patients with epilepsy receive no antiepileptic treatment, largely for economic and social reasons. Further epidemiological studies should be a priority to improve understanding of possible risk factors and thereby the prevention of epilepsy in Africa, and action should be taken to improve access to treatment.

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Conflict of interest statement

Declaration of interests

We declare no competing interests.

Figures

Figure 1
Figure 1. Flow chart showing selection procedure for articles in this Review
Figure 2
Figure 2. Global meta-analysis of epilepsy prevalence in sub-Saharan Africa
For each item in figures 2–4, the following information was collected: authors, year of publication, journal, country, type of study, study population, method of data collection, and results on prevalence, incidence, seizure types, causes and risk factors, and treatment. Raw or adjusted prevalence expressed as the number of cases per 1000 population was presented in a summary table with 95% CI. Incidence is expressed as number of cases per 100 000 inhabitants per year. 95% CI were calculated by an exact method when not provided in the publication. Median prevalence was calculated from all studies that reported prevalence. Random-effects meta-analysis was done and forest plots obtained. Weighted prevalence rates were calculated. Weights were based on the precision of the estimates for each study (ie, SE of prevalence assuming a Poisson distribution for calculation of 95% CI). We also calculated I2, which reflects the percentage of total variation across studies that is due to heterogeneity rather than chance. Because heterogeneity was statistically significant, random-effects models were used. We calculated an overall pooled prevalence as well as one stratified by method (door-to-door vs cross-sectional) and geographical region (west, east, central, and southern Africa). Analyses used Stata v11.1. *Studies in which the estimates are based only on active epilepsy.
Figure 3
Figure 3. Meta-analysis of epilepsy prevalence in sub-Saharan Africa according to the type of study
*Studies in which the estimates are based only on active epilepsy.
Figure 4
Figure 4. Meta-analysis of epilepsy prevalence in sub-Saharan Africa according to geographical region
*Studies in which the estimates are based only on active epilepsy.
See this image and copyright information in PMC

References

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    1. Preux P-M, Druet-Cabanac M. Epidemiology and aetiology of epilepsy in sub-Saharan Africa. Lancet Neurol. 2005;4:21–31. - PubMed
    1. Ngugi AK, Bottomley C, Kleinschmidt I, Sander JW, Newton CR. Estimation of the burden of active and life-time epilepsy: a meta-analytic approach. Epilepsia. 2010;51:883–90. - PMC - PubMed
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