. 2015 May 5;84(18):1838-45.

doi: 10.1212/WNL.0000000000001542. Epub 2015 Apr 3.

Prevalence and factors associated with convulsive status epilepticus in Africans with epilepsy

Collaborators, Affiliations

Collaborators

SEEDS Writing Group:
Ryan Wagner, Rhian Twine, Myles Connor, F Xavier Gómez Olivé, Mark Collinson, Kathleen Kahn, Stephen Tollman, Honratio Masanja, Alexander Mathew, Angelina Kakooza, George Pariyo, Stefan Peterson, Donald Ndyomughenyi, Symon M Kariuki, Anthony K Ngugi, Rachael Odhiambo, Eddie Chengo, Martin Chabi, Evasius Bauni, Gathoni Kamuyu, Victor Mung'ala Odera, James O Mageto, Charles R Newton, Ken Ae-Ngibise, Bright Akpalu, Albert Akpalu, Francis Agbokey, Patrick Adjei, Seth Owusu-Agyei, Christian Bottomley, Immo Kleinschmidt, Victor C K Doku, Peter Odermatt, Brian Neville, Josemir W Sander, Steve White, Thomas Nutman, Patricia Wilkins, John Noh

Affiliations

¹ From Kenya Medical Research Institute-Wellcome Trust Research Programme (S.M.K., E.C., G.K., A.K.N., C.R.J.N.), Kilifi, Kenya; Nuffield Department of Medicine (S.M.K.), University of Oxford, UK; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.-M., R.G.W., E.C., G.K., A.K.N., C.R.J.N.), Accra, Ghana; Iganga-Mayuge Health and Demographic Surveillance System (A.K.-M.), Iganga; the Department of Paediatrics and Child Health (A.K.-M.), Makerere University College of Health Sciences, Kampala, Uganda; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) (R.G.W.), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Global Health (R.G.W.), Department of Public Health and Clinical Medicine, Umeå University, Sweden; the Neurophysiology Department (S.W.), Great Ormond Street Hospital for Children, London; the Neurosciences Unit (B.G.R.N., C.R.J.N.), UCL Institute of Child Health, London, UK; Population Health Sciences/Research Support Unit (A.K.N.), Faculty of Health Sciences, Aga Khan University (East Africa), Nairobi, Kenya; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S.), Bucks, UK; Stichting Epilepsie Instellingen Nederland-SEIN (J.W.S.), Heemstede, Netherlands; Clinical Research Unit (C.R.J.N.), London School of Hygiene and Tropical Medicine; and the Department of Psychiatry (C.R.J.N.), University of Oxford, UK. skariuki@kemri-wellcome.org.
² From Kenya Medical Research Institute-Wellcome Trust Research Programme (S.M.K., E.C., G.K., A.K.N., C.R.J.N.), Kilifi, Kenya; Nuffield Department of Medicine (S.M.K.), University of Oxford, UK; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.-M., R.G.W., E.C., G.K., A.K.N., C.R.J.N.), Accra, Ghana; Iganga-Mayuge Health and Demographic Surveillance System (A.K.-M.), Iganga; the Department of Paediatrics and Child Health (A.K.-M.), Makerere University College of Health Sciences, Kampala, Uganda; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) (R.G.W.), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Global Health (R.G.W.), Department of Public Health and Clinical Medicine, Umeå University, Sweden; the Neurophysiology Department (S.W.), Great Ormond Street Hospital for Children, London; the Neurosciences Unit (B.G.R.N., C.R.J.N.), UCL Institute of Child Health, London, UK; Population Health Sciences/Research Support Unit (A.K.N.), Faculty of Health Sciences, Aga Khan University (East Africa), Nairobi, Kenya; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S.), Bucks, UK; Stichting Epilepsie Instellingen Nederland-SEIN (J.W.S.), Heemstede, Netherlands; Clinical Research Unit (C.R.J.N.), London School of Hygiene and Tropical Medicine; and the Department of Psychiatry (C.R.J.N.), University of Oxford, UK.

PMID: 25841025
PMCID: PMC4433462
DOI: 10.1212/WNL.0000000000001542

Prevalence and factors associated with convulsive status epilepticus in Africans with epilepsy

Symon M Kariuki et al. Neurology. 2015.

. 2015 May 5;84(18):1838-45.

doi: 10.1212/WNL.0000000000001542. Epub 2015 Apr 3.

Collaborators

SEEDS Writing Group:
Ryan Wagner, Rhian Twine, Myles Connor, F Xavier Gómez Olivé, Mark Collinson, Kathleen Kahn, Stephen Tollman, Honratio Masanja, Alexander Mathew, Angelina Kakooza, George Pariyo, Stefan Peterson, Donald Ndyomughenyi, Symon M Kariuki, Anthony K Ngugi, Rachael Odhiambo, Eddie Chengo, Martin Chabi, Evasius Bauni, Gathoni Kamuyu, Victor Mung'ala Odera, James O Mageto, Charles R Newton, Ken Ae-Ngibise, Bright Akpalu, Albert Akpalu, Francis Agbokey, Patrick Adjei, Seth Owusu-Agyei, Christian Bottomley, Immo Kleinschmidt, Victor C K Doku, Peter Odermatt, Brian Neville, Josemir W Sander, Steve White, Thomas Nutman, Patricia Wilkins, John Noh

Affiliations

¹ From Kenya Medical Research Institute-Wellcome Trust Research Programme (S.M.K., E.C., G.K., A.K.N., C.R.J.N.), Kilifi, Kenya; Nuffield Department of Medicine (S.M.K.), University of Oxford, UK; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.-M., R.G.W., E.C., G.K., A.K.N., C.R.J.N.), Accra, Ghana; Iganga-Mayuge Health and Demographic Surveillance System (A.K.-M.), Iganga; the Department of Paediatrics and Child Health (A.K.-M.), Makerere University College of Health Sciences, Kampala, Uganda; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) (R.G.W.), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Global Health (R.G.W.), Department of Public Health and Clinical Medicine, Umeå University, Sweden; the Neurophysiology Department (S.W.), Great Ormond Street Hospital for Children, London; the Neurosciences Unit (B.G.R.N., C.R.J.N.), UCL Institute of Child Health, London, UK; Population Health Sciences/Research Support Unit (A.K.N.), Faculty of Health Sciences, Aga Khan University (East Africa), Nairobi, Kenya; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S.), Bucks, UK; Stichting Epilepsie Instellingen Nederland-SEIN (J.W.S.), Heemstede, Netherlands; Clinical Research Unit (C.R.J.N.), London School of Hygiene and Tropical Medicine; and the Department of Psychiatry (C.R.J.N.), University of Oxford, UK. skariuki@kemri-wellcome.org.
² From Kenya Medical Research Institute-Wellcome Trust Research Programme (S.M.K., E.C., G.K., A.K.N., C.R.J.N.), Kilifi, Kenya; Nuffield Department of Medicine (S.M.K.), University of Oxford, UK; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.-M., R.G.W., E.C., G.K., A.K.N., C.R.J.N.), Accra, Ghana; Iganga-Mayuge Health and Demographic Surveillance System (A.K.-M.), Iganga; the Department of Paediatrics and Child Health (A.K.-M.), Makerere University College of Health Sciences, Kampala, Uganda; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) (R.G.W.), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Global Health (R.G.W.), Department of Public Health and Clinical Medicine, Umeå University, Sweden; the Neurophysiology Department (S.W.), Great Ormond Street Hospital for Children, London; the Neurosciences Unit (B.G.R.N., C.R.J.N.), UCL Institute of Child Health, London, UK; Population Health Sciences/Research Support Unit (A.K.N.), Faculty of Health Sciences, Aga Khan University (East Africa), Nairobi, Kenya; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S.), Bucks, UK; Stichting Epilepsie Instellingen Nederland-SEIN (J.W.S.), Heemstede, Netherlands; Clinical Research Unit (C.R.J.N.), London School of Hygiene and Tropical Medicine; and the Department of Psychiatry (C.R.J.N.), University of Oxford, UK.

PMID: 25841025
PMCID: PMC4433462
DOI: 10.1212/WNL.0000000000001542

Abstract

Objective: We conducted a community survey to estimate the prevalence and describe the features, risk factors, and consequences of convulsive status epilepticus (CSE) among people with active convulsive epilepsy (ACE) identified in a multisite survey in Africa.

Methods: We obtained clinical histories of CSE and neurologic examination data among 1,196 people with ACE identified from a population of 379,166 people in 3 sites: Agincourt, South Africa; Iganga-Mayuge, Uganda; and Kilifi, Kenya. We performed serologic assessment for the presence of antibodies to parasitic infections and HIV and determined adherence to antiepileptic drugs. Consequences of CSE were assessed using a questionnaire. Logistic regression was used to identify risk factors.

Results: The adjusted prevalence of CSE in ACE among the general population across the 3 sites was 2.3 per 1,000, and differed with site (p < 0.0001). Over half (55%) of CSE occurred in febrile illnesses and focal seizures were present in 61%. Risk factors for CSE in ACE were neurologic impairments, acute encephalopathy, previous hospitalization, and presence of antibody titers to falciparum malaria and HIV; these differed across sites. Burns (15%), lack of education (49%), being single (77%), and unemployment (78%) were common in CSE; these differed across the 3 sites. Nine percent with and 10% without CSE died.

Conclusions: CSE is common in people with ACE in Africa; most occurs with febrile illnesses, is untreated, and has focal features suggesting preventable risk factors. Effective prevention and the management of infections and neurologic impairments may reduce the burden of CSE in ACE.

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Figures

**Figure 1. Investigations performed in convulsive status epilepticus in active convulsive epilepsy**
People with convulsive status epilepticus (CSE) in active convulsive epilepsy (ACE) who had EEG performed, and antiepileptic drug (AED) blood levels and antibody titers to parasitic infections and HIV determined. ACE = active convulsive epilepsy; IgG = immunoglobulin G.

**Figure 2. Prevalence of convulsive status epilepticus associated with active convulsive epilepsy by age group in Africa**
The cumulative prevalence of convulsive status epilepticus in active convulsive epilepsy increased up to 18 years then declined steadily across 3 sites in sub-Saharan Africa.

See this image and copyright information in PMC

References

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Prevalence and factors associated with convulsive status epilepticus in Africans with epilepsy

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Prevalence and factors associated with convulsive status epilepticus in Africans with epilepsy

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