CLINICAL STUDIES / ETUDES CLINIQUES
CLINICAL ASPECTS OF SEIZURE DISORDERS AT OUAGADOUGOU BURKINA FASO RETROSPECTIVE STUDY OF 532 CASES
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.
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.
Keywords : Epilepsy, Burkina Faso
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.
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.
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
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.
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.
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.