Bola Adamolekun

Knowledge and attitudes of teachers towards epilepsy in Zimbabwe

Objective ‐ As a preliminary to designing a health education programme on epilepsy for teachers in Zimbabwe, we evaluated the knowledge and attitudes to epilepsy of teachers in Epworth, a poor, high density suburb of Harare, Zimbabwe. Materials and methods ‐ All teachers in Epworth were invited to awareness workshops on epilepsy. A questionnaire on knowledge and attitude of epilepsy was distributed to all consenting participants. Results ‐ 165 teachers (Male: Female 1:1.9) responded. Of the respondents 89% had heard or read about epilepsy, while 70.6% had observed an epileptic seizure. Epilepsy was considered hereditary by 34.6%, while 12.6% thought it was a form of insanity. Only 0.6% thought evil spirits were a cause, 22.6% thought that epilepsy was contagious, 82% would allow their child to play with an epileptic child, 76% would marry an epileptic while 55.7% would employ an epileptic. The majority would accommodate an epileptic and teach an epileptic child in class. Conclusions ‐ These positive attitudes towards epilepsy by teachers may be attributed to their higher level of education and may imply that with increasing levels of formal education in the general African population, a more tolerant attitude towards epilepsy can be expected.

An evaluation of the impact of health worker and patient education on the care and compliance of patients with epilepsy in Zimbabwe.

Summary: Purpose: The use of primary health care personnel to identify cases of epilepsy and initiate simple treatment protocols has been advocated as a solution to the numeric inadequacy and uneven distribution of medical manpower available for the management of epilepsy in developing countries. This study sought to evaluate the effectiveness of primary health care nurses in the diagnosis and management of epilepsy, as well as the impact of patient‐information pamphlets on drug compliance and clinic attendance of patients with epilepsy.

Neurological disorders associated with cassava diet: a review of putative etiological mechanisms.

Tropical ataxic neuropathy (TAN) and epidemic spastic paraparesis (konzo) are two neurological disorders associated with the consumption of cassava (Manihot esculenta) in several African countries. TAN is characterized by sensory polyneuropathy, sensory ataxia, bilateral optic atrophy and bilateral sensori-neural deafness. It occurs in elderly individuals subsisting on a monotonous cassava diet with minimal protein supplementation. Konzo is a syndrome of symmetrical spastic paraparesis with a predilection for children and young women and invariably associated with consumption of inadequately processed bitter cassava roots with minimal protein supplementation. Despite numerous epidemiological, clinical and biochemical studies aimed at elucidating the etiological mechanisms of these disorders, their etiologies remain unknown, and there is no known treatment. The diseases continue to be prevalent in endemic areas, causing significant disability and increased mortality. A fresh appraisal of the putative etiologic mechanisms proposed for these intriguing and enigmatic syndromes is presented in this paper. Evidences against a causal role for cyanide intoxication are discussed, and evidences implicating thiamine deficiency as a unifying etiological mechanism for these neurological syndromes are presented. It is concluded that urgent research is needed to evaluate thiamine status and implement a therapeutic trial of thiamine in these debilitating neurological disorders.

Oral health and dental treatment needs in Nigerian patients with epilepsy.

Summary: Purpose: We determined the prevalence of oral disorders and the dental treatment needs of outpatients with epilepsy.

Etiology of Konzo, epidemic spastic paraparesis associated with cyanogenic glycosides in cassava: Role of thiamine deficiency?

Konzo is a syndrome of symmetrical, non-progressive, non-remitting spastic paraparesis occurring in epidemic and endemic forms in several countries in Africa, invariably associated with monotonous consumption of inadequately processed bitter cassava roots (Manihot esculenta) with very minimal protein supplementation. Despite numerous epidemiological, clinical and biochemical studies by authors in several countries aimed at elucidating the etiological mechanisms of Konzo, the etiology remains unknown. High cyanide consumption with low dietary sulfur intake due to almost exclusive consumption of insufficiently processed bitter cassava roots was proposed as the cause of Konzo, but there has been no evidence of a causal association between cyanide consumption and Konzo. In this paper a new etiological mechanism of thiamine deficiency is presented, based on detailed review of the epidemiological, clinical and biochemical features of Konzo. It is postulated that in Konzo patients, a severe exacerbation of thiamine deficiency results from the inactivation of thiamine that occurs when, in the absence of dietary sulfur-containing amino acids; the sulfur in thiamine is utilized for the detoxification of cyanide consumed in improperly processed bitter cassava. Thiamine is known to be rendered inactive when the sulfur in its thiazole moiety is combined with hydrogen cyanide. This hypothesis may stimulate studies examining the role of thiamine in the etiology of Konzo, and may lead to the formulation of strategies for the prevention and treatment of this debilitating disease.

The impact of epilepsy on the quality of life of people with epilepsy in Zimbabwe: A pilot study*

Epilepsy is a common cause of psychosocial disability and has been perceived to have a profound impact on the social functioning of individuals with epilepsy. In Zimbabwe a combination of developing world economic priorities (with provision of social and health services for disabled people not a major goal) and culturally mediated perceptions of epilepsy as a non-medical and feared stigma may further disadvantage people with epilepsy (PWE) in this respect. In order to assess both the level of psychosocial functioning of individuals with epilepsy and their own perception of it, three groups of people were sampled: attenders at a specialized epilepsy clinic and members of two community-based support groups. All completed a brief quality-of-life questionnaire with activities of daily living added. Those carers present completed the same questionnaire at the time of sampling. The results indicated that 36 of 38 people with epilepsy sampled, and their carers, did not perceive themselves to have sufficient cognitive impairment to interfere with social functioning, work performance or relationships with other as assessed by a subsection of the WHO SIDAM (objective evaluation of cognitive performance) interview. However, an adapted activities of daily Living Questionnaire (ADLQ) showed that three-quarters of carers (and two-thirds of PWE) felt that functioning was mildly to moderately reduced, particularly in the areas of solving daily problems and speed of thinking. One-quarter of PWE experienced problems with relationships to others, just less than one-fifth of PWE reported more than four areas of reduced functioning. Of special interest was the fact that 25 (66%) reported sexual functioning as not applicable, although only four of these were of an age group which is not sexually active (less than 15 years old). In addition one-third of the central Hospital Group reported difficulties with using public transport, but none of the Community Support Group members, implying that the use of Public transport becomes an issue when it is necessary to travel long distances and that PWE curtail their travel but do not necessarily view this as a restriction. The samples chosen were from groups which, compared with PWE as a whole, are likely to include more disabled individuals, because attenders at a specialized epilepsy clinic and members of support groups self-select for more symptomatic epilepsy and a visibility. Therefore the proportion of PWE perceived to have difficulties with ADL in this project is not representative for PWE as a whole. The implications of our study are firstly that there is a significant need for selected groups of PWE in Zimbabwe to receive attention to psychosocial abilities and secondly that there are certain specific areas such as sexual functioning and the use of transport which deserve special attention. A much more detailed inventory of neuro-psychological tests will be of value to plan treatment strategies for those selected by the crude screening instruments used in this project. An important future comparison will be a survey of ADL and psychosocial functioning amongst PWE in rural communities, because it is uncertain whether PWE in rural communities are generally more or less disabled than those in the city.

Intrinsic Ictal Dynamics at the Seizure Focus: Effects of Secondary Generalization Revealed by Complexity Measures

Summary:  Purpose: Partial seizures (PSs) may be self‐limited regional events or propagate further and secondarily generalize. The mechanisms and dynamics of secondarily generalized tonic–clonic seizures (GTCSs) are not well understood. Methods with which to assess the dynamic of those events are also limited.

An evaluation of the management of epilepsy by primary health care nurses in Chitungwiza, Zimbabwe

In order to design an effective training program for nurses on the management of epilepsy in Zimbabwe, the drug management of epilepsy by community health nurses without prior training in epilepsy management was evaluated. Epilepsy patients in Chitungwiza, a high-density suburb of Harare, were routinely managed at four health clinics run by nurses. The patients also attended a monthly epilepsy support group (ESG) program, which provided them with vocational and social rehabilitative support. Neurologists evaluated the drug therapy of all patients attending this support group program over a 2-year period. The specialist interventions required to drug therapy in patients with inadequate seizure control or drug side effects were noted. A total of 114 epilepsy patients (age range 8-56 years, M:F=1:1.2) were seen, of these 84.2% had generalized seizures, 40.3% of patients had been seizure-free for at least 6 months, 71.9% of patients were on phenobarbitone, while 59.6% were on monotherapy. No drug intervention was required to on-going drug therapy in 43% of patient consultations. The most important intervention in patients with inadequate seizure control was an increase in drug dose, required in 29% of consultations. Of serum drug level estimations in clinically indicated cases, 58% were below the therapeutic ranges. This tendency to sub-therapeutic dosing with AED amongst nurses implied that a written AED drug therapy protocol specifying optimal maintenance doses and dose increment schedules may be beneficial to the community-based nursing management of epilepsy.

Investigation of an epidemic of seasonal ataxia in Ikare, Western Nigeria

Seasonal outbreaks of an acute ataxic syndrome occur annually in parts of South‐Western Nigeria, characterized by cerebellar ataxia, nystagmus and varying levels of impaired consciousness following consumption of the roasted larvae of Anaphe venata Butler (Lepidoptera, Notodontidae). An investigation of an epidemic in Ikare, headquarters of the Akoko north‐east local Government in Western Nigeria (pop. 60,000) in the 1993 disease season is reported. The diagnosis of seasonal ataxia was verified in 34 consecutive new admissions (M:F 1: 3.25, median age 29 years, range 2–70 years). All were of low socio‐economic status, and had consumed the larvae of Anaphe venata prior to the onset of disease. There were 1,126 admissions for the seasonal ataxic syndrome in Ikare in the 1993 season, with an estimated attack rate of 1.87%. The peak incidence was in August, when patients with the syndrome accounted for 71% of all hospital admissions. There was no mortality. Control measures included therapy with high‐potency multivitamins and health education.

Treatment of patients with coexisting epileptic and nonepileptic seizures

A majority of studies have reported a rate of concurrence of epileptic seizures (ESs) in patients with nonepileptic seizures (NESs) of about 10-18%. We explored the relationship between the two paroxysmal disorders (ESs and NESs) in a series of patients with both, and report a treatment for these patients that proved remarkably effective: reduction of the dose of antiepileptic drug to the minimum required to achieve optimal freedom from seizures. NESs are hypothesized to have a psychobiological basis, and it has been proposed that they be recognized as posttraumatic startle seizures. Excessive suppression of epileptic paroxysmal activity appears to favor the expression of posttraumatic paroxysmal activity in patients with both paroxysmal disorders, and the manifestation of ESs and NESs tends to alternate. Of etiological significance is the finding that the patients commonly have both a personal history of trauma and a family history of epilepsy.