Morenikeji Komolafe

Quality of Life and Associated Factors among Adults with Epilepsy in Nigeria

Objective: Epilepsy is a common condition worldwide and has been observed to affect quality of life (QOL). Though, much has been written on this subject among western populations, little research has been done in developing countries of Africa including Nigeria. The study aims to identify factors associated with quality of life among adult epilepsy patients in this environment. Method: Respondents were evaluated using the 10-item Quality of Life in Epilepsy Inventory (QOLIE-10), the 30-item General Health Questionnaire (GHQ-30), the modified Mini Mental State Examination (mMMSE), and the Hospital Anxiety and Depression Scale (HADS). Diagnosis of epilepsy was based on clinical and electroencephalographic findings. Results: The mean age of the 51 respondents was 27.7years (SD = 9.7). Thirteen (25.5%) had an average of 2 seizure episodes in the month preceding the interview, while 37 (72.5%) have had the condition for more than 5 years. Factors that were significantly associated with overall quality of life included being female (p < 0.05), seizure frequency (p < 0.01), using more than 1 anti-epileptic drugs (AEDs) (p < 0.01), GHQ-30 score (p < 0.01), high anxiety score (p < 0.001), and high depression score (p < 0.01). Multiple regression analysis showed that depressive symptoms were the single most important factor explaining low QOL. Other factors were GHQ-30 score, seizure frequency, and being a woman. Conclusion: Controlling seizures and paying attention to the psychological needs of adult epileptics will have a positive effect on the QOL among Nigerian epileptics.

Treatment of Cerebrospinal Fluid Shunting Complications in a Nigerian Neurosurgery Programme

Background/Aims: For a century since the first cerebrospinal fluid (CSF) shunt surgery, ventriculoperitoneal (VP) shunt insertion for the treatment of hydrocephalus has routinely been performed. A lot of common and rare complications following this procedure have been reported in 24–47% of the cases. The aim of this paper was to present our experience with the treatment of hydrocephalus in our centre and highlight our management of two unusual complications with the available resources. Methods: Retrospective clinical review. Results: A total of 86 patients with hydrocephalus were seen in our unit. There were 52 males and 34 females (male:female ratio 3:2). The age of the patients ranged from 1 day to 68 years. The majority of the patients (92%) were below 5 years of age. Sixty-five patients had shunting procedures [VP shunt: 62 (95.4%); endoscopic third ventriculostomy: 3 (4.6%)]. Of the 62 patients with VP shunts, 16 (25.8%) had complications while 2 of the 3 patients with endoscopic third ventriculostomies had complications. The complications following the VP shunts were CSF shunt sepsis (n = 12; 19.4%), abdominal complications (n = 3; 4.8%), subdural haematoma (n = 2; 3.2%) and scalp necrosis in 1 patient. Conclusion: VP shunt procedures have come to stay and will remain with us despite recent advances such as endoscopic third ventriculostomy. Care should be taken to prevent all complications whether common or rare by paying particular attention to patient selection, shunt selection and surgical details. The adaptation of local technology and justified use of limited facilities and resources can go a long way in the management of both common and rare complications in developing nations.

The social and economic impacts of epilepsy on women in Nigeria.

BACKGROUND Persons with epilepsy in sub-Saharan Africa experience stigma and social marginalization. There is paucity of data on the social and economic impacts of epilepsy in these patients and in particular, groups like women. We sought to determine the social and economic impacts of epilepsy on Nigerian women and especially how it affects their treatment and outcomes. METHODS We carried out a cross-sectional survey of 63 women with epilepsy (WWE) and 69 controls matched for age, social status and site of care. A structured questionnaire was used to document information on demographic characteristics, education, employment status, economic status, health care use, personal safety and perceived stigma. The data were collated and analyzed with SPSS version 15. RESULTS Unemployment, fewer years of formal education, lower marriage rates and higher stigma scores were more frequent among WWE than controls. Physical and sexual abuse with transactional sex was also reported among WWE. We also noted poorer environmental and housing conditions and lower mean personal and household incomes among WWE compared to the control group. CONCLUSION WWE in this sample from Nigeria have worse social and economic status when compared with women with other non-stigmatized chronic medical conditions.

Interictal anxiety and depression symptoms in Nigerians with epilepsy: A controlled study

The goals of this study were to compare symptoms of anxiety and depression between patients with epilepsy and a healthy control group, and to determine the possible factors associated with clinically significant anxiety and depression symptoms in patients with epilepsy. One hundred and four adult Nigerians (52 with epilepsy and 52 matched healthy controls) were assessed with the Hospital Anxiety and Depression Scale (HADS). The results obtained indicated a statistically significant difference in anxiety and depression symptoms between patients with epilepsy and controls. The association between anxiety symptoms and polytherapy was significant (P=0.008), as was the association between depression symptoms and duration of epilepsy longer than 10 years (P=0.04). Emotional problems are more common in patients with epilepsy than in the general population. Identifying and monitoring those with epilepsy of long duration and rational prescription of antiepileptic drugs are important in reducing the risk of affective problems.

Intellectual impairment in patients with epilepsy in Ile‐Ife, Nigeria

Introduction –  Epilepsy is the most common non‐infectious neurologic disease in developing countries such as Africa, including Nigeria. This study was designed to assess the intellectual performance of patients with epilepsy (PWE) in Nigeria hoping that the result will serve as the basis for educational, vocational, and social counseling.

Awareness of risk factors and warning signs of stroke in a Nigeria university.

BACKGROUND Rapid access to medical services which is an important predictor of treatment and rehabilitation outcome requires that there is an understanding of stroke risk factors and early warning signs. This study assessed awareness of stroke risk factors and warning signs among students and staff of Obafemi Awolowo University, Nigeria. METHODS This was a cross sectional survey involving 994 (500 students and 494 staff) respondents. Information on the awareness of stroke risk factors and warning signs was collected with the aid of a structured questionnaire. Descriptive and inferential statistics were used for data analysis. RESULTS Weakness (66.2%) was the most commonly identified warning sign of stroke with more staff (69.8%) identifying correctly than students (62.6%). Hypertension (83.4%) was the most commonly identified stroke risk factor, with more staff (91.7%) identifying correctly than students (83.2%). There were significant differences (p < 0.05) in the awareness of some risk factors (age, hypertension, stress and obesity), and warning signs (dizziness, numbness, weakness, headache and vision problems) between students and staff. Predictors for adequate awareness of both stroke risk factors and warning signs were younger age, smoking history and higher educational level. CONCLUSIONS Majority of the respondents recognized individual important stroke risk factors and warning signs, but few recognized multiple stroke risk factors and warning signs. Awareness programs on stroke should be organized, even in communities with educated people to increase public awareness on the prevention of stroke and on the reduction of morbidity in the survivors.

New onset neuromyelitis optica in a young Nigerian woman with possible antiphospholipid syndrome: a case report

IntroductionDevics neuromyelitis optica is an inflammatory demyelinating disease that targets the optic nerves and spinal cord. It has a worldwide distribution and distinctive features that distinguish it from multiple sclerosis. There has been no previous report of neuromyelitis optica from our practice environment, and we are not aware of any case associated with antiphospholipid syndrome in an African person.Case presentationWe report the case of a 28-year-old Nigerian woman who presented with neck pain, paroxysmal tonic spasms, a positive Lhermittes sign and spastic quadriplegia. She later developed bilateral optic neuritis and had clinical and biochemical features of antiphospholipid syndrome. Her initial magnetic resonance imaging showed a central linear hyperintense focus in the intramedullary portion of C2 to C4. Repeat magnetic resonance imaging after treatment revealed resolution of the signal intensity noticed earlier.ConclusionNeuromyelitis optica should be considered in the differential diagnoses of acute myelopathy in Africans. We also highlight the unusual association with antiphospholipid syndrome. Physicians should screen such patients for autoimmune disorders.

Cognitive impairment and quality of life among stroke survivors in Nigeria.

The study investigated cognitive impairment and quality of life (QOL) among 109 consecutive stroke survivors and 109 normal controls. Each group comprised 64 (58.7%) men and 45 (41.3%) women. The modified Mini Mental State Examination (mMMSE) and the WHO Quality of Life Questionnaire (WHOQOL-Bréf) indicated that 19 (17.4%) stroke survivors had cognitive deficits (mMMSE score < 16) compared with 5 (4.6%) control participants (χ12 = 4.27, p<.05). Control participants performed significantly better on orientation, language comprehension, laterality, and the WHOQOL-Bréf. Being GHQ-30 positive predicted poor performance on the mMMSE among the stroke survivors and reduced QOL on three of the four domains of the WHOQOL-Bréf. In addition, previous psychiatric illness, paresis, low education, and shorter time elapsed after a stroke predicted reduced QOL on one or more domains of the WHOQOL-Bréf but age and sex of the stroke survivors were not associated with quality of life, and not with cognitive function.

Depressive symptoms and associated factors following cerebrovascular accident among Nigerians

Background: Much has been written on post stroke depression in the last 10 years in developed countries. However little is known about this important condition in this environment, thus the need for this study. Aims: This study intends to estimate the prevalence of post stroke depression (PSD) and identify other associated factors. Methods: One hundred and eighteen stroke survivors, managed at a Nigerian Teaching Hospital (mean post stroke survival duration = 11 months) were compared with 118 hypertensive controls using Beck Depression Inventory (BDI) and the modified Mini Mental State Examination (mMMSE). Sociodemographic variables were controlled for. Results: Sixteen (13.6%) control subjects compared with 47 representing 38.8% had significant depressive symptoms. Cognitive deficit, paresis and low education were identified as predictors of depressive symptoms (PSD) among survivors. Conclusion: Physicians need to be alert to this condition, especially since it can be treated and this will improve the quality of life among this group of patients.

Factors implicated for late presentations of gross congenital anomaly of the nervous system in a developing nation.

Background. Gross congenital lesions of the nervous system are obvious at birth and usually present early for management and corrective surgery. However in tropical and developing nations, late presentations are common. Aims: To determine the factors responsible for very late presentations of gross congenital lesions. Methods. We conducted a prospective study of all cases of congenital CNS anomalies that presented very late (>6 months after birth) to our neurosurgical clinic over an eight year period (2000–2008). Results. A total of 81 patients were seen during the study period. The age ranged from 6months to 47years. Hydrocephalus accounted for about half of the cases 37 (48.3%). The others were spina bifida 15 (18.5%), encephalocele 10 (12.4%), subgaleal inclusion dermoid cyst 7 (8.6%), and craniosynostosis 6 (7.4%), neurofibroma 4(4.9%), and anencephaly 2 (2.5%). Reasons given for late presentations were ignorance, poverty and in some the expectation that the baby would die. Other reasons for late presentation were that the patient was either about to start school or get married. Conclusion. Late presentations of congenital CNS lesions are associated with many complications most of which could have been avoided with early medical treatment. Health education should include issues regarding congenital malformations delivered by trained experts.