Taofiki Sunmonu

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.

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.

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.

Tuberculous meningitis presenting with unusual clinical features in Nigerians: Two case reports

BackgroundTuberculous meningitis is common in developing countries and accounts for about 7.8% to 14% of all cases of tuberculosis in Nigeria.Case presentationCase 1 was a 17-year-old woman who presented with a 3-week history of weakness of the right upper and lower limbs, a 6-hour history of inability to speak and irrational behaviour. She had no remarkable past medical history. Physical examination revealed pyrexia (temperature of 38.2°C) and altered level of consciousness (Glasgow coma score = 7/15). The signs of meningeal irritation were present and she had anisocoria and right spastic hemiparesis. Other aspects of physical examination were normal. Laboratory investigations showed an elevated erythrocyte sedimentation rate, normal cerebrospinal fluid protein and reduced glucose. The brain computed tomography scan showed features in keeping with obstructive hydrocephalus and she was immediately commenced on antituberculous drugs, intravenous steroids and mannitol. She made a remarkable clinical recovery and was discharged home 6 weeks after admission. Case 2 was a 40-year-old man who presented with a 6-week history of headache and fever and a 2-week history of alteration in level of consciousness. There was no history of neck pain and/or stiffness, nausea or vomiting. He had no other remarkable past medical history. He had been placed on various intravenous antibiotics in private hospitals before presentation, with no clinical improvement. Physical examination showed a young man in a coma (Glasgow coma score = 4/15) and febrile (temperature of 38.5°C) with signs of meningeal irritation. The brain stem reflexes were impaired and he had spastic quadriparesis. Further physical examination was essentially normal. The cerebrospinal fluid analysis showed features in keeping with meningeal inflammation and he had a raised erythrocyte sedimentation rate. The brain computed tomography scan showed features in keeping with obstructive hydrocephalus. He was placed on antituberculous drugs and intravenous steroids but despite this his clinical condition deteriorated and he died on the sixth day after admission.ConclusionLate presentation of tuberculous meningitis is not rare in Nigerians and we report two cases of tuberculous meningitis that presented late to our health care facility. This report is intended to make clinicians aware of the unusual clinical presentations of tuberculous meningitis.

Interleukin–6 (IL-6) rs1800796 and cyclin dependent kinase inhibitor (CDKN2A/CDKN2B) rs2383207 are associated with ischemic stroke in indigenous West African Men

BACKGROUND Inherited genetic variations offer a possible explanation for the observed peculiarities of stroke in sub - Saharan African populations. Interleukin-6 polymorphisms have been previously associated with ischemic stroke in some non-African populations. AIM Herein we investigated, for the first time, the association of genetic polymorphisms of IL-6, CDKN2A- CDKN2B and other genes with ischemic stroke among indigenous West African participants in the Stroke Investigative Research and Education Network (SIREN) Study. METHODS Twenty-three previously identified single nucleotide polymorphisms (SNPs) in 14 genes of relevance to the neurobiology of ischemic stroke were investigated. Logistic regression models adjusting for known cardiovascular disease risk factors were constructed to assess the associations of the 23 SNPs in rigorously phenotyped cases (N=429) of ischemic stroke (Men=198; Women=231) and stroke- free (N=483) controls (Men=236; Women=247). RESULTS Interleukin-6 (IL6) rs1800796 (C minor allele; frequency: West Africans=8.6%) was significantly associated with ischemic stroke in men (OR=2.006, 95% CI=[1.065, 3.777], p=0.031) with hypertension in the model but not in women. In addition, rs2383207 in CDKN2A/CDKN2B (minor allele A with frequency: West Africans=1.7%) was also associated with ischemic stroke in men (OR=2.550, 95% CI=[1.027, 6.331], p=0.044) with primary covariates in the model, but not in women. Polymorphisms in other genes did not show significant association with ischemic stroke. CONCLUSION Polymorphisms rs1800796 in IL6 gene and rs2383207 in CDKN2A/CDKN2B gene have significant associations with ischemic stroke in indigenous West African men. CDKN2A/CDKN2B SNP rs2383207 is independently associated with ischemic stroke in indigenous West African men. Further research should focus on the contributions of inflammatory genes and other genetic polymorphisms, as well as the influence of sex on the neurobiology of stroke in people of African ancestry.

Sleep disturbances among patients with epilepsy in Nigeria

BACKGROUND There is a complex inter-relationship between sleep disorders and epilepsy, and there are few studies in Nigeria on sleep disorders in epilepsy. This study was carried out to determine the prevalence, pattern and predictors of sleep disturbances among persons with epilepsy (PWE). MATERIALS AND METHODS This was a multi-center, cross-sectional study of 124 PWE in Nigeria. A questionnaire was used to collect data on social and demographic variables, epilepsy- related variables and sleep disturbances in PWE. Exclusion criteria were mental retardation, and use of sedative drugs. The data was analyzed using Statistical Package for Social Sciences version 11.0 and P < 0.05 was considered as significant. RESULTS There were 77 males and 47 females with a mean age of 33.4 ± 13.1 years. The mean age of seizure onset was 23.7 ± 14.6 years, while the mean duration of epilepsy was 9.5 ± 9.4 years. The commonest type of epilepsy was secondarily generalized tonic-clonic seizures (62%). The prevalence of sleep disorders in PWE was 82%. Parasomnias occurred in 46%, followed by obstructive sleep apnea in 23%, insomnia (19%) excessive daytime sleepiness (EDS) (17%), and restless leg syndrome (11%). None of the socio-demographic or epilepsy- related variables was predictive of EDS or parasomnias in PWE (P > 0.05). CONCLUSION There is a high frequency of sleep disorders among PWE. Clinicians should screen PWE for sleep disturbances.

Patients’ knowledge about their disorder: Perspective of patients with epilepsy in a tertiary health facility in southwestern Nigeria

OBJECTIVE Previous studies have shown that patients with epilepsy do not have adequate knowledge about their disorder, suggesting that patient education is a vital part of comprehensive care for epilepsy. The goal of this study was to evaluate what Nigerian patients with epilepsy know about their disorder. METHODS Forty-six patients with EEG- and clinically confirmed epilepsy participated in the study. The patients completed the Epilepsy Patients Knowledge Questionnaire. The questionnaire includes topics related to etiology of epilepsy, safety, compliance, legal issues of driving, and employment. The questionnaire scores were correlated with demographic variables, duration of epilepsy, and level of education of the patients. RESULTS The mean age of the respondents was 26.78 ± 9.27 years; there were 27 males and 19 females. The mean duration of epilepsy in the group was 7.6 ± 7.5 years. The mean rates of correct responses to the issues of safety and compliance were 31.6 and 76.8%, respectively. The mean scores on legal issues of driving and employment were 45.7 and 42.4%, respectively. The lowest score (10.9%) was on the etiology of epilepsy. CONCLUSION Nigerian patients with epilepsy lack adequate knowledge about their disorder, and there is a need for improved educational intervention in these patients.

Cognitive assessment in patients with epilepsy using the Community Screening Interview for Dementia

OBJECTIVE Epilepsy is the most common neurological disease worldwide. It may be complicated by cognitive impairments with consequent deleterious effects on education, vocation, and social and family life of affected individuals. We assessed the cognitive functions of Nigerian patients with epilepsy using the modified Community Screening Interview for Dementia (CSID) questionnaire. METHODS Eighty-two subjects (41 patients with epilepsy and 41 normal controls) participated in the study. The CSID was used to assess language, memory, orientation, attention, calculation, and praxis. The SPSS statistical package was used for data analysis. RESULTS The mean ages (in years) of patients with epilepsy and controls were 28.32+/-9.22 and 25.98+/-7.72, respectively. The patients with epilepsy performed poorly when compared with the controls (P<0.05) in the domains Language, Memory, Attention and Calculation, and Praxis, whereas there was no statistically significant difference between the patients and controls in Orientation scores. Duration of epilepsy and of antiepileptic drug (AED) therapy had a significant negative impact on all domains of the CSID (P<0.05), whereas type of AED used did not. The CSID had a sensitivity of 91.7%. CONCLUSION This study showed that patients with epilepsy have significant cognitive impairments compared with controls, and duration of epilepsy and AED therapy have deleterious effects on their cognitive performance. In addition, the CSID has acceptable sensitivity and predictive value. It is recommended that cognitive function assessment should be an integral part of routine evaluation of patients with epilepsy.

APOL1, CDKN2A/CDKN2B, and HDAC9 polymorphisms and small vessel ischemic stroke

Worldwide, the highest frequencies of APOL1‐associated kidney variants are found in indigenous West Africans among whom small vessel disease (SVD) ischemic stroke is the most common stroke phenotype. The objective of this study was to investigate the association and effect sizes of 23 selected SNPs in 14 genes of relevance, including the APOL1 G1 variants, with the occurrence of SVD ischemic stroke among indigenous West African participants in the Stroke Investigative Research and Education Network (SIREN) Study.

Cognitive functions in patients with liver cirrhosis: assessment using community screening interview for dementia.

INTRODUCTION Neurocognitive dysfunction is common in patients with liver cirrhosis who have no evidence of overt hepatic encephalopathy and is usually associated with impairment of activities of daily living in the patients. MATERIALS AND METHODS Forty patients with liver cirrhosis without overt hepatic encephalopathy were studied along with forty-one healthy controls. Blood samples were taken from the patients for liver function tests and Hepatitis B and C screening. Liver disease severity was graded using the Child-Pugh scoring system. Community Screening Interview for the Dementia (CSID) questionnaire was administered to all subjects. The CSID questionnaire assesses the cognitive functions of the subjects in the domains of language, memory, orientation, attention/calculation, and praxis. The data were collated and analyzed with the aid of SPSS 15.0 software for frequency, means, and comparison of means using Students t-test and one-way ANOVA. Significant level was put at P< 0.05. RESULTS The mean age ± SD of the patients was 46.15 ± 15.31 years and the controls was 45.66 ± 11.54 years. There were 30 males and 10 females in the patients group while the control had has 26 males and 15 females. Majority of the patients had secondary level of education. Nine out of 40 patients (23%) had abnormally low total CSID score. The patients with liver cirrhosis performed poorly in the domains of language, memory, attention/calculation, and praxis. There was no difference in the orientation scores between the patients and the normal controls. The type of Hepatitis virus infection, serum liver enzyme, serum albumin, serum bilirubin, prothrombin time and Child Pugh class of the patients did not influence cognitive performance in the patients. CONCLUSION Patients with liver cirrhosis have significant cognitive impairment compared with controls and liver function tests/ clinical parameters in the patients did not correlate with their cognitive functions.