Prevalence and mortality of epilepsies with convulsive and non-convulsive seizures in Kilifi, Kenya

ABSTRACT

Seizure

OBJECTIVES: The prevalence of all epilepsies (both convulsive and non-convulsive seizures) in Low- and Middle-Income Countries (LMIC), particularly sub-Saharan Africa is unknown. Under estimation of non-convulsive epilepsies in data from these countries may lead to inadequate and sub-optimal allocation of resources to control and prevent epilepsy. We determined the prevalence of all types of epilepsies and compared the mortality between convulsive seizures and non-convulsive seizures in a resource limited rural area in Kenya. METHODS: Trained clinicians identified cases of epilepsy in a randomly selected sample of 4,441 residents in the Kilifi Health and Demographic Surveillance System site using a cross-sectional survey design. Seizure types were classified by epileptologists using the current guidelines of the International League Against Epilepsy (ILAE). We estimated prevalence for epilepsy with convulsive seizures and non-convulsive seizures and for epilepsy with non-convulsive seizures only and compared premature mortality between these groups of seizures. RESULTS: Of the 4441 people visited, 141 had lifetime epilepsy and 96 active epilepsy, which is a crude prevalence of 31.7/1,000 persons (95% CI: 26.6-36.9) and 21.6/1,000 (95% CI: 17.3-25.9), respectively. Both convulsive and non-convulsive seizures occurred in 7% people with epilepsy (PWE), only convulsive seizures in 52% and only non-convulsive seizures in 35% PWE; there was insufficient information to classify epilepsy in the remainder 6%. The age- and sex-adjusted prevalence of lifetime people was 23.5/1,000 (95% CI: 11.0-36.0), with the adjusted prevalence of epilepsy with non-convulsive seizures only estimated at 8.2/1,000 (95%CI:3.9-12.6). The mortality rate in PWE was 6.3/1,000 (95%CI: 3.4-11.8), compared to 2.8/1,000 (2.3-3.3) in those without epilepsy; hazard ratio (HR) =2.31 (1.22-4.39; p=0.011). The annual mortality rate was 11.2/1,000 (95%CI: 5.3-23.4) in PWE with convulsive and non-convulsive seizures and none died in PWE with non-convulsive seizures alone. CONCLUSIONS: Our study shows that epilepsy with non-convulsive seizures is common and adds to the prevalence of previously reported estimates of active convulsive epilepsy. Both epilepsy with convulsive seizures and that with non-convulsive seizures should be identified for optimising treatment and for planning resource allocation.

Kariuki, S. M., Ngugi, A. K., Kombe, M. Z., Kazungu, M., Chengo, E., Odhiambo, R., Nyaguara, A., Neville, B. G., Newton, C. R.

Pages:51-55, Volume:89, Edition:5/18/2021, Date,Jul

Link: https://www.ncbi.nlm.nih.gov/pubmed/34000517

Notes:Kariuki, Symon M|Ngugi, Anthony K|Kombe, Martha Z|Kazungu, Michael|Chengo, Eddie|Odhiambo, Rachael|Nyaguara, Amek|Neville, Brian G|Newton, Charles Rjc|eng|WT_/Wellcome Trust/United Kingdom|083744/WT_/Wellcome Trust/United Kingdom|099782/WT_/Wellcome Trust/United Kingdom|England|2021/05/18 06:00|Seizure. 2021 Jul;89:51-55. doi: 10.1016/j.seizure.2021.04.028. Epub 2021 May 14.

ISBN: 1532-2688 (Electronic)|1059-1311 (Linking) Permanent ID: PMC7611274 Accession Number: 34000517

Author Address: KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya| Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS) – INDEPTH Network, Accra, Ghana| Department of Public Health, Pwani University, Kilifi, Kenya| Department of Psychiatry, University of Oxford, Oxford, United Kingdom. Electronic address: skariuki@kemri-wellcome.org.|Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS) – INDEPTH Network, Accra, Ghana| Department of Population Health, Medical College (East Africa), Aga Khan University, Nairobi, Kenya.|KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya| Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS) – INDEPTH Network, Accra, Ghana.|Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS) – INDEPTH Network, Accra, Ghana.|Foundation for People with Epilepsy, Malindi, Kenya.|Department of Population Health, Medical College (East Africa), Aga Khan University, Nairobi, Kenya.|KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.|Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS) – INDEPTH Network, Accra, Ghana| Neurosciences Unit, UCL Institute of Child Health, London, United Kingdom.|KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya| Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS) – INDEPTH Network, Accra, Ghana| Department of Public Health, Pwani University, Kilifi, Kenya| Department of Psychiatry, University of Oxford, Oxford, United Kingdom.

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