Posterior reversible encephalopathy syndrome complicating postpartum eclampsia in a Nigerian: case report.

AIMS AND OBJECTIVES: This is a case of posterior reversible encephalopathy syndrome (PRES) associated with postpartum eclampsia in a primiparous Nigerian. CASE PRESENTATION: A 20-year-old primiparous woman presented to the emergency unit of the department of obstetrics and gynaecology of our hospital with symptoms and signs consistent with postpartum eclampsia. While being managed for this, she developed weakness of the left limbs with associated altered sensorium. Significant findings on physical examination were hypertension, left-sided hemiparesis and cortical blindness. She had a computed tomographic (CT) scan of the brain which showed features consistent with posterior reversible encephalopathy syndrome. She was given full supportive care with control of her blood pressure and she made a significant improvement. She was discharged home about 3 weeks after admission with improvement in clinical condition and is currently being followed up in our neurology clinic. CONCLUSION: PRES complicating eclampsia is a clinicoradiological diagnosis. In most cases neurological symptoms improve with good supportive care and adequate treatment of the underlying condition as was the case in this patient. However permanent neurological sequelae can result from delayed diagnosis and treatment; therefore a high index of suspicion, early diagnosis and treatment are essential.

Cost of epilepsy care in a Nigerian tertiary hospital.

AIMS AND OBJECTIVES: The economic impact of epilepsy is enormous in terms of use of health care resources and loss of productivity. There is presently scanty data on economic impact of epilepsy in Nigeria,which necessitated this study. SUBJECTS AND METHODS: This cross-sectional study is on epilepsy patients age e"16 years who attended Neurology clinic at UITH Ilorin. Data collected included clinical characteristics, utilisation of resources and cost of care. Direct medical costs included recurring costs like consultation, hospitalisation, medication and investigation fees. Indirect costs were number of days lost due to seizure attack and travelling to clinic by patients and relatives. RESULTS: Sixty-five patients (32 males, 33 females) participated in the study with age range of 16 to 74 years and mean (SD) of 35±17 years. Total clinic attendance was 314 days and 53 days were spent on admission. Close to 25% of patients resided outside Ilorin metropolis and distance traveled to attend clinic varied from 4 to 200 km (mean=47±30.6 km). The total annual cost per patient was 41, 878 ($279.2 USD). It consisted of direct cost [DC] of 33,616 (80%) and indirect cost [IC] of 8262 (20%). The three leading consumptive items in DC were: antiepileptic drugs (AEDs)-24,138, investigations-5373 and transportation-2387. Majority (76.9%) of the patients were on carbamazepine. Self-estimated monthly family income varies from 3000 to 200,000 (median of 25,000). Only 23 patients (35.4%) bore the cost of care themselves. Of the IC, lost earnings due to absenteeism from work amounted to 6177. Equivalent of 1 USD was 150 at time of study. CONCLUSION: AEDs accounted for a significant proportion of TC. Increase in availability of generic drugs could help bring down the cost of care within affordable reach of indigent patients.

Cost of epilepsy care in a Nigerian tertiary hospital.

AIMS AND OBJECTIVES: The economic impact of epilepsy is enormous in terms of use of health care resources and loss of productivity. There is presently scanty data on economic impact of epilepsy in Nigeria,which necessitated this study. SUBJECTS AND METHODS: This cross-sectional study is on epilepsy patients age e"16 years who attended Neurology clinic at UITH Ilorin. Data collected included clinical characteristics, utilisation of resources and cost of care. Direct medical costs included recurring costs like consultation, hospitalisation, medication and investigation fees. Indirect costs were number of days lost due to seizure attack and travelling to clinic by patients and relatives. RESULTS: Sixty-five patients (32 males, 33 females) participated in the study with age range of 16 to 74 years and mean (SD) of 35 ± 17 years. Total clinic attendance was 314 days and 53 days were spent on admission. Close to 25 % of patients resided outside Ilorin metropolis and distance traveled to attend clinic varied from 4 to 200 km (mean=47 ± 30.6 km). The total annual cost per patient was 41, 878 ($279.2 USD). It consisted of direct cost [DC] of 33,616 (80%) and indirect cost [IC] of 8262 (20%). The three leading consumptive items in DC were: antiepileptic drugs (AEDs) - 24,138, investigations - 5373 and transportation - 2387. Majority (76.9%) of the patients were on carbamazepine. Self-estimated monthly family income varies from 3000 to 200,000 (median of 25,000). Only 23 patients (35.4%) bore the cost of care themselves. Of the IC, lost earnings due to absenteeism from work amounted to 6177. Equivalent of 1 USD was 150 at time of study. CONCLUSION. AEDs accounted for a significant proportion of TC. Increase in availability of generic drugs could help bring down the cost of care within affordable reach of indigent patients.