Factors associated with epileptiform EEG patterns in Nigerian epileptics.

We reviewed electroencephalographic (EEG) records of 626 epileptic patients for the frequency of epileptiform patterns (EP). The purpose of this study was to determine the factors determining the occurrence of EP. Epileptiform pattern was detected in 46% of patients studied. The occurrence of EP was associated with age, seizure type, longer duration of epilepsy, and proximity of EEG examination to last attack. We found no association between seizure frequency, medication status at EEG examination and the occurrence of EP. The yield of diagnostically useful findings in the interictal EEG would be increased if the test is performed as close as possible to the last seizure.

Rarity of dementia (by DSM-III-R) in an urban community in Nigeria.

Dementia of the elderly, a public health problem world-wide, is underdocumented in black Africa. We carried out a door-to-door survey in Idikan in NW3 ward, a political and administrative unit, with a population of 9000: in Ibadan city, Nigeria, to determine the burden of dementia. Census and demographic listing was done by trained clinical students who concurrently administered a modified Mini Mental State Examination as a screening instrument to those aged 40 years or more. Only 2 out of 932 subjects refused: 293 (31%) were aged 65 years or more. Those who were positive to the screening test and 20% of negatives were investigated by neurologists. Decline in cognitive function significantly correlated with age, female sex and low level of education. Impaired cognition was present in 41 (4.4%) but was due to depressive disorders in 7 (0.6%) patients. In none of the remaining 34 (3.8%) subjects could a diagnosis of dementia as defined by DSM-III-R be justified.

An unusual association of a rare variant of Friedreich's ataxia with type-I neurofibromatosis in a Nigerian Fulani family: a 5-year follow-up study.

A very rare form of heredofamilial spinocerebellar degenerative disorder is reported in a 12-year old boy and his 39-year old Fulani mother. The two cases were compatible with the clinical picture of Harding's variant of spastic ataxia of childhood--a clinical and genetic entity distinct from the more common Friedreich's ataxia. The mode of progression of the disease and the computed tomographic (CT) and electrophysiologic findings in both patients also support the diagnosis. In addition, the mother had the typical clinical picture of type-1 neurofibromatosis combined with the rare heredofamilial ataxic syndrome. The signs of neurofibromatosis could not be detected in her child. The cases were followed up regularly for 5 years with the aim of identifying possible complications. These cases are reported because of the extreme rarity of Harding's variant of heredofamilial ataxia and the rarity of the association of this disorder with type-1 neurofibromatosis.

Coexisting malignant melanoma and vitiligo in a Nigerian.

A case of malignant melanoma associated with vitiligo in a middle aged Nigerian is presented. The Association has been well documented in some other parts of the world, but this is the first of its type in the West African subregion. The occurrence of vitiligo in melanoma patients is generally believed to be beneficial, and has been well recognised to presage long time survival for the patient. The course of events in our patient is still being observed.

Computerized tomographic findings in adolescent and adult Nigerian epileptics.

We evaluated CT findings in 75 Nigerians who suffer from epilepsy aged 12 years and over to determine factors associated with positive yield for judicious utilisation of CT. There were 48 males and 27 females with a mean age of 36 +/- 15 years. CT was normal in 41 subjects (54.7%). The commonest CT abnormality was cortical atrophy encountered in 16 subjects. The other abnormalities were occupying lesions (13) comprising 11 neoplasms and 2 subdural haematoma, vascular lesions (4) and poroencephaly (1). The presence of CT abnormality was statistically significantly associated with neurologic deficit, partial seizure type and EEG abnormalities (P < 0.05). The decision on when to request CT scan in epileptics could therefore be influenced by our findings.

Clinically-diagnosed dementing illnesses in Ibadan: features, types and associated conditions.

In this hospital-based study of dementing illnesses in Ibadan, 37 cases were seen over a 6 year period from 1984 to 1989 out of 57,440 cases admitted. The average hospital frequency was 64 cases per 100,000 admissions. Eighteen cases (48.7%) had vascular dementia. The other types encountered were: secondary dementias (8), mixed (5), probable primary degenerative (1) and the remaining 5 cases were unclassifiable. The associated conditions were mainly hypertension, parkinsonism, diabetes mellitus and benign prostatic hyperplasia. The findings confirm the relative rarity of primary degenerative dementia in Nigeria and raise the possibility of prevention of the predominant type by identifying the stroke-prone individuals early and intervening.

Cervical myelopathy and rheumatoid arthritis: a retrospective analysis of management.

BACKGROUND: Although a number of recent studies have described the outcome of surgical treatment of patients with rheumatoid cervical myelopathy, few have reported outcome in those unable to have surgery. We sought to examine the outcome in this group of patients regardless of surgical intervention. DESIGN: Retrospective and descriptive. SETTING: Department of Rheumatology, Freeman Hospital, Newcastle upon Tyne, UK. METHODS: Retrospective review of case notes of 40 patients (31 females, 9 males) with rheumatoid cervical myelopathy diagnosed 1988-1997. RESULTS: The mean age was 64 years (range 36-80 years). The mean duration of rheumatoid arthritis (RA) before the development of myelopathy was 21 years (range 5-44 years). The common impairments were paraesthesia in the arms, neck pain and weakness. Twenty-five patients (60%) were deemed fit for surgery (group I). Twenty-two patients successfully had operative treatment and the others refused. Twelve of the 15 patients who reported pain preoperatively obtained pain relief. Six of the 11 patients who were nonambulant (Ranawat class IIIB) were able to walk postoperatively. There were two deaths within six months (9% mortality) after primary surgery due to pneumonia and sepsis. Seven of the 15 patients managed conservatively (group II) because of coexisting medical complications died within six months of presentation (47% mortality). CONCLUSIONS: The study confirms the overall benefit of surgical intervention in those who are medically stable. Following surgery some functional improvement may occur even in patients with severe myelopathy.