Normative data for ulnar nerve conduction and the influence of gender and height on ulnar nerve conduction velocity in healthy Nigerians.

Background: Despite the usefulness of ulnar nerve conduction studies in identifying disorders of ulnar nerves, there is a lack of normative values for the ulnar nerve in Nigerian population. Objective: The objective of the study was to generate normative values for motor and sensory ulnar nerve conduction studies (NCSs) in Nigerian population and to determine the influence of gender and height on ulnar nerve conduction velocity (NCV). Materials and Methods: A total of 200 healthy volunteers were selected after clinical evaluation to exclude common causes of ulnar neuropathy. We carried out NCS of ulnar nerves on all the healthy volunteers according to a standardized protocol. The NCS parameters included in the final analysis were amplitude, latency, NCV, and f-wave latency. Ethical approval was obtained for the study. Results: The mean ulnar nerve sensory velocity was 55.22 ± 5.67 with 2.5 and 97.5 percentile of 46.9 and 70.1, respectively. The mean latency of the ulnar nerve (sensory) was 2.97 ± 0.62 with 2.5 and 97.5 percentile of 2.00 and 4.52, respectively. The mean amplitude of the ulnar nerve (sensory) was 35.56 ± 9.97 with 2.5 and 97.5 percentile of 15.9 and 57.7, respectively). The ulnar NCV was significantly (P = 0.0202) higher in male. Mild inverse correlation (r = 0.2) was found between ulnar NCV and height of the participants (P = 0.0089). Conclusion: In the Nigerian population, normative values of motor and sensory ulnar nerve conduction parameters are similar to the existing values in the literature. The ulnar NCV appeared to be influenced by height and gender.

Résumé Contexte: Malgré l'utilité des études de conduction du nerf ulnaire pour identifier les troubles des nerfs ulnaire, il y a un manque de normative valeurs pour le nerf ulnaire dans la population nigériane. Objectif: L'objectif de l'étude était de générer des valeurs normatives pour les moteurs et études de conduction sensorielle du nerf ulnaire (NCS) dans la population nigériane et pour déterminer l'influence du sexe et de la taille sur le nerf ulnaire vitesse de conduction (NCV). Matériel et méthodes: Un total de 200 volontaires sains ont été sélectionnés après évaluation clinique pour exclure causes courantes de neuropathie ulnaire. Nous avons réalisé une NCS des nerfs ulnaire sur tous les volontaires sains selon un protocole standardisé.Les paramètres NCS inclus dans l'analyse finale étaient l'amplitude, la latence, la NCV et la latence de l'onde f. L'approbation éthique a été obtenue pour le étude. Résultats: La vitesse sensorielle moyenne du nerf ulnaire était de 55,22 ± 5,67 avec 2,5 et 97,5 percentile de 46,9 et 70,1, respectivement. La moyenne la latence du nerf ulnaire (sensoriel) était de 2,97 ± 0,62 avec 2,5 et 97,5 percentile de 2,00 et 4,52, respectivement. L'amplitude moyenne de l'ulnaire nerf (sensoriel) était de 35,56 ± 9,97 avec 2,5 et 97,5 percentile de 15,9 et 57,7, respectivement). Le NCV ulnaire était significativement (P = 0,0202)plus élevé chez les hommes. Une légère corrélation inverse (r = 0,2) a été trouvée entre la NCV ulnaire et la taille des participants (P = 0,0089). Conclusion: dans la population nigériane, les valeurs normatives des paramètres de conduction du nerf ulnaire moteur et sensoriel sont similaires aux valeurs existantes dans le Littérature. Le NCV ulnaire semble être influencé par la taille et le sexe. Mots-clés: Électromyographie, test de conduction nerveuse, Nigérians, normatif, nerf cubital.

Prevalence of active epilepsy, lifetime epilepsy prevalence, and burden of epilepsy in Sub-Saharan Africa from meta-analysis of door-to-door population-based surveys.

BACKGROUND: There is marked variation in the prevalence of epilepsy across Sub-Saharan Africa (SSA). In order to accurately estimate the clinical and public health impacts of epilepsy in the region, robust and reliable epidemiological data are required for appropriate estimation of logistical, economical, and social impacts of epilepsy including policy formulation and intervention in the region. OBJECTIVE: We sought to evaluate the prevalence of active epilepsy (AE) and lifetime epilepsy prevalence in SSA using available data collected at community level. METHODS: We carefully searched online databases and identified the required articles using prespecified criteria. Random-effects model (REM) was used to estimate the active and lifetime prevalence from data generated from studies in SSA.. The burden of epilepsy, in terms of the number of people with the disease, was also obtained. Heterogeneity in the analysis was further explored using subgroup analysis and meta-regression techniques. RESULT: A total of 39 and 12 community-based door-to-door surveys addressing AE and lifetime epilepsy, respectively, from different countries of SSA met the inclusion criteria for the study. Random-effects model estimates of overall prevalence of epilepsy were 9 per 1000 persons (95% confidence interval (CI): 8.0-9.9 per 1000 persons) for AE and 16 per 1000 persons (95% CI: 12.3-19.7 per 1000 persons) for lifetime epilepsy. The prevalence was highest in the Central Africa subregion with 30.2 per 1000 persons (95% CI: 6.2 to 66.7 per 1000 persons). The prevalence of AE in the rural settlement was twice that of the urban settlements. About 9,596,551 (95% CI: 8,530,267-10,556,206) people with AE and 17,060,535 (95% CI: 13,115,286-21,005,784) people with lifetime epilepsy live in SSA. CONCLUSION: This study estimates the active (9/1000) and lifetime (16/1000) epilepsy with a remarkable burden of the disease in SSA. However, the prevalence, which is higher in the rural setting, varies within the subregion of SSA.

Neurocysticercosis in people with epilepsy in Sub-Saharan Africa: A systematic review and meta-analysis of the prevalence and strength of association.

PURPOSE: We analyzed studies on neurocysticercosis (NCC) and epilepsy across Sub-Saharan Africa (SSA) to determine the prevalence of NCC in people with epilepsy (PWE) and the strength of association of NCC with epilepsy in the region. METHODS: We conducted a systematic review of the existing literature on NCC and epilepsy in SSA. Diagnostic methods for NCC in the studies selected for our analysis included one or more of the following: positive brain CT, serum ELISA and serum EITB. A common prevalence and overall odds-ratio were then estimated using meta-analysis. RESULTS: A total of 25 (overall) and 20 (case-control) studies met the inclusion criteria for the prevalence and strength of association estimation, respectively. The overall prevalence estimate of NCC in PWE was 22 % [95 % confidence interval [CI]: 17-27.0 %). The figures were higher in the Southern and Eastern Africa sub-region (45 % and 25 % respectively) but lower in the Central and Western Africa sub-region (6 % and 15 % respectively). The prevalence of NCC estimate in PWE varied with method of diagnosis; with 29 % 18 % and 15 % in studies that used a minimum of Brain CT, ELISA and EITB respectively. The overall odds ratio was 2.4 (95 % CI 2.1-2.8), p < 0.0001. CONCLUSION: The overall prevalence of NCC in PWE in SSA was 22 %. The prevalence figure varied with the sub-region of SSA. The odd of NCC in PWE in SSA was 2.4. In spite of the sub-regional variation in NCC prevalence, this meta-analysis suggests that neurocysticercosis contributes significantly to epilepsy in SSA.

Prevalence and burden of epilepsy in Nigeria: A systematic review and meta-analysis of community-based door-to-door surveys.

BACKGROUND: Studies on prevalence of epilepsy in Nigeria yielded figures ranging between 3.1 and 37 per 1000, giving one of the widest variations in prevalence of epilepsy world over. In order to accurately estimate clinical and public health impacts of epilepsy in Nigeria, robust and reliable epidemiological data are required for an appropriate estimation of logistical, economical, and social impacts of epilepsy. OBJECTIVE: The objectives of the study were to determine, using meta-analysis, the prevalence of epilepsy by pooling data from community-based door-to-door surveys conducted in various parts of Nigeria, explore the existing variation in prevalence of epilepsy in Nigeria along geopolitical regions and settlement setting of the country, and then evaluate the burden of epilepsy in Nigeria. METHODS: Prevalence estimates were derived from a random effects meta-analysis of observational studies reporting the prevalence of epilepsy in Nigeria. The derived estimate for the prevalence of epilepsy was applied to the total populations in Nigeria to give an estimated burden of epilepsy in Nigeria. RESULT: Nine community-based door-to-door surveys, with quality data from different regions in Nigeria, were included. I-squared (I2) heterogeneity was 88.5%. Random effects model (REM) estimate of overall prevalence of epilepsy from the studies was 8 per 1000 (95% confidence interval (95% CI): 6-10). The prevalence was highest (11 per 1000) in the south western part of the country. It was also higher among the rural (15 per 1000 people) than the urban (6 per 1000) dwellers. The burden of epilepsy in Nigeria, based on the prevalence estimate was 1,280,000 persons (95% CI: 960,000-1,600,000 persons). CONCLUSION: In Nigeria, the estimated prevalence of epilepsy is 8 per 1000 people indicating a substantial burden of the disease in the country.

Electroencephalography abnormalities in generalized epilepsy and their predictors: A multicenter experience.

BACKGROUND: In spite of the overwhelming significance of knowledge of basic elements of electroencephalography (EEG) in its application to the diagnostic workup and the management of patients with suspected or already established generalized epilepsy (GE), there is a dearth of data on the pattern and utility of clinical variables that can independently determine EEG abnormalities in GE. OBJECTIVE: The study was designed to evaluate the frequency and pattern of EEG abnormality as well as assess the utility of clinical variables in predicting the likelihood of an abnormal EEG in GE. METHODS: It was a cross-sectional study involving the analysis of EEGs of consecutive patients with clinical diagnosis of idiopathic GE from three centers over a 7-year period. Information on sociodemographic and seizure variables was obtained. The International Federation of Societies for Electroencephalography and Clinical Neurophysiology definition of interictal epileptiform discharges (interictal epileptiform activity [IEA]) was adopted in the study. RESULTS:: A total of 403 patients comprising 242 (60%) males and 161 (40%) females with clinical diagnosis of GE had EEG. Their age ranged between 2 weeks and 70 years, with a median age of 21 years and an interquartile age of 26 years. Two hundred and thirty-seven (58.8%) and 213 (52.9%) patients had abnormal EEG and IEA, respectively. Before adjustment for confounders, female gender (P = 0.0001), pediatric age group (P = 0.0388), duration of epilepsy of 1-4 years (P = 0.01387), uncontrolled seizure (P = 0.0060), and seizure frequency (P = 0.0001) were significantly associated with the presence of abnormal EEG. However, age, female gender, poor seizure control, and seizure frequencies were the independent predictors of EEG abnormality. CONCLUSION: The study showed that about 58% of patients with GE patients had abnormal EEG. Age, poor seizure control, and high frequency of seizure were independent predictors of the presence of EEG abnormality.

Contexte: Malgré l'importance considérable de la onnaissance des éléments fondamentaux de l'électroencéphalographie (EEG) dans son application au bilan diagnostique et dans la prise en charge des patients atteints d'épilepsie généralisée (GE) suspectée ou déjà établie, on manque de données sur le profil. et l'utilité des variables cliniques qui peuvent déterminer indépendamment les anomalies EEG dans GE. Objectif: L'étude a été conçue pour évaluer la fréquence et le profil de l'anomalie EEG ainsi que pour évaluer l'utilité des variables cliniques dans la prédiction de la probabilité d'un EEG anormal dans GE. Méthodes: Il s'agissait d'une étude transversale impliquant l'analyse des EEG de patients consécutifs avec un diagnostic clinique de GE idiopathique à partir de trois centres sur une période de 7 ans. Des informations sur les variables sociodémographiques et de saisie ont été obtenues. La Fédération internationale des sociétés d'électroencéphalographie et de dé fi nition clinique de neurophysiologie des décharges épileptiformes intercritiques (activité épileptiforme inter-ictale [IEA]) a été adoptée dans l'étude. Résultats: Un total de 403 patients comprenant 242 (60%) mâles et 161 (40%) femelles avec le diagnostic clinique de GE avait EEG. Leur âge variait entre 2 semaines et 70 ans, avec un âge médian de 21 ans et un âge interquartile de 26 ans. Deux cent trente-sept (58,8%) et 213 (52,9%) patients avaient des EEG et IEA anormaux, respectivement. Avant ajustement pour les facteurs confondants, sexe féminin (P = 0,0001), groupe d'âge pédiatrique (P = 0,0388), durée de l'épilepsie de 1 à 4 ans (P = 0,01387), crise incontrôlée (P = 0,0060) et fréquence des crises (P = 0,0001) étaient significativement associés à la présence d'EEG anormal. Cependant, l'âge, le sexe féminin, le faible contrôle des crises épileptiques et la fréquence des crises étaient les prédicteurs indépendants de l'anomalie de l'EEG. CONCLUSION: L'étude a montré qu'environ 58% des patients avec GE avaient un EEG anormal. L'âge, le mauvais contrôle des crises et la fréquence élevée des crises étaient des prédicteurs indépendants de la présence d'une anomalie de l'EEG. Mots-clés: Anomalies, électroencéphalographie, épilepsie, généralisée.

Depression in patients with epilepsy in Northwestern Nigeria: Prevalence and clinical correlates.

BACKGROUND: The impact of seizure disorder on people living with epilepsy (PWE) is worsened by the occurrence of comorbid psychiatric disorders, such as depression, which have been found commonly in PWE. Despite the dire consequences comorbid depression has on PWE, it still remains underdiagnosed and undertreated. OBJECTIVE: To determine the prevalence of depression and associated clinical factors in PWE in Northwestern Nigeria. MATERIALS AND METHODS: A total of 255 consecutive patients with epilepsy aged 18 years and above, from two health facilities, were recruited in this cross-sectional study. Following completion of a structured proforma detailing sociodemographic and seizure characteristics, Mini International Neuropsychiatric Interview was administered to diagnose depression in the patients. RESULTS: A total of 255 patients, with a mean age of 32 years (standard deviation = 1.31), comprising 147 (57.6%) males and 108 (42.4%) females were studied. Majority (79.2%) of the patients had primarily generalized seizure type. Overall, depressive disorder was present in 52 (20.4%) patients. A significant association was found between previous hospitalization for epilepsy (P = 0.009), increased frequency of seizures, (P = 0.004), and prolonged duration of epilepsy, (P = 0.006). The independent predictors of depression included duration of epilepsy (P = 0.0001), previous hospitalization for epilepsy (P = 0.011), and frequency of seizures (P = 0.028). CONCLUSION: Depression was common in PWE. Female gender, previous hospitalization for epilepsy, increased frequency of seizures and prolonged duration of epilepsy were associated with depression in PWE. Previous hospitalization for epilepsy, increased frequency of seizures, and prolonged duration of epilepsy were independent predictors of depression.

Epilepsy and education in developing countries: a survey of school teachers' knowledge about epilepsy and their attitude towards students with epilepsy in Northwestern Nigeria.

INTRODUCTION: Students living with epilepsy still find themselves confronted with social barriers that prevent them from academic achievements. OBJECTIVE: The aim of this study was to evaluate knowledge and attitudes of school teachers and to determine the factors associated with good knowledge and positive attitude among nursery, primary and secondary school teachers in Kano, Northwestern Nigeria. METHODS: A 20-item validated semi-structured questionnaire was self-administered to 200 teachers, selected through multistage sampling technique, in Kano, Northwestern Nigeria. RESULTS: The respondents comprised 124 (62%) males and 76(38%) females. Their age ranged between 17 and 55 with a median age of 26 years. All the respondents have heard or read about epilepsy, 13% have had students with epilepsy in their classes before, fifty one (25.5%) of them would object to having an epileptic child in their class. To one hundred and seventy one (85.5%) all seizures were convulsive, 81% of them admitted to not having adequate knowledge of the initial procedure should their student develop epileptic seizure, 60% believed that epileptic student should be separated from non-epileptic students in the classroom and 44.5% of them preferred alternative medicine. Overall, fifty nine (29.5%) teachers had fair to good knowledge about epilepsy. and one hundred and sixty four (82%) had positive attitude to students with epilepsy. Statistically significant association was found between level of education attained by the respondents and good knowledge about epilepsy as well as between female gender and good attitude. However, none of the variables was statistically significant predictor of knowledge or attitude among the respondents. CONCLUSION: There was low level of knowledge and misconceptions about epilepsy but fair attitude towards epileptic students in Northwestern Nigeria. Higher level of education of the teachers was significantly associated with good attitude.