Etiologies of epilepsy and health-seeking itinerary of patients with epilepsy in a resource poor setting: analysis of 342 Nigerian Africans.

PURPOSE: The understanding of causation of epilepsy, especially in resource poor African countries where prevalence rates are very high, would aid strategies for primary prevention. This study sought to determine the causes of epilepsy in Nigerian Africans and health-itinerary of patients with epilepsy. METHOD: This was an observational, cross-sectional descriptive study of consecutive newly diagnosed adult patients with epilepsy using a mixed-methods approach of face-to-face in-depth interview of patients' parents and relations, health care personnel who had given medical attention at any time and telephone interview. A structured interview schedule was used to obtain demographic information, details of seizure variables, health seeking itinerary and history of previous hospitalizations. Data was analyzed descriptively with SPSS version 17. RESULTS: Three hundred and forty-two patients with epilepsy with a mean age of 31.4±11.98 years participated in the study. Most of the patients (68.1%; 233/342) were unemployed and students. There were 270 (78.9%) patients with generalized epilepsy. No identifiable etiology was found in 37.7%, but of the remaining 62.3%, the commonest causes included post traumatic (19.6%), recurrent childhood febrile convulsions (13.2%), post-stroke (6.7%), brain tumors (5.9%), neonatal jaundice (5.3%), birth-related asphyxia (5%) and history of previous CNS infections (4.7%). Family history of epilepsy was obtained in 9.9%, all of whom had primarily generalized seizures. 61.4% of them sought initial attention from the traditional healers or in prayer houses. CONCLUSION: This study showed the pattern of causes of epilepsy in Nigerian Africans. The health seeking behavior and itinerary of the PWE revealed a preference for traditional healers. There is need for health policies and epilepsy awareness campaigns to prevent causes of seizures and improve the knowledge of the public respectively.

Pericardiectomy in post-traumatic suppurative constrictive pericarditis: case report.

A 13-year-old male was seen at the Hospital with a 5-months history of right chest swelling, pain and recurrent fever and breathlessness on mild exertion. There was a history of gunshot to his chest two and half years before presentation.On admission he was febrile with a temperature of 39 degrees C. The chest wall swelling measuring 6 cm/6 cm was tender and fluctuant and needle aspiration yielded purulent fluids. His blood pressure and pulse were 110/60 mmHg (14.6/8 Kpa) and 100 per minute respectively. The chest radiograph showed massive cardiomegaly with pellets lodging in the right 5(th )costosternal joint. Echocardiography confirmed massive pericardial effusion. The electrocardiogram showed sinus rhythm and low voltage of QRS complexes without chamber enlargement. A diagnosis of constrictive pericarditis with purulent pericardial effusion secondary to foreign body abscess was made.His clinical picture improved after an initial incision and drainage of the right anterior chest wall abscess under ketamine intravenous anaesthesia. Two weeks after, he had pericardiectomy under general anaesthesia using a nitrous/oxygen/halothane relaxant technique which was uneventful.