Prescription patterns and therapeutic gaps among persons with epilepsy in Southwestern Nigeria.

Introduction: Pharmacotherapy with antiseizure medications (ASMs) has been a cornerstone for achieving long-term remissions in persons with epilepsy (PWEs). This study aims to determine the prescription patterns and treatment gaps (TGs) among PWEs. Methods: Accordingly, a descriptive cross-sectional study was conducted with 940 PWEs aged ≥18 years having clinically confirmed diagnosis of epilepsy based on the International League Against Epilepsy (ILAE) criteria. At a scheduled interview with each participant, a previously established questionnaire was used to obtain clinical information relating to epilepsy in terms of the age of onset, etiology, duration of epilepsy, frequency, types, and number of ASMs used. Results: There were fewer male participants [445 (47.4%) vs. 495 (53.6%)] than females, with a higher mean age of onset [(35.19 ± 21.10 vs. 31.58 ± 20.82 years; p = 0.009]. The medication characteristics showed that 336 (35.7%) of the 940 PWEs recruited were not on any ASMs, whereas the remaining 604 (64.3%) patients were on ASMs, with 504 (83.4%) on monotherapy vs. 100 (16.6%) on polytherapy. The PWEs on ASM monotherapy had a higher mean age [40.92 ± 19.40 vs. 33.61 ± 16.51 years; p < 0.001] and higher mean age of onset [34.47 ± 21.80 vs. 25.39 ± 19.78 years; p < 0.001] than those on polytherapy. Furthermore, there were more persons on ASM monotherapy among the participants with seizure duration < 2 years [251 (87.5%) vs. 36 (12.5%)] and seizure duration > 2 years [253 (79.8%) vs 64 (20.2%)]. Conclusion: The majority of the participants receiving ASMs were on monotherapy, with carbamazepine being the most frequently prescribed medication. Furthermore, about a third of the participants had TGs; therefore, healthcare providers should focus on alleviating the TGs among PWEs.

Relationship between depression and sex steroid hormone among women with epilepsy.

Introduction: Sex steroid hormones are emerging significant biomarkers of depression among Women with Epilepsy (WWE) with promising prognostic potential and therapeutic end point. Therefore, the study is aimed at exploring the association between sex steroids hormones, Anti-seizure Medication (ASM) and depression among WWE. Methodology: A baseline questionnaire was used to obtain socio-demographics and clinical characteristic from one hundred and twelve (112) WWE and 50 age matched healthy control. The diagnosis of epilepsy and Electroencephalography (EEG) description was based on 2017 International League Against Epilepsy (ILAE) criteria. Blood samples were collected from cases and control during Luteal Phase (LP) and Follicular Phase (FP). The Zung Self-Rating Depression Scale (ZSRDS) was used to assess depression. Result: The prevalence of depression among WWE is 18.8%, with a significant difference between the level of formal education (p0.000), age (p0.000), and mean ZSRDS (p0.000) among cases and control. There is a statistical difference in hormonal levels between cases and control with regards to higher testosterone [3.28 ± 9.99 vs. 0.31 ± 0.30; p0.037], lower FP prolactin [16.37 ± 20.14 vs. 17.20 ± 7.44; p0.778], and lower LP prolactin [15.74 ± 18.22 vs. 17.67 ± 7.27; p0.473]. Testosterone (p0.024), FP Follicle Stimulating Hormone (FSH) (p0.009), FP Estradiol (p0.006), LP FSH (p0.031), LP Progesterone (p0.023), and LP Prolactin (p0.000) were associated with depression. However, only prolactin (p0.042) and testosterone (p0.000) predicts depression among WWE. Conclusion: There was higher mean depression score, lower prolactin and higher testosterone level among cases compared to control. Furthermore, there was lower prolactin and higher testosterone level in Carbamazepine (CBZ) group compared to Levetiracetam (LEV) groups.

Predictors and associated factors with adverse drug reaction in people with epilepsy.

OBJECTIVES: There is a need for early identification and intervention of Adverse Drug Reaction (ADR) to alleviate the unacceptably growing burden, morbidity, and mortality associated with People With Epilepsy (PWE). This study is aimed at identifying associated factors and predictors of ADR among PWE. METHODS: It is an interviewer-administered questionnaire-based study consisting of 940 consenting participants aged 16 years and above attending epilepsy clinics for 5 years with diagnosis confirmed by International League against Epilepsy (ILAE) criteria and supported by Electroencephalography (EEG). Twenty-one-item Liverpool Adverse Effect Profile (LAEP) and 8-item Morinsky Medication Adherence Scale (MMAS) were used to assess ADR and adherence respectively. RESULTS: The highest reported ADR in PWE were nervousness (34.3%), aggression (33.6%), and weight gain (32.3%). Specifically, 20.1% of the participants complained of memory problems. On the other hand, ADR associated with skin, mouth/gum and hair loss was 9.3%, 8.9%, and 7.2% respectively, and these were the lowest reported ADRs. Using the MMAS, 545(90.2%), 28(4.6%), and 31(5.1%) of PWE in this study were classified as having high, medium, and low adherence, respectively. Duration of Anti-Seizure Medication (ASM) use and duration of epilepsy were the major determinants of ADR in PWE on the regression model. CONCLUSION: Duration of ASM use and duration of epilepsy are the major determinants of ADR in PWE. Effective strategies to identify and reduce ADR should be incorporated into the management of PWE by Health Care Providers (HCPs) to improve their quality of life.

Cognitive dysfunction in Nigerian women with epilepsy on carbamazepine and levetiracetam monotherapy.

BACKGROUND: This study aims to identify the determinants of cognitive dysfunction and compare the effect of CPZ and LTC on cognition in WWE. METHODS: An observational study involving 87 consenting adult WWE aged between 16 and 40 years on LTC or CZP monotherapy. At enrollment, an interviewer-based questionnaire was used to obtain demographic and clinical information from participants. The diagnosis of epilepsy was mainly clinical and supported by electroencephalographic (EEG) features and classified based on recommendation by the 2017 International League Against Epilepsy (ILAE). Zung Self-Reporting Depression Scale (ZSRDS) was used to assess the mood of participants. The Community Screening Interview for Dementia (CSID) was used to assess various cognition domains. The National Hospital Seizure Severity Scale (NHS-3) was used to assess disease severity. RESULTS: There were statistical differences between the CZP and LTC groups in all domains of cognition assessed except for orientation. The total CSID scores of the LTC group were 59.2 (4.9) as opposed to CZP group, 57.2 (5.0); p: .005. Those with focal onset seizures had lower median total CSID score (58; IQR: 54-62) when compared to those with generalized onset seizures (62; IQR: 58-62), p: .012. There was a significant correlation between ZSRD score and NHS-3 score; rho: 0.30, p: .007. Bivariate analysis shows statistically significant correlation between total CSID score and ZSRDS (rho: -0.65), BMI (rho: 0.22), and NHSS-3 score (rho: -0.36), respectively. However, the effect of AED on CSID scores was lost after multivariate quantile regression with only ZSRDS retaining significance. CONCLUSION: Depression, seizure severity, type and structural etiology were associated with cognitive impairment among WWE. However, on regression model, only depression was statistically significant. The presence of more risks for cognitive impairment in the CZP group limits possible conclusion of LTC superiority.

Polycystic ovarian syndrome in Nigerian women with epilepsy on carbamazepine/levetiracetam monotherapy.

OBJECTIVE: The study is aimed at comparing effects of older drugs like carbamazepine (CBZ) and newer agent like levetiracetam (LEV) on polycystic ovarian syndrome (PCOS) in women with epilepsy (WWE). METHODS: An interviewer-based questionnaire was used to obtain relevant clinical information from 50 WWE on CBZ and LEV monotherapy, respectively, and 50 age-matched controls. The diagnosis of epilepsy was clinical with electroencephalographic features taken into consideration and the seizures classified using the 2017 International League Against Epilepsy classification. The diagnosis of PCOS was based on the European Society for Human Reproduction and Embryology/American Society for Reproductive Medicine. RESULTS: The frequency of PCOS and its subcomponent were higher among WWE compare to controls. PCOS was present in 22 (44%) of LEV group compare to 8 (16%) CBZ group. The frequency of its subcomponent was higher among those on LEV except for comparable effect with regard to oligomenorrhea. The levels of the sex steroid hormone were comparable in both groups of WWE except luteal phase luteinizing hormone, which was lower among the LEV group (P .001). The follicular phase estradiol level was lower (P .021), and follicle-stimulating hormone level was about 2-fold higher (P .03) among WWE compare to controls. The mean value testosterone was significantly lower among controls compared to WWE. CONCLUSIONS: The increased frequency of PCOS and its subcomponent and the unsatisfactory effect of LEV compared to CBZ on reproductive endocrine function underscore the need for routine reproductive endocrine evaluation to improve overall quality of life.

Impact of post-stroke disability and disability-perception on health-related quality of life of stroke survivors: the moderating effect of disability-severity.

OBJECTIVE: The influence of disability-perception on health-related quality of life (HRQoL) remains unclear. This study investigated impact of disability and disability-perception on HRQoL of stroke survivors and explores the moderating effect of disability-severity. METHODS: Post-stroke disability, disability-perception/acceptance and HRQoL were assessed in 102 stroke survivors using the World Health Organisation Disability Assessment Schedule, Attitudes towards Disabled Persons Form-A and Short Form-36, respectively. RESULTS: There was significant disability score of at least 42 in the participants with severe disability accounting for 76.5% while 52% of them having positive disability-perception. Although no sex difference exists in their HRQoL, their score was just fair (46.1 ± 1.9) with their physical health being most affected. Severe disability impacted negatively on their HRQoL but disability-perception had no significant effect except in 'role limitation due to the emotional problem' domain. Only severe disability moderated the effects of disability on the overall HRQoL (R 2 change = 3.2%; p = 0.018). Disability-severity (mild/moderate and severe disability) moderated the effects of disability level on their physical health (R 2 change = 3.1% and 6%; p = 0.012 and 0.0001, respectively). CONCLUSION: Significant disability exists among stroke survivors and impaired their HRQoL while disability-severity moderating the effect. More stroke survivors have positive attitude towards their disability and impact positively on their physical health.

Gender and obstetric factors in the determination of the age of onset of schizophrenia in a Nigerian cohort.

The importance of gender and obstetric factors as predictors of the age of onset of schizophrenia is debatable. Unfortunately, there is a significant dearth of studies in developing countries such as Nigeria. This study involved a survey of patients with schizophrenia (n = 1,445; N = 2,393), from March 2014 to March 2016, from a psychiatric hospital in southwest Nigeria. Structured diagnostic interviews were used to confirm diagnosis. Females had a higher age of onset (M = 34.91, SD = 15.52) compared with males (M = 28.78, SD = 10.62; p = .00, M = 32.74 ± 12.96). Gender and marital status were the only variables significantly related to the age of onset (p = .00). Our model predicted 10.1% of the variability in the determination of the age of onset of schizophrenia. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Perception of victims of rape and perception of gender social roles among college students in Southwest Nigeria: validation of a 5-item gender scale.

Our study focused on the perception of victims of rape and the relationship with the perception of social roles for gender among college students in southwest Nigeria using a 5-item gender social scale and a perception of victims of rape questionnaire. The study was done among 312 college students in Southwest Nigeria and explored the perception of victims of rape and gender social roles. The aim was to determine the relationship between perception of rape victims and view of gender social roles. We used a perception of rape victims questionnaire and a validated 5-item gender social roles scale to assess the views of participants. The findings revealed that females had better perception of victims of rape than males. Females also had more positive views of females' social roles involving gender. However, there was poor perception on work-related social roles and the traditional concept of headship in the varied situations described on the 5-item gender social scale. Old stereotypes of typically blaming victims of rape were not common beliefs among college students. There were no significant correlations between perception of victims of rape and perception of gender social roles among college students. Seemingly, the perception of victims of rape does not have a significant relationship with the concept of gender social roles.

Vestibular disorders in elderly patients: characteristics, causes and consequences.

INTRODUCTION: This study assessed vestibular disorders in elderly patients, describing the causes, clinical characteristics, therapies and treatment outcomes. METHODS: Five-year hospital-based prospective study, conducted at the ENT clinic of a tertiary referral center. Subjects were consecutive elderly patients with dizziness, treated and followed-up for a minimum of six months. Data was generated using structured questionnaire and case record files. Analyzed results were presented in simple descriptive forms as graphs and tables. RESULTS: Among the elderly patients, prevalence of vestibular disorders was 18.6%, 49.1% were retired, 71.9% were married, M:F was 1:1.1. Mean age±SD were 69.4±1.1 and 69.0±0.8 years for males and females respectively. 56.9% of the patients presented early on experiencing the vestibular symptoms. The symptoms were associated with nausea or vomiting in 26.3%, with an aura in 12.3%. While 50.9% of the patients experienced intermittent symptoms, laterality of the symptoms was not clear in 45.6%. Positional vertigo was diagnosed in 33.3% while in 17.5%, the symptoms could be attributable to previous trauma or assaults. 31.6% of the elderly were referred to ENT surgeons by other specialties, 45.6% were managed with multidisciplinary approach, while 82.5% had the vestibular symptoms initially controlled with labyrinthine sedatives. At follow-up, 43.9% had intermittent periods of recurrence of symptoms. CONCLUSION: Prevalence of vestibular disorders in elderly patients is high, most patients present early with intermittent, relatively innocuous symptoms which may be difficult to lateralize. Positional vertigo was the most common cause, it is frequently relieved with labyrinthine sedatives but tends to recur intermittently.

Validation study of the Siriraj Stroke score in African Nigerians and evaluation of the discriminant values of its parameters: a preliminary prospective CT scan study.

BACKGROUND AND PURPOSE: CT scanning is important to identify stroke pathology and exclude mimics. Its poor availability in our environment makes the search for simple, reliable clinical-score imperative. This study aims to validate the Siriraj Stroke score (SSS) and determine the discriminant values of its parameters in the black population of African-Nigerians. METHODS: A prospective multicenter study was carried out on patients that presented with stroke and had brain CT scan done within 14 days of onset. An interviewer structured questionnaire was administered and SSS computed. The stroke-type was classified and compared with CT diagnosis. Data were analyzed using Epi-info-2002. RESULTS: 1122 patients presented with clinical features of stroke, of which only 101 (9%) could afford the cost of CT scan. Of these, 90 had CT-scan features consistent with acute stroke, 5 had cortical atrophy and 1 was normal. Thus, 96 patients were analyzed, of which 68 (71%) had cerebral ischemia and 28 (29%) had intracerebral hemorrhage. The 6 patients with no visible infarct on CT were regarded as cerebral infarction. The correlation between SSS, headache, vomiting, loss-of-consciousness and CT diagnosis achieved statistical significance, whereas atheroma markers and diastolic blood pressure did not. The SSS has an overall predictive accuracy of 80%. CONCLUSIONS: This preliminary study has shown that only 9% of our hospital stroke population had benefit of CT scan. The limited number of patients studied and their potential lack of representativeness, represent a funding issue to properly establish the performance of clinical scoring systems and assist in descriptive epidemiology of hospital and community-based stroke studies in resource-poor settings. However, in this study, the SSS diagnosis correlates significantly with CT diagnosis.