Epilepsy surgery in Africa: state of the art and challenges.

OBJECTIVE: Epilepsy is an important public health problem representing 0.6% of the global burden of disease that particularly impacts people living in the lowest income countries where epilepsy incidence may be 10 fold more than in the developed world. The battery of treatments designed to counteract the clinical manifestations of this disease are various and range from a wide spectrum of antiseizure medicationand specific diets, to surgical techniques for resection of the epileptogenic focus. The aim of our study was to describe the State of the art of Epilepsy Surgery (ES) in Africa and examine ways to deal with the high surgical treatment gap. METHODOLOGY: In an observational study, we prospectively disseminated questionnaires via email or directly administered to main epileptologists and neurologists involved in epilepsy care, in key African countries. We also conducted a literature search using PubMed, Google scholar on ES in all the African countries. RESULTS: We received responses from the majority of African countries, which allowed us to identify 3 levels of care for ES in African countries, a first level that uses ES with invasive presurgical evaluation, a second level that uses ES but without invasive presurgical evaluation, and a third level that does not use ES, and we summarized these results on a map. DISCUSSION: This paper studied the availability of ES as a treatment modality in several African countries. We aimed to establish optimal pathways for initiating ES with noninvasive Electroencephalography and readily available investigations. This could be achieved through collaboration with epilepsy programs in developed countries directly or by using telemedicine.

The impact of African-trained neurosurgeons on sub-Saharan Africa.

OBJECTIVE: Sub-Saharan Africa (SSA) represents 17% of the world's land, 14% of the population, and 1% of the gross domestic product. Previous reports have indicated that 81/500 African neurosurgeons (16.2%) worked in SSA-i.e., 1 neurosurgeon per 6 million inhabitants. Over the past decades, efforts have been made to improve neurosurgery availability in SSA. In this study, the authors provide an update by means of the polling of neurosurgeons who trained in North Africa and went back to practice in SSA. METHODS: Neurosurgeons who had full training at the World Federation of Neurosurgical Societies (WFNS) Rabat Training Center (RTC) over the past 16 years were polled with an 18-question survey focused on demographics, practice/case types, and operating room equipment availability. RESULTS: Data collected from all 21 (100%) WFNS RTC graduates showed that all neurosurgeons returned to work to SSA in 12 different countries, 90% working in low-income and 10% in lower-middle-income countries, defined by the World Bank as a Gross National Income per capita of ≤ US$995 and US$996-$3895, respectively. The cumulative population in the geographical areas in which they practice is 267 million, with a total of 102 neurosurgeons reported, resulting in 1 neurosurgeon per 2.62 million inhabitants. Upon return to SSA, WFNS RTC graduates were employed in public/private hospitals (62%), military hospitals (14.3%), academic centers (14.3%), and private practice (9.5%). The majority reported an even split between spine and cranial and between trauma and elective; 71% performed between 50 and more than 100 neurosurgical procedures/year. Equipment available varied across the cohort. A CT scanner was available to 86%, MRI to 38%, surgical microscope to 33%, endoscope to 19.1%, and neuronavigation to 0%. Three (14.3%) neurosurgeons had access to none of the above. CONCLUSIONS: Neurosurgery availability in SSA has significantly improved over the past decade thanks to the dedication of senior African neurosurgeons, organizations, and volunteers who believed in forming the new neurosurgery generation in the same continent where they practice. Challenges include limited resources and the need to continue expanding efforts in local neurosurgery training and continuing medical education. Focus on affordable and low-maintenance technology is needed.

Epidemiology of migraine among students in Mali.

Migraine is a debilitating but benign disease that can affect the quality of life of patients, disrupt the emotional relationships and impact on educational and vocational activities. The aim of our work was to study the epidemiology and impact of migraine in schools in the urban district of GAO in Mali. This is a cross-sectional study among students in the city of Gao. The survey was conducted in 11 schools, each of which represented a cluster. The study involved 733 students and diagnosis of migraine was made according to the 2004 IHS criteria except the criterion for the number of crises. The overall prevalence of migraine in school was 17.3% (95% CI [14.6% to 20%]). The headache prevalence among students was 20% (95% CI [16.91% to 23.09]), it was significantly higher 23.0% in girls than in boys 14.8% (p < 0.01). About its impact on school life, 63.8% of students had experienced absenteeism due to migraine from 1 to 14 days in the last quarter preceding the survey with a limiting concentration in 19.2% of students with migraine. In conclusion, migraine is common among students of Gao, it is more important in female. It has a negative impact on academic performance. It is therefore necessary to control its management to reduce the extent of the disease in this environment.

L'epilepsie en milieu scolaire : enquete chez les enseignants de la ville de Kati au Mali et revue de la litterature

Introduction La prevalence de l'epilepsie en Afrique subsaharienne est elevee. Nous avons mene une etude transversale et descriptive dans l'ensemble des ecoles primaires de la ville de Kati (200 000 habitants). Les enseignants furent interviewes de maniere exhaustive a l'aide de questionnaires portant; d'une part; sur les connaissances; attitudes et pratiques des enseignants en matiere d'epilepsie et; d'autre part; sur leurs avis sur les consequences psychologiques; sociales pour l'enfant epileptique et les incidences sur sa scolarite.Resultats Nous avons interroge 92 enseignants (60 hommes et 32 femmes). L'age moyen des enseignants etait de 30 ans. La majorite d'entre eux avait une experience professionnelle de plus de 5 ans. Environ 38% des enseignants attribuaient la maladie a une cause surnaturelle. Plus de 39% des enseignants pensaient que l'epilepsie etait contagieuse et 61% pensaient que l'epilepsie etait incurable. 79% interdisaient systematiquement la pratique du sport a l'enfant epileptique. Environ 55% pensaient que l'enfant epileptique avait des capacites cognitives inferieures a celles de l'enfant non epileptique et 88% affirmaient que l'enfant epileptique etait incapable d'avoir une scolarite normale. 59% trouvaient que l'eleve epileptique etait victime de stigmatisation et de marginalisation. Devant une crise; 68% renvoyaient l'enfant au domicile.Conclusion Ce travail fait apparaitre un besoin de formation des enseignants en matiere d'epilepsie. Les donnees actuelles sur la frequence de l'epilepsie en milieu scolaire justifient une attention particuliere des services de sante et de ceux de l'education nationale sur la scolarisation de l'enfant epileptique