Seizure variables and cognitive performance in patients with epilepsy

Background and Purpose Epilepsy is highly prevalent in developing African countries with significant morbidity, social stigmatization, poor quality of life and preventable mortality. There are scanty reports on the contributions of seizure variables like seizure types, frequency of seizures, duration of epilepsy, age at onset and anti-epileptic drugs to cognitive disturbances in Nigerian Africans. This study assessed the effects of seizure variables on the cognitive performances of patients with epilepsy. Methods The cognitive functions of 41 patients with epilepsy and 41 controls were assessed with a computerassisted cognitive test battery, Iron Psychology (acronym - FePsy) using the simple and complex reaction time tasks for mental speed, recognition memory test (RMT) for memory and continuous performance test for attention. Results The cognitive performances of the patients using complex reaction time and the recognition memory tasks were worse than those of the controls (pConclusions The seizure variables negatively affected cognitive performances of Nigerian patients with epilepsy. Cognitive assessment is recommended as part of regular evaluation of patients with epilepsy

Morbidity and Mortality Patterns among Neurological Patients in the Intensive Care Unit of a Tertiary Health Facility

Background/Objective: The morbidity and mortality of neurological patients managed in the intensive care unit reflect the causes of neurological disorders and the effectiveness of management. Method: The morbidity and mortality patterns of neurological patients admitted into the intensive care unit of the University of Benin Teaching Hospital (UBTH), a tertiary health institution in Nigeria, was examined over an 18-year period (January 1985 to December 2003). A complete sampling frame was used with all patients' records scrutinized. Results: A total of 187 patients, (16.6% of the total ICU admissions) with neurological morbidity were admitted during the period. We observed that morbidity was high for preventable etiologies \u2013 head injury (119 patients constituting 63.7%), tetanus (26 patients constituting 13.9%), hypertensive encephalopathy (12 patients constituting 6.4%) and meningitis (8 patients constituting 4.8%). The case fatality rates for these causes were 50.4%, 61.5%, 66.7% and 62.5% respectively. The case fatality rate for cerebral malaria was 100%. In addition, males (67.9%) were more likely to have trauma-related morbidity (P<.001) than females (32.1%). Overall mortality rate was high (52.4%) and calls for urgent attention. Conclusion: We concluded that preventable morbidities (head injury, tetanus, meningitis and hypertensive encephalopathy) accounted for fatality among neurological patients in the ICU, Benin City, Nigeria. Mortality was higher among those that required significant intensive interventions. Improved public awareness, traffic legislation, prompt emergency medical care and immunization against tetanus and meningitis should reduce morbidity and mortality.Introduction/Objectif: La morbidit\ue9 et la mortalit\ue9 des malades neurologiques trait\ue9s dans le Service de soins intensifs a montr\ue9 les causes des troubles neurologiques et l'efficacit\ue9 de la prise en charge. M\ue9thodes: La tendance de la morbidit\ue9 et de la mortalit\ue9 des malades neurologiques admis dans le service des soins intensifs du centre hospitalier universitaire du Benin (CHUB), un centre de la sente tertiaire au Nigeria, a \ue9t\ue9 \ue9tudi\ue9 au cours d'une p\ue9riode de 10 ans (janvier 1985 au d\ue9cembre 2003). Un plan de sondage complet a \ue9t\ue9 utilis\ue9 avec tous les dossiers des patients \ue9tudi\ue9s. R\ue9sultats: Un total de 187 patients, (16,6% du total des admissions ICU) atteints de la morbidit\ue9 neurologique ont \ue9t\ue9 admis au cours de la p\ue9riode. Nous avons not\ue9 que le taux de la morbidit\ue9 est \ue9lev\ue9 pour les \ue9tiologies \ue9vitables \u2013 blessures de t\ueate (119 patients recens\ue9s en 63,7%) ; le t\ue9tanos (26 malades recens\ue9s en 13,9%) ; hypertension enc\ue9phalopathie (12 malades recens\ue9s en 6,4%) et la m\ue9ningite (8 malades recens\ue9s en 4,8%) ; Le taux du cas de la fatalit\ue9 pour ces causes \ue9taient 50,4%, 61,5%, 66,7% et 62,5% respectivement. Le taux du cas de la fatalit\ue9 pour la fi\ue8vre c\ue9r\ue9brale \ue9tait 100%. En outre, sexe masculin (67,9(%) \ue9taient plus susceptibles d'avoir des traumatismes li\ue9s \ue0 la morbidit\ue9 (p<0,001) que chez le sexe f\ue9minin (32,1%). Dans l'ensemble, le taux de la mortalit\ue9 \ue9tait \ue9lev\ue9 (52,4%) et demande une attention d'urgence. Conclusion: Nous avons conclu que des morbidit\ue9s \ue9vitables (blessures \ue0 la t\ueate, le t\ue9tanos, la m\ue9ningite et hypertendus enc\ue9phalopathie) constituaient pour la fatalit\ue9 parmi des malades neurologiques \ue0 ICH, Benin, Nig\ue9ria. La mortalit\ue9 \ue9tait plus \ue9lev\ue9e chez ceux que ont besoin d'une intervention intensive significative. Am\ue9lioration dans la sensibilisation du publique, la l\ue9gislation sur la circulation rapide, les soins m\ue9dicaux d'urgence et de la vaccination contre le t\ue9tanos et la m\ue9ningite devrait permettre de r\ue9duire la morbidit\ue9 et la mortalit\ue9

Cognitive Effects Of Anti-Epileptic Drugs In Nigerians With Epilepsy

Background Epilepsy is particularly highly prevalent in developing African countries and has been associated with cognitive disturbances, but more importantly is the contribution of the anti-epileptic drugs (AEDs). Objective This study aimed at comparing the effects of AEDs on the cognitive functions of Nigerian epileptic patients. Methods This is a prospective study of 55 consecutive patients with epilepsy, aged 14 years and above, over a two year period (October 2000 to October 2002), recruited from the Neurology Clinic of the University Teaching Hospital, Benin City, Nigeria. Anti-epileptic treatment with either carbamazepine (19 patients), phenytoin (18 patients), or phenobarbitone (18 patients) which was randomly assigned constituted the interventional measure. Cognitive testing, using the Iron Psychology (FePsy) a computerized neuro-psychological test battery, measured the visual and auditory reaction times, the continuous performance test and the recognition memory test to assess the mental speed, attention and memory respectively. Results The effect of the individual drug on cognitive performance revealed significant impairment of mental speed (p0.05). Carbamazepine did not significantly affect the verbal (Words section) memory scores (p>0.05) implying better performance in tasks of verbal memory (

Multiple intracranial tuberculomas in an HIV-negative 28 year old male - a case report.

Intracranial tuberculomas are uncommon complications of tuberculosis, especially in immuno-competent individuals with no evidence of extra-cranial foci. We report a case of an HIV- negative young male who presented with presumed cerebral and cerebellar tuberculomas without identifiable extra-cranial focus. The CT scan revealed multiple intracranial ring-enhanced lesions. The remarkable response to antituberculous drugs and steroid (prednisolone) with near complete resolution of clinical and radiological signs was highly suggestive of diagnosis. In the differential diagnosis of intracranial mass lesions in sub-Saharan Africa, a high index of clinical suspicion is needed to avoid misdiagnosis of intracranial tuberculoma. Keywords: intracranial, tuberculomas, diagnosis, treatmentNigerian Journal of Clinical Practice Vol. 10 (3) 2007 pp. 262-26

Depressive symptoms in patients with epilepsy: Analysis of self-rating and physician's assessment

Background : Depression has significant negative impact on the quality of life in patients with epilepsy (PWE). Aim: This study assessed the prevalence of depression in PWE and the impact of seizure variables on the depression scores. Settings and Design : A case-control study of randomly selected PWE attending a tertiary hospital in a metropolitan, Nigeria. Materials and Methods : A total of 152 randomly selected subjects the Beck Depression Inventory (BDI) for quantitative assessment of depression, while the Hamilton Rating Scale for Depression (HRSD) was used by the investigators. Statistical Analysis : The Student t test assessed statistical significance of differences in the BDI and HRSD scores, whereas the scores were correlated with Pearson′s correlation coefficient. Logistic regression analysis and Chi-square test for trend assessed the impact of seizure variables on the scores. The level of significance was taken as P < 0.05. Results : The prevalence of depressive symptoms was 42% and 45% using the HRSD and BDI, respectively, with significant differences in the scores of the patients and controls on the both scales (P < 0.001). The PWE scores on both scales yielded a correlation coefficient of 0.8 indicating their utility in detecting depressive symptoms. Seizure control was the most potent predictor of depression (HRSD: P = 0.004; BDI: P = 0.001). Conclusions : Depressive symptoms are common in epilepsy. Early detection and prompt management are recommended. Good seizure control with an appropriate antiepileptic drug, among other interventional measures, may contribute to the prevention of depression in epilepsy

Morbidity and Mortality Patterns among Neurological Patients in the Intensive Care Unit of a Tertiary Health Facility

Background/Objective: The morbidity and mortality of neurological patients managed in the intensive care unit reflect the causes of neurological disorders and the effectiveness of management. Method: The morbidity and mortality patterns of neurological patients admitted into the intensive care unit of the University of Benin Teaching Hospital (UBTH), a tertiary health institution in Nigeria, was examined over an 18-year period (January 1985 to December 2003). A complete sampling frame was used with all patients&apos; records scrutinized. Results: A total of 187 patients, (16.6% of the total ICU admissions) with neurological morbidity were admitted during the period. We observed that morbidity was high for preventable etiologies – head injury (119 patients constituting 63.7%), tetanus (26 patients constituting 13.9%), hypertensive encephalopathy (12 patients constituting 6.4%) and meningitis (8 patients constituting 4.8%). The case fatality rates for these causes were 50.4%, 61.5%, 66.7% and 62.5% respectively. The case fatality rate for cerebral malaria was 100%. In addition, males (67.9%) were more likely to have trauma-related morbidity (P<.001) than females (32.1%). Overall mortality rate was high (52.4%) and calls for urgent attention. Conclusion: We concluded that preventable morbidities (head injury, tetanus, meningitis and hypertensive encephalopathy) accounted for fatality among neurological patients in the ICU, Benin City, Nigeria. Mortality was higher among those that required significant intensive interventions. Improved public awareness, traffic legislation, prompt emergency medical care and immunization against tetanus and meningitis should reduce morbidity and mortality.Introduction/Objectif: La morbidité et la mortalité des malades neurologiques traités dans le Service de soins intensifs a montré les causes des troubles neurologiques et l&apos;efficacité de la prise en charge. Méthodes: La tendance de la morbidité et de la mortalité des malades neurologiques admis dans le service des soins intensifs du centre hospitalier universitaire du Benin (CHUB), un centre de la sente tertiaire au Nigeria, a été étudié au cours d&apos;une période de 10 ans (janvier 1985 au décembre 2003). Un plan de sondage complet a été utilisé avec tous les dossiers des patients étudiés. Résultats: Un total de 187 patients, (16,6% du total des admissions ICU) atteints de la morbidité neurologique ont été admis au cours de la période. Nous avons noté que le taux de la morbidité est élevé pour les étiologies évitables – blessures de tête (119 patients recensés en 63,7%) ; le tétanos (26 malades recensés en 13,9%) ; hypertension encéphalopathie (12 malades recensés en 6,4%) et la méningite (8 malades recensés en 4,8%) ; Le taux du cas de la fatalité pour ces causes étaient 50,4%, 61,5%, 66,7% et 62,5% respectivement. Le taux du cas de la fatalité pour la fièvre cérébrale était 100%. En outre, sexe masculin (67,9(%) étaient plus susceptibles d&apos;avoir des traumatismes liés à la morbidité (p<0,001) que chez le sexe féminin (32,1%). Dans l&apos;ensemble, le taux de la mortalité était élevé (52,4%) et demande une attention d&apos;urgence. Conclusion: Nous avons conclu que des morbidités évitables (blessures à la tête, le tétanos, la méningite et hypertendus encéphalopathie) constituaient pour la fatalité parmi des malades neurologiques à ICH, Benin, Nigéria. La mortalité était plus élevée chez ceux que ont besoin d&apos;une intervention intensive significative. Amélioration dans la sensibilisation du publique, la législation sur la circulation rapide, les soins médicaux d&apos;urgence et de la vaccination contre le tétanos et la méningite devrait permettre de réduire la morbidité et la mortalité

Adult stroke registry in West Africa: Profile of 334 in-patients in the University of Benin Teaching Hospital, Benin City, Nigeria

Background: Profiling of stroke types in sub-Saharan Africa until recently has been done in part with the clinical diagnosis, where neuroimaging is not affordable or accessible. Objective: To profile all first-ever stroke using cranial computed tomography (CT) scan. Methods: Three hundred and thirty-four first-ever stroke had demographic data as well as the duration of admission or time to event (outcome), stroke type and severity, volume of hemorrhage in cases of parenchymal hemorrhage captured from the stroke unit register. Operationally outcome was defined as discharge to follow-up or discharge against medical advice (DAMA) or all-cause in-hospital mortality, stroke type was defined by cranial CT as cerebral infarct or intracerebral hemorrhage (ICH) or subarachnoid hemorrhage. Stroke severity was defined by the Canadian Neurological Scale (CNS) and the National Institutes of Health Stroke Score (NIHSS). Data were analyzed as appropriate. Results: Mean age was 62.63 ± 14.90 years, comprising 190 (56.9%) males and 144 (43.1%) females. Mean duration of admission was 12.91 ± 11.38 days. Totally, 251 had cerebral infarct (75.15%), 81 (24.25%) had ICH, 2 (0.60%) had subarachnoid hemorrhage. A total of 177 (51.19%) were discharged to follow-up, 15 (4.50%) were DAMA with acute case fatality of 148 (44.31%). Mean CNS score was 2.85 ± 2.57 and mean NIHSS was 17.29 ± 5.15. Age, time to outcome and NIHSS were the predictors of outcome (survival or discharged to follow-up and all-cause mortality) (odds ratio [OR] =1.043, P = 0.016, OR = 0.923, P = 0.001, OR = 2.467, P < 0.001 respectively) and NIHSS was the only predictor of survival (hazard ratio = 0.872, P < 0.001). Conclusion: This neuroimaging profiling of acute stroke type and outcome is expected to be an improvement over reviews based largely on the presumptive diagnosis

Development and pilot testing of an online module for ethics education based on the Nigerian National Code for Health Research Ethics

Abstract Background The formulation and implementation of national ethical regulations to protect research participants is fundamental to ethical conduct of research. Ethics education and capacity are inadequate in developing African countries. This study was designed to develop a module for online training in research ethics based on the Nigerian National Code of Health Research Ethics and assess its ease of use and reliability among biomedical researchers in Nigeria. Methodology This was a three-phased evaluation study. Phase one involved development of an online training module based on the Nigerian Code of Health Research Ethics (NCHRE) and uploading it to the Collaborative Institutional Training Initiative (CITI) website while the second phase entailed the evaluation of the module for comprehensibility, readability and ease of use by 45 Nigerian biomedical researchers. The third phase involved modification and re-evaluation of the module by 30 Nigerian biomedical researchers and determination of test-retest reliability of the module using Cronbach’s alpha. Results The online module was easily accessible and comprehensible to 95% of study participants. There were significant differences in the pretest and posttest scores of study participants during the evaluation of the online module (p = 0.001) with correlation coefficients of 0.9 and 0.8 for the pretest and posttest scores respectively. The module also demonstrated excellent test-retest reliability and internal consistency as shown by Cronbach’s alpha coefficients of 0.92 and 0.84 for the pretest and posttest respectively. Conclusion The module based on the Nigerian Code was developed, tested and made available online as a valuable tool for training in cultural and societal relevant ethical principles to orient national and international biomedical researchers working in Nigeria. It would complement other general research ethics and Good Clinical Practice modules. Participants suggested that awareness of the online module should be increased through seminars, advertisement on government websites and portals used by Nigerian biomedical researchers, and incorporation of the Code into the undergraduate medical training curriculum.</p

Characteristics Of Tetanus Cases Seen Over A Ten Year Period In A Tertiary Health Facility In Benin City, Nigeria

Tetanus remains a great public health problem in developing sub-Saharan Africa and it is associated with high mortality. We evaluated the epidemiological characteristics and clinical profiles of tetanus cases seen in a tertiary health facility in Benin City, Nigeria between 1990 and 2000. All consecutive patients admitted in the Medical wards of the University Teaching Hospital, Benin City between 1990 and 2000 were recruited. It is a prospective study which analyzed all patients with tetanus within the study period. A total of 66 cases were admitted into the medical wards during this period, with a female preponderance (F/M = 1.4:1). The highest number of cases was in the age group 16-29 years. Majority was seen during the wet season and the commonest site of injuring was the lower limb. Injury from stepping on wood and cuts from cutlass accounted for most of the cases. The mean incubation period was 13.4+13.1 days and the mean onset time was 5.9+8.0 days. The mean duration of hospital stay was 21.8+13.3 days. The mortality rate was 27.4%. Severity of spasms, duration of hospital stay, incubation period, onset time, immunization status, socio-economic background and the type of initial care received affected mortality. Early diagnosis and emphasis on preventive strategies remain the bedrock of reduction of mortality in Sub-Saharan Africa. Keywords: Tetanus, Nigeria, sub-Saharan Africa, characteristics, mortality.Journal of Mining and Geology Vol. 5 (1&amp;2) 2006: pp. 44-5