Women's perspectives on epilepsy and its sociocultural impact in south western Nigeria

Background There has been little study of the specific implications of living with epilepsy for women in societies where they already face gender based marginalization. Purpose Understanding the sociocultural aspects of epilepsy in women will help to improve the management of epilepsy in the community. Methods A series of six focus groups were held in urban and rural Southwest Nigeria.Results Epilepsy was commonly attributed to a spiritual attack, witchcraft and other supernatural causes. Denial of the diagnosis of epilepsy was common among women with nocturnal or focal seizures. Majority of women with epilepsy preferred multiple modalities of care in the following order: traditional, spiritual and western. The cost of traditional care was astronomical and most were already impoverished by the time they sought western care. WWE experienced stigma, social exclusion, isolation particularly from paternal relations, in -laws, and community members. Epilepsy related stigma contributed to schooling problems, difficulty in getting married, separation, divorce and problems with childcare and role fulfilment. One unanticipated result of this study was that public announcements made to identify rural study participants created a demand for western health services in rural populations previously unaware that epilepsy could be controlled through western medication.Conclusion Women with epilepsy face significant and persistent social, economic and cultural barriers. There is the need to educate women, their family and community members to reduce misconceptions and stigma. Community based medical treatment can be improved by taking into consideration the surrounding social, economic and cultural challenges faced by women with epilepsy. The care of epilepsy need to be incorporated into the primary health care system; regular awareness campaigns to be carried out in order to improve knowledge and attitudes and reduce stigma and social exclusion of women with epilepsy. Specific social welfare programmes and educational programme should be established to encourage the full integration of women with epilepsy in the society

Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality

Background and purpose: Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). Results: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. Conclusions: During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT

Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality.

BACKGROUND AND PURPOSE: Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. METHODS: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). RESULTS: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. CONCLUSIONS: During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT

Epilepsy and Sleep Disorders: a Clinical Review

Patients with epilepsy (PWE) are at risk of developing sleep disorders and there is a complex inter-relationship between sleep disorders and epilepsy. Sleep disorders could be misdiagnosed as epilepsy and also worsen epilepsy. We searched Medline and Pubmed between 1962-2012, using the following search terms 'sleep', 'epilepsy', 'parasomnia', 'Obstructive Sleep apnea', 'restless legs' 'idiopathic generalized epilepsy'. One hundred and eighteen relevant studies were reviewed and categorized into the effects of epilepsy on sleep, effects of sleep and sleep deprivation on seizures, effects of anticonvulsants on sleep, insomnia, excessive day time sleepiness, obstructive sleep apnoea, parasomnias, REM behavior disorder, sudden unexpected death in epilepsy and quality of life. Sleep disorders are common in persons with epilepsy. Physicians and general practitioners need to know the interaction of sleep disorders and epilepsy.This problem has been under researched in Nigeria. More studies are needed to assess the prevalence and pattern of sleep disorders among PWE's in Nigeria.Key words: Sleep disorder, Epilepsy, Nigeria

Women’s Issues and Epilepsy: A Look at Health Care Practitioners

Previous reports from developed countries indicated that health care professionals had poor knowledge of women’s issues and epilepsy and the women with epilepsy may not be adequately informed about their illness. Health care professionals that attended the 18th Pan African Association of Neurological Sciences in Yaounde, Cameroun were asked to complete the knowledge of women issues and epilepsy (KOWIE) II questionnaire. A totalof 55 health care professionals participated in the survey. 67.3% were males while 32.7% were females. The mean age of the respondents was 39.35 (+12.07) years. About thirty six percent of the respondents were neurologists, 27.3% were in Internal Medicine while the rest comprised of general practitioners, pediatric neurologists, neurosurgeons, neuroscience nurses and neurophysiologists. There was poor knowledge of the effect of sex hormones on seizure threshold during menstrual cycles while only one fourth of the respondents were aware of the high incidence of sexual dysfunctions in women with epilepsy. About half of the respondents were aware of the deleterious effect of antiepileptic drugs on bone health. Their knowledge was better on pregnancy related issues such as the importance of administration of vitamin K to neonates of women with epilepsy to prevent haemorhagic disease of the newborn, the need for women with epilepsy to continue anti-epileptic drugs during pregnancy. More than half of the respondents were aware that the best antiepileptic drugs in pregnancy is the one that is most appropriate for the patients seizure type or syndrome. However there was no relationship between the number of years in practice or the number of patients seen per month by the respondents and the survey accuracy score. But the specialty of the respondents influenced the survey score as the paediatric and adult neurologists had the highest survey accuracy score. This study showed that the paediatric and adult neurologists were better informed on women’s  issues and epilepsy than other clinical neuroscientists