Génétique de l’épilepsie en Afrique: défis et perspectives futures

Despite the diversity of the African population, genetic studies, of epilepsy in particular, have been limited, especially in sub-Saharan Africa. In recent years, with the regression of infectious diseases in developing countries, the focus has shifted more towards non communicable disorders. The prevalence of epilepsy in Africa is higher compared to other continents. Although this has been attributed to the high rate of infectious diseases, genetic contributions should not be ignored. Research in genetic epilepsy in Africa could well benefit from the decreasing cost of genetic analysis, and could contribute to further our knowledge on the spectrum of these diseases in Africa. The growing collaboration between African research institutions and those of developed countries offers a unique opportunity to boost research in Africa and improve our global understanding of human disease, thus leading to the development of better therapeutic approaches.Malgré la diversité de la population africaine, les études génétiques, de l’épilepsie en particulier, ont été limitées, surtout en Afrique sub-saharienne. Dans les années récentes, avec la régression des maladies infectieuses dans les pays en développement, les regards sont tournés vers les maladies non transmissibles. La prévalence de l’épilepsie en Afrique est plus élevée que dans les autres continents. Bien que ceci ait été lié au taux élevé des maladies infectieuses, la contribution génétique ne devrait pas être ignorée. La recherche sur la génétique de l’épilepsie pourrait bénéficier de la baisse continue des coûts d’analyses génétiques et pourrait contribuer à l’augmentation de notre connaissance du spectre de ces maladies en Afrique. La collaboration croissante entre les institutions de recherche africaines et celles des pays développés offre une opportunité unique de booster la recherche en Afrique et améliorer notre compréhension des maladies humaines, permettant ainsi le développement de meilleures approches thérapeutiques

Case management of epilepsy in rural villages of Mali, a three years cohort study.

International audienc

Results of an action-research on epilepsy in rural Mali.

To evaluate the RARE (Réseau Action-Recherche sur l'Epilepsie) program, a model of managing and treating people with epilepsy (PWE) at a primary health-care level in rural areas of Mali, we assessed treatment efficacy and compliance of patients who underwent the first year follow-up.A network of rural general practitioners (GPs) settled in six rural districts of the regions of Koulikoro, Segou and Sikasso, was involved in the diagnosis, evaluation and monitoring of all the identified PWE and in the distribution of phenobarbital (PB). All the participants were included in a prospective database and followed-up by GPs at 4 months intervals during the first year. Seizure frequency, treatment doses and appearance of adverse events (AEs) were systematically recorded. Efficacy was evaluated in terms of reduction of seizures frequency while noncompliance in terms of time to study withdrawal for any cause.596 patients treated with PB were included in the analysis. Of these, 74.0% completed the first year follow-up. At the final visit, 59.6% were seizure-free: 31.0% for 12 months, 10.2% for 8 months and 18.4% for 4 months. Adults and patients with convulsive seizures were the most drug-resistant (p<0.002). Few AEs were recorded. The multivariate analysis showed that being a woman, presenting convulsive seizures, having more than 5 seizures/month and had never be treated were predictors of withdrawal (p ≤ 0.05) at 12 months.This study showed a good response and compliance to the treatment and allowed the identification of some factors associated with failure of management in a setting very near to clinical practice. Awareness campaigns are needed to assure a broader accessibility to treatment and to improve the compliance and continuity with treatment programs

Prise en charge de l'épilepsie en zone rurale au Mali. Suivi sur trois ans d'une cohorte de patients.

International audienc

Kaplan-Meier plots illustrating time to withdrawal for any cause for the groups of convulsive and non-convulsive seizures.

<p>Kaplan-Meier plots illustrating time to withdrawal for any cause for the groups of convulsive and non-convulsive seizures.</p

Time to first seizure.

<p>Kaplan-Meier analysis for cumulative event rates during the first year follow-up for the groups of convulsive and non-convulsive seizures.</p

Factors influencing patients withdrawal: univariate and multivariable analysis of the 596 treated people with epilepsy.

<p>Factors influencing patients withdrawal: univariate and multivariable analysis of the 596 treated people with epilepsy.</p

Patients enrollment and treatments underwent.

<p>Patients enrollment and treatments underwent.</p