title: Prevalence and factors associated with convulsive status epilepticus in Africans with epilepsy.
abstract: OBJECTIVE
  We conducted a community survey to estimate the prevalence and describe the features, risk factors, and consequences of convulsive status epilepticus (CSE) among people with active convulsive epilepsy (ACE) identified in a multisite survey in Africa.
  
  
  METHODS
  We obtained clinical histories of CSE and neurologic examination data among 1,196 people with ACE identified from a population of 379,166 people in 3 sites: Agincourt, South Africa; Iganga-Mayuge, Uganda; and Kilifi, Kenya. We performed serologic assessment for the presence of antibodies to parasitic infections and HIV and determined adherence to antiepileptic drugs. Consequences of CSE were assessed using a questionnaire. Logistic regression was used to identify risk factors.
  
  
  RESULTS
  The adjusted prevalence of CSE in ACE among the general population across the 3 sites was 2.3 per 1,000, and differed with site (p < 0.0001). Over half (55%) of CSE occurred in febrile illnesses and focal seizures were present in 61%. Risk factors for CSE in ACE were neurologic impairments, acute encephalopathy, previous hospitalization, and presence of antibody titers to falciparum malaria and HIV; these differed across sites. Burns (15%), lack of education (49%), being single (77%), and unemployment (78%) were common in CSE; these differed across the 3 sites. Nine percent with and 10% without CSE died.
  
  
  CONCLUSIONS
  CSE is common in people with ACE in Africa; most occurs with febrile illnesses, is untreated, and has focal features suggesting preventable risk factors. Effective prevention and the management of infections and neurologic impairments may reduce the burden of CSE in ACE.
authors.affiliation: From Kenya Medical Research Institute-Wellcome Trust Research Programme (S.M.K., E.C., G.K., A.K.N., C.R.J.N.), Kilifi, Kenya; Nuffield Department of Medicine (S.M.K.), University of Oxford, UK; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.-M., R.G.W., E.C., G.K., A.K.N., C.R.J.N.), Accra, Ghana; Iganga-Mayuge Health and Demographic Surveillance System (A.K.-M.), Iganga; the Department of Paediatrics and Child Health (A.K.-M.), Makerere University College of Health Sciences, Kampala, Uganda; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) (R.G.W.), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Global Health (R.G.W.), Department of Public Health and Clinical Medicine, Umeå University, Sweden; the Neurophysiology Department (S.W.), Great Ormond Street Hospital for Children, London; the Neurosciences Unit (B.G.R.N., C.R.J.N.), UCL Institute of Child Health, London, UK; Population Health Sciences/Research Support Unit (A.K.N.), Faculty of Health Sciences, Aga Khan University (East Africa), Nairobi, Kenya; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S.), Bucks, UK; Stichting Epilepsie Instellingen Nederland-SEIN (J.W.S.), Heemstede, Netherlands; Clinical Research Unit (C.R.J.N.), London School of Hygiene and Tropical Medicine; and the Department of Psychiatry (C.R.J.N.), University of Oxford, UK. skariuki@kemri-wellcome.org.
authors.forename: Symon M
authors.initials: SM
authors.lastname: Kariuki
authors.affiliation: From Kenya Medical Research Institute-Wellcome Trust Research Programme (S.M.K., E.C., G.K., A.K.N., C.R.J.N.), Kilifi, Kenya; Nuffield Department of Medicine (S.M.K.), University of Oxford, UK; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.-M., R.G.W., E.C., G.K., A.K.N., C.R.J.N.), Accra, Ghana; Iganga-Mayuge Health and Demographic Surveillance System (A.K.-M.), Iganga; the Department of Paediatrics and Child Health (A.K.-M.), Makerere University College of Health Sciences, Kampala, Uganda; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) (R.G.W.), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Global Health (R.G.W.), Department of Public Health and Clinical Medicine, Umeå University, Sweden; the Neurophysiology Department (S.W.), Great Ormond Street Hospital for Children, London; the Neurosciences Unit (B.G.R.N., C.R.J.N.), UCL Institute of Child Health, London, UK; Population Health Sciences/Research Support Unit (A.K.N.), Faculty of Health Sciences, Aga Khan University (East Africa), Nairobi, Kenya; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S.), Bucks, UK; Stichting Epilepsie Instellingen Nederland-SEIN (J.W.S.), Heemstede, Netherlands; Clinical Research Unit (C.R.J.N.), London School of Hygiene and Tropical Medicine; and the Department of Psychiatry (C.R.J.N.), University of Oxford, UK.
authors.forename: Angelina
authors.initials: A
authors.lastname: Kakooza-Mwesige
authors.affiliation: From Kenya Medical Research Institute-Wellcome Trust Research Programme (S.M.K., E.C., G.K., A.K.N., C.R.J.N.), Kilifi, Kenya; Nuffield Department of Medicine (S.M.K.), University of Oxford, UK; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.-M., R.G.W., E.C., G.K., A.K.N., C.R.J.N.), Accra, Ghana; Iganga-Mayuge Health and Demographic Surveillance System (A.K.-M.), Iganga; the Department of Paediatrics and Child Health (A.K.-M.), Makerere University College of Health Sciences, Kampala, Uganda; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) (R.G.W.), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Global Health (R.G.W.), Department of Public Health and Clinical Medicine, Umeå University, Sweden; the Neurophysiology Department (S.W.), Great Ormond Street Hospital for Children, London; the Neurosciences Unit (B.G.R.N., C.R.J.N.), UCL Institute of Child Health, London, UK; Population Health Sciences/Research Support Unit (A.K.N.), Faculty of Health Sciences, Aga Khan University (East Africa), Nairobi, Kenya; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S.), Bucks, UK; Stichting Epilepsie Instellingen Nederland-SEIN (J.W.S.), Heemstede, Netherlands; Clinical Research Unit (C.R.J.N.), London School of Hygiene and Tropical Medicine; and the Department of Psychiatry (C.R.J.N.), University of Oxford, UK.
authors.forename: Ryan G
authors.initials: RG
authors.lastname: Wagner
authors.affiliation: From Kenya Medical Research Institute-Wellcome Trust Research Programme (S.M.K., E.C., G.K., A.K.N., C.R.J.N.), Kilifi, Kenya; Nuffield Department of Medicine (S.M.K.), University of Oxford, UK; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.-M., R.G.W., E.C., G.K., A.K.N., C.R.J.N.), Accra, Ghana; Iganga-Mayuge Health and Demographic Surveillance System (A.K.-M.), Iganga; the Department of Paediatrics and Child Health (A.K.-M.), Makerere University College of Health Sciences, Kampala, Uganda; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) (R.G.W.), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Global Health (R.G.W.), Department of Public Health and Clinical Medicine, Umeå University, Sweden; the Neurophysiology Department (S.W.), Great Ormond Street Hospital for Children, London; the Neurosciences Unit (B.G.R.N., C.R.J.N.), UCL Institute of Child Health, London, UK; Population Health Sciences/Research Support Unit (A.K.N.), Faculty of Health Sciences, Aga Khan University (East Africa), Nairobi, Kenya; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S.), Bucks, UK; Stichting Epilepsie Instellingen Nederland-SEIN (J.W.S.), Heemstede, Netherlands; Clinical Research Unit (C.R.J.N.), London School of Hygiene and Tropical Medicine; and the Department of Psychiatry (C.R.J.N.), University of Oxford, UK.
authors.forename: Eddie
authors.initials: E
authors.lastname: Chengo
authors.affiliation: From Kenya Medical Research Institute-Wellcome Trust Research Programme (S.M.K., E.C., G.K., A.K.N., C.R.J.N.), Kilifi, Kenya; Nuffield Department of Medicine (S.M.K.), University of Oxford, UK; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.-M., R.G.W., E.C., G.K., A.K.N., C.R.J.N.), Accra, Ghana; Iganga-Mayuge Health and Demographic Surveillance System (A.K.-M.), Iganga; the Department of Paediatrics and Child Health (A.K.-M.), Makerere University College of Health Sciences, Kampala, Uganda; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) (R.G.W.), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Global Health (R.G.W.), Department of Public Health and Clinical Medicine, Umeå University, Sweden; the Neurophysiology Department (S.W.), Great Ormond Street Hospital for Children, London; the Neurosciences Unit (B.G.R.N., C.R.J.N.), UCL Institute of Child Health, London, UK; Population Health Sciences/Research Support Unit (A.K.N.), Faculty of Health Sciences, Aga Khan University (East Africa), Nairobi, Kenya; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S.), Bucks, UK; Stichting Epilepsie Instellingen Nederland-SEIN (J.W.S.), Heemstede, Netherlands; Clinical Research Unit (C.R.J.N.), London School of Hygiene and Tropical Medicine; and the Department of Psychiatry (C.R.J.N.), University of Oxford, UK.
authors.forename: Steven
authors.initials: S
authors.lastname: White
authors.affiliation: From Kenya Medical Research Institute-Wellcome Trust Research Programme (S.M.K., E.C., G.K., A.K.N., C.R.J.N.), Kilifi, Kenya; Nuffield Department of Medicine (S.M.K.), University of Oxford, UK; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.-M., R.G.W., E.C., G.K., A.K.N., C.R.J.N.), Accra, Ghana; Iganga-Mayuge Health and Demographic Surveillance System (A.K.-M.), Iganga; the Department of Paediatrics and Child Health (A.K.-M.), Makerere University College of Health Sciences, Kampala, Uganda; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) (R.G.W.), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Global Health (R.G.W.), Department of Public Health and Clinical Medicine, Umeå University, Sweden; the Neurophysiology Department (S.W.), Great Ormond Street Hospital for Children, London; the Neurosciences Unit (B.G.R.N., C.R.J.N.), UCL Institute of Child Health, London, UK; Population Health Sciences/Research Support Unit (A.K.N.), Faculty of Health Sciences, Aga Khan University (East Africa), Nairobi, Kenya; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S.), Bucks, UK; Stichting Epilepsie Instellingen Nederland-SEIN (J.W.S.), Heemstede, Netherlands; Clinical Research Unit (C.R.J.N.), London School of Hygiene and Tropical Medicine; and the Department of Psychiatry (C.R.J.N.), University of Oxford, UK.
authors.forename: Gathoni
authors.initials: G
authors.lastname: Kamuyu
authors.affiliation: From Kenya Medical Research Institute-Wellcome Trust Research Programme (S.M.K., E.C., G.K., A.K.N., C.R.J.N.), Kilifi, Kenya; Nuffield Department of Medicine (S.M.K.), University of Oxford, UK; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.-M., R.G.W., E.C., G.K., A.K.N., C.R.J.N.), Accra, Ghana; Iganga-Mayuge Health and Demographic Surveillance System (A.K.-M.), Iganga; the Department of Paediatrics and Child Health (A.K.-M.), Makerere University College of Health Sciences, Kampala, Uganda; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) (R.G.W.), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Global Health (R.G.W.), Department of Public Health and Clinical Medicine, Umeå University, Sweden; the Neurophysiology Department (S.W.), Great Ormond Street Hospital for Children, London; the Neurosciences Unit (B.G.R.N., C.R.J.N.), UCL Institute of Child Health, London, UK; Population Health Sciences/Research Support Unit (A.K.N.), Faculty of Health Sciences, Aga Khan University (East Africa), Nairobi, Kenya; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S.), Bucks, UK; Stichting Epilepsie Instellingen Nederland-SEIN (J.W.S.), Heemstede, Netherlands; Clinical Research Unit (C.R.J.N.), London School of Hygiene and Tropical Medicine; and the Department of Psychiatry (C.R.J.N.), University of Oxford, UK.
authors.forename: Anthony K
authors.initials: AK
authors.lastname: Ngugi
authors.affiliation: From Kenya Medical Research Institute-Wellcome Trust Research Programme (S.M.K., E.C., G.K., A.K.N., C.R.J.N.), Kilifi, Kenya; Nuffield Department of Medicine (S.M.K.), University of Oxford, UK; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.-M., R.G.W., E.C., G.K., A.K.N., C.R.J.N.), Accra, Ghana; Iganga-Mayuge Health and Demographic Surveillance System (A.K.-M.), Iganga; the Department of Paediatrics and Child Health (A.K.-M.), Makerere University College of Health Sciences, Kampala, Uganda; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) (R.G.W.), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Global Health (R.G.W.), Department of Public Health and Clinical Medicine, Umeå University, Sweden; the Neurophysiology Department (S.W.), Great Ormond Street Hospital for Children, London; the Neurosciences Unit (B.G.R.N., C.R.J.N.), UCL Institute of Child Health, London, UK; Population Health Sciences/Research Support Unit (A.K.N.), Faculty of Health Sciences, Aga Khan University (East Africa), Nairobi, Kenya; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S.), Bucks, UK; Stichting Epilepsie Instellingen Nederland-SEIN (J.W.S.), Heemstede, Netherlands; Clinical Research Unit (C.R.J.N.), London School of Hygiene and Tropical Medicine; and the Department of Psychiatry (C.R.J.N.), University of Oxford, UK.
authors.forename: Josemir W
authors.initials: JW
authors.lastname: Sander
authors.affiliation: From Kenya Medical Research Institute-Wellcome Trust Research Programme (S.M.K., E.C., G.K., A.K.N., C.R.J.N.), Kilifi, Kenya; Nuffield Department of Medicine (S.M.K.), University of Oxford, UK; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.-M., R.G.W., E.C., G.K., A.K.N., C.R.J.N.), Accra, Ghana; Iganga-Mayuge Health and Demographic Surveillance System (A.K.-M.), Iganga; the Department of Paediatrics and Child Health (A.K.-M.), Makerere University College of Health Sciences, Kampala, Uganda; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) (R.G.W.), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Global Health (R.G.W.), Department of Public Health and Clinical Medicine, Umeå University, Sweden; the Neurophysiology Department (S.W.), Great Ormond Street Hospital for Children, London; the Neurosciences Unit (B.G.R.N., C.R.J.N.), UCL Institute of Child Health, London, UK; Population Health Sciences/Research Support Unit (A.K.N.), Faculty of Health Sciences, Aga Khan University (East Africa), Nairobi, Kenya; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S.), Bucks, UK; Stichting Epilepsie Instellingen Nederland-SEIN (J.W.S.), Heemstede, Netherlands; Clinical Research Unit (C.R.J.N.), London School of Hygiene and Tropical Medicine; and the Department of Psychiatry (C.R.J.N.), University of Oxford, UK.
authors.forename: Brian G R
authors.initials: BG
authors.lastname: Neville
authors.affiliation: From Kenya Medical Research Institute-Wellcome Trust Research Programme (S.M.K., E.C., G.K., A.K.N., C.R.J.N.), Kilifi, Kenya; Nuffield Department of Medicine (S.M.K.), University of Oxford, UK; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.-M., R.G.W., E.C., G.K., A.K.N., C.R.J.N.), Accra, Ghana; Iganga-Mayuge Health and Demographic Surveillance System (A.K.-M.), Iganga; the Department of Paediatrics and Child Health (A.K.-M.), Makerere University College of Health Sciences, Kampala, Uganda; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) (R.G.W.), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Global Health (R.G.W.), Department of Public Health and Clinical Medicine, Umeå University, Sweden; the Neurophysiology Department (S.W.), Great Ormond Street Hospital for Children, London; the Neurosciences Unit (B.G.R.N., C.R.J.N.), UCL Institute of Child Health, London, UK; Population Health Sciences/Research Support Unit (A.K.N.), Faculty of Health Sciences, Aga Khan University (East Africa), Nairobi, Kenya; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S.), Bucks, UK; Stichting Epilepsie Instellingen Nederland-SEIN (J.W.S.), Heemstede, Netherlands; Clinical Research Unit (C.R.J.N.), London School of Hygiene and Tropical Medicine; and the Department of Psychiatry (C.R.J.N.), University of Oxford, UK.
authors.forename: Charles R J
authors.initials: CR
authors.lastname: Newton
mesh_terms: D000293:Adolescent; D000328:Adult; D000913:Antibodies, Protozoan / Q000276:immunology; D000927:Anticonvulsants / Q000627:therapeutic use; D001927:Brain Diseases / Q000453:epidemiology; D002056:Burns / Q000453:epidemiology; D002648:Child; D004522:Educational Status; D004827:Epilepsy / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D015483:HIV Antibodies / Q000276:immunology; D015658:HIV Infections / Q000453:epidemiology* / Q000276:immunology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D016015:Logistic Models; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000276:immunology; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data; D015995:Prevalence; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D013226:Status Epilepticus / Q000453:epidemiology* / Q000401:mortality; D014454:Uganda / Q000453:epidemiology; D014478:Unemployment / Q000706:statistics & numerical data; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000913:Antibodies, Protozoan; D000927:Anticonvulsants; D015483:HIV Antibodies
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