Electroencephalographic features of convulsive epilepsy in Africa: A multicentre study of prevalence, pattern and associated factors.
OBJECTIVE
We investigated the prevalence and pattern of electroencephalographic (EEG) features of epilepsy and the associated factors in Africans with active convulsive epilepsy (ACE).


METHODS
We characterized electroencephalographic features and determined associated factors in a sample of people with ACE in five African sites. Mixed-effects modified Poisson regression model was used to determine factors associated with abnormal EEGs.


RESULTS
Recordings were performed on 1426 people of whom 751 (53%) had abnormal EEGs, being an adjusted prevalence of 2.7 (95% confidence interval (95% CI), 2.5-2.9) per 1000. 52% of the abnormal EEG had focal features (75% with temporal lobe involvement). The frequency and pattern of changes differed with site. Abnormal EEGs were associated with adverse perinatal events (risk ratio (RR)=1.19 (95% CI, 1.07-1.33)), cognitive impairments (RR=1.50 (95% CI, 1.30-1.73)), use of anti-epileptic drugs (RR=1.25 (95% CI, 1.05-1.49)), focal seizures (RR=1.09 (95% CI, 1.00-1.19)) and seizure frequency (RR=1.18 (95% CI, 1.10-1.26) for daily seizures; RR=1.22 (95% CI, 1.10-1.35) for weekly seizures and RR=1.15 (95% CI, 1.03-1.28) for monthly seizures)).


CONCLUSIONS
EEG abnormalities are common in Africans with epilepsy and are associated with preventable risk factors.


CONCLUSIONS
EEG is helpful in identifying focal epilepsy in Africa, where timing of focal aetiologies is problematic and there is a lack of neuroimaging services.
KEMRI-Wellcome Trust Research Programme, P.O. Box 230, Kilifi, Kenya; Nuffield Department of Medicine, University of Oxford, OX3 7BN Oxford, UK. Electronic address: skariuki@kemri-wellcome.org.
Symon M
SM
Kariuki
Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children, WC1N 3JH London, UK.
Steven
S
White
KEMRI-Wellcome Trust Research Programme, P.O. Box 230, Kilifi, Kenya; Foundation for People with Epilepsy, 80200 Malindi, Kenya.
Eddie
E
Chengo
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, P.O. Box 2 Cornhoek 1360, Johannesburg, South Africa; Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901 85 Umeå, Sweden.
Ryan G
RG
Wagner
Kintampo Health and Demographic Surveillance System, P.O. Box 200, Kintampo, Ghana.
Kenneth A
KA
Ae-Ngibise
Iganga-Mayuge Health and Demographic Surveillance System, P.O. Box 111, Iganga, Uganda; Department of Paediatrics and Child Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
Angelina
A
Kakooza-Mwesige
Ifakara Health and Demographic Surveillance System, P.O. Box 78373, Ifakara, Tanzania.
Honorati
H
Masanja
Population Health Sciences/Research Support Unit, Faculty of Health Sciences, Aga Khan University (East Africa), Aga Khan Hospital Building, Third Parklands Ave., P.O. Box 30270, Nairobi, Kenya.
Anthony K
AK
Ngugi
NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG and Epilepsy Society, Chalfont St. Peter SL9 8ES, Bucks, UK; Stichting Epilepsie Instellingen Nederland-SEIN, 2103SW Heemstede, Netherlands.
Josemir W
JW
Sander
Neurosciences Unit, UCL Institute of Child Health, WC1E 6BT London, UK.
Brian G
BG
Neville
KEMRI-Wellcome Trust Research Programme, P.O. Box 230, Kilifi, Kenya; Department of Psychiatry, University of Oxford, OX3 7JX Oxford, UK.
Charles R
CR
Newton
D000293:Adolescent; D000328:Adult; D000349:Africa / Q000453:epidemiology; D002648:Child; D004569:Electroencephalography / Q000379:methods*; D004827:Epilepsy / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D055815:Young Adult
Active convulsive epilepsy; Africa; Electroencephalographic features; Risk factors