Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, Kilifi, Kenya.
Epilepsia. 2010 Dec;51(12):2370-6. doi: 10.1111/j.1528-1167.2010.02653.x.
Epilepsy is common in sub-Saharan Africa but is poorly characterized. Most studies are hospital-based, and may not reflect the situation in rural areas with limited access to medical care. We examined people with active convulsive epilepsy (ACE), to determine if the clinical features could help elucidate the causes.
We conducted a detailed descriptive analysis of 445 people with ACE identified through a community-based survey of 151,408 people in rural Kenya, including the examination of electroencephalograms.
Approximately half of the 445 people with ACE were children aged 6 to 18 years. Seizures began in childhood in 78% of those diagnosed. An episode of status epilepticus was recalled by 36% cases, with an episode of status epilepticus precipitated by fever in 26%. Overall 169 had an abnormal electroencephalogram, 29% had focal features, and 34% had epileptiform activity. In the 146 individuals who reported generalized tonic-clonic seizures only, 22% had focal features on their electroencephalogram. Overall 71% of patients with ACE had evidence of focal abnormality, documented by partial onset seizures, focal neurologic deficits, or focal abnormalities on the electroencephalogram. Increased seizure frequency was strongly associated with age and cognitive impairment in all ages and nonattendance at school in children (p < 0.01).
Children and adolescents bear the brunt of epilepsy in a rural population in Africa. The predominance of focal features and the high proportion of patients with status epilepticus, suggests that much of the epilepsy in this region has identifiable causes, many of which could be prevented.
在撒哈拉以南非洲，癫痫很常见，但描述不足。大多数研究都是基于医院的，可能无法反映在医疗资源有限的农村地区的情况。我们研究了患有活动性癫痫（ACE）的患者，以确定临床特征是否有助于阐明病因。
我们对通过肯尼亚农村地区 151408 人的社区调查中确定的 445 名 ACE 患者进行了详细的描述性分析，包括脑电图检查。
445 名 ACE 患者中约有一半是 6 至 18 岁的儿童。在确诊的患者中，78%的患者在儿童时期就开始出现癫痫发作。36%的患者曾出现过癫痫持续状态，26%的患者癫痫持续状态是由发热引起的。总的来说，有 169 人的脑电图异常，29%有局灶性特征，34%有癫痫样活动。在报告仅有全身性强直-阵挛发作的 146 名个体中，22%的人脑电图有局灶性特征。总的来说，71%的 ACE 患者有局灶性异常的证据，表现为部分发作性癫痫、局灶性神经功能缺损或脑电图上的局灶性异常。癫痫发作频率的增加与所有年龄段的年龄和认知障碍以及儿童不上学（p<0.01）密切相关。
在非洲农村地区，儿童和青少年是癫痫的主要负担人群。局灶性特征占主导地位，癫痫持续状态的比例较高，这表明该地区的许多癫痫都有明确的病因，其中许多病因是可以预防的。
