clove and Epilepsy

Status Epilepticus (SE) is a diagnostic and therapeutic emergency. The purpose of this study was to establish the frequency, the clinical and therapeutic features of patients with SE at the Department of Neurology of Befelatanana.. we conducted a retrospective, descriptive study from January to June 2015. The sociodemographic and clinical features of patients were collected and analyzed on Epi info 7.. the study involved 53 patients, 54.71% of whom were epileptic (n=29). There was a predominance of patients under 65 years of age (86.79%). The average age of patients was 43.09 years with a sex-ratio of 1.30. Convulsive SE prevailed in 98.11% of cases (n=52). Generalized convulsive SE occurred in 66.03% of cases. STESS below 3 (77.35%) predominated. There were no epileptic abnormalities on standard EEG within 24 hours in all patients with SE. Non-adherence to antiepileptic therapy (9.43%) and sleep deprivation (18.86%) were reported as a trigger factor of SE. No seizure was reported for up to 72 hours after initiation of treatment in 84,90% of cases. We found no significant association between epileptic or non-epileptic status and STESS (p = 0.302), treatment protocol (p = 0.532), and 72-hour remission of seizures (p = 0.211).. SE affects young and epileptic people. Our treatment protocol allowed for crisis remission within 72h in most cases. A validation study about this therapeutic protocol is required.

Topics: Adult; Epilepsy; Hospitals; Humans; Madagascar; Neurology; Retrospective Studies; Seizures; Status Epilepticus

Epilepsy is a chronic disease of the brain that affects approximately 50 million people globally, with over 80 % of them living in low- and middle-income countries (LMICs). In Madagascar, as in most LMICs, one of the main obstacles to treatment is the stigma and discrimination experienced by patients. Beliefs and prejudices regarding this disease are common, especially among children. "Ao Tsara" is an educational comic book regarding epilepsy, which has been translated in Malagasy from a French version, and which objective is to raise awareness and fight epilepsy related stigma and discrimination. Comic books have indeed been used successfully to raise awareness and change behaviors in several areas of public health.. We conducted a study to evaluate the effect of a single reading of this comic book on epilepsy related knowledge, attitudes and practices (KAP) in schoolchildren in Madagascar. This quasi-experimental study compared data collected before and immediately after reading "Ao Tsara". It was conducted both in a school in an urban area and in a school in a rural area.. We recruited 244 children with a mean age of 11.4 (±1.5) in this study. We noted a significant improvement in the global KAP score after reading the comic book, overall as well as both in the urban school and the rural school. Out of a maximum score of twenty, the global KAP score increased from 9.4 to 11.2 (p < 0.001). Although the increase in knowledge was reasonable (from 10.2 to 12.9, p < 0.001) and the corresponding subscore after reading the comic book was at a satisfactory level, that was not the case for attitudes & practices, where the sub-score despite a significant increase remained low (from 8.7 to 9.5 out of a maximum score of twenty, p < 0.001). The comic book was much appreciated by the children with more than 50.0 % giving it the top rating, and 66.4 % stating they had learned a lot from it.. A single reading of the comic book has demonstrated a positive effect on the knowledge, attitudes and practices of primary school children in Madagascar. This educational tool, which was much enjoyed by the children, could be of great value to raise awareness about epilepsy in Madagascar. By targeting a slightly older age group and adjusting the reading approach, the outcomes could be optimized especially in terms of attitudes and practices.

Topics: Aged; Books; Child; Educational Status; Epilepsy; Health Knowledge, Attitudes, Practice; Humans; Madagascar; Surveys and Questionnaires

Epilepsy is a major public health issue in low- and middle-income countries, where the availability and accessibility of quality treatment remain important issues, the severity of which may be aggravated by poor quality antiepileptic drugs (AEDs). The primary objective of this study was to measure the quality of AEDs in rural and urban areas in 3 African countries.. This cross-sectional study was carried out in Gabon, Kenya, and Madagascar. Both official and unofficial supply chains in urban and rural areas were investigated. Samples of oral AEDs were collected in areas where a patient could buy or obtain them. Pharmacological analytical procedures and Medicine Quality Assessment Reporting Guidelines were used to assess quality.. In total, 102 batches, representing 3782 units of AEDs, were sampled. Overall, 32.3% of the tablets were of poor quality, but no significant difference was observed across sites: 26.5% in Gabon, 37.0% in Kenya, and 34.1% in Madagascar (P = .7). The highest proportions of substandard medications were found in the carbamazepine (38.7%; 95% confidence interval [CI] 21.8-57.8) and phenytoin (83.3%; 95% CI 35.8-99.5) batches, which were mainly flawed by their failure to dissolve. Sodium valproate was the AED with the poorest quality (32.1%; 95% CI 15.8-42.3). The phenobarbital (94.1%; 95% CI 80.3-99.2) and diazepam (100.0%) batches were of better quality. The prevalence of substandard quality medications increased in samples supplied by public facilities (odds ratio [OR] 9.9; 95% CI 1.2-84.1; P < .04) and manufacturers located in China (OR 119.8; 95% CI 8.7-1651.9; P < .001). The prevalence of AEDs of bad quality increased when they were stored improperly (OR 5.4; 95% CI 1.2-24.1; P < .03).. No counterfeiting was observed. However, inadequate AED storage conditions are likely to lead to ineffective and possibly dangerous AEDs, even when good-quality AEDs are initially imported.

Topics: Administration, Oral; Anticonvulsants; Cross-Sectional Studies; Developing Countries; Epilepsy; Gabon; Humans; Kenya; Madagascar; Quality Control; Rural Health; Urban Health

To determine the accessibility of treatment and the quality of antiepileptic drugs (AEDs) in the Haute Matsiatra district of Madagascar.. Cross-sectional descriptive study and interviews. Samples of 10 units of each available AED were collected, and the active ingredient was quantified by reversed-phase high-performance liquid chromatography (RP-HPLC) with photodiode-array UV detection. The quality of an AED was considered satisfactory if the quantity of active ingredient in each tablet was in the range ±15% of the average value according to the European Pharmacopeia (6th edition, 2008).. The area was well served with health infrastructure but rescue facilities were poorly distributed. Available AEDs were all first-generation, and 73% were generic formulations. People with epilepsy (PWE) surveyed consulted traditional healers and most were treated with plants. PWE did not consider themselves sick but believed they were "possessed"; they consulted a doctor only immediately after a seizure, following the advice of traditional healers. The most prescribed AED was phenobarbital, costing between 0.03 and 0.12 US Dollar (US$) per 100mg. The purchase of full treatment was difficult for 77% of PWE and as a result, 39% took nothing. The quality of AEDs were considered unsatisfactory in 2.8% of cases.. The AEDs collected in Haute Matsiatra were globally of good quality. The main limiting elements were a lack of knowledge among PWE that epilepsy is a disease, and the cost of traditional treatments.

Topics: Adolescent; Adult; Anticonvulsants; Cross-Sectional Studies; Epilepsy; Female; Health Services Accessibility; Humans; Madagascar; Male; Phenobarbital; Young Adult

Topics: Epilepsy; Female; Health Knowledge, Attitudes, Practice; Humans; Madagascar; Male

Using an indirect assessment technique we assessed the epilepsy treatment gap (ETG) in Madagascar. We estimate the ETG in Madagascar to be 92%. However, given the sociological, economic and sanitary conditions of the country, it is likely that the true ETG is even higher than our estimate. Our study also documents the lack of access to treatment for patients in this developing country. The indirect method could be used to assess the treatment gaps of other chronic medical conditions.

Topics: Anticonvulsants; Barbiturates; Delivery of Health Care; Developing Countries; Diazepam; Drug Therapy, Combination; Epilepsy; Health Services Accessibility; Humans; Hypnotics and Sedatives; Madagascar; Phenobarbital

Being associated to fecal-oral transmission, cysticercosis is contracted either by auto-infection or by ingestion of food contaminated with eggs from the pork tape worm (Taenia solium). In the stomach, the larvae named cysticercus (Cysticercus cellulosae) hatches from the eggs and invades the host through the mucosa membrane. Human cysticercosis occurs in highly prevalent proportions in many developing countries including Madagascar where hygiene conditions are deplicable. Serology tests applicable to epidemiological surveillance of cysticercosis and associated pathology in the Malagasy population have been developed: an enzyme-linked immunosorbent assay (ELISA) for screening purpose, and an enzyme-linked immunoelectrotransfer blot assay (EITB) for confirmative testing. Two specific bands (13 and 14 kDa) have been identified as significant markers of the cysticercus in an active (vesicle) stage of the infection when cestocidal treatment is strongly indicated. The same bands may on the other hand be absent at early (cyste) as well as late (calcified) stages of the infection. Series of studies, including 4,375 serum samples, have been undertaken from 1994 until 1999 aiming at determinating the cysticercosis sero-prevalence in different provinces of Madagascar. It was confirmed that cysticercosis is highly frequent on the island, and that there exists a marked variation in the prevalence from 7 to 21% between the different provinces: less than 10% in coastal regions (Mahajanga and Toamasina) increasing to 20% in central regions (Ihosy, Ambositra and Mahasolo). It has also been observed that cysticercosis may occur in individuals at any age, and that it is equally distributed in urban as in rural areas. However, it is more frequently detected in women than in men. Madagascar is an endemic country for cysticercosis, which causes major and severe disease with implications in the public health sector. A national control program is, therefore, urgently warranted.

Topics: Adolescent; Adult; Age Distribution; Aged; Child; Cross-Sectional Studies; Cysticercosis; Eggs; Endemic Diseases; Enzyme-Linked Immunosorbent Assay; Epilepsy; Feces; Female; Hand Disinfection; Humans; Immunoenzyme Techniques; Madagascar; Male; Mass Screening; Middle Aged; Needs Assessment; Population Surveillance; Residence Characteristics; Seroepidemiologic Studies; Sex Distribution; Toilet Facilities

Neurocysticercosis is the most frequent parasitosis of central nervous system in the world. Neurological manifestations are in relation with locations number and topography, inflammatory reactions level and state of development of the parasite. Epilepsy is the main revealing symptom. Among other neurological manifestations, chronic headache, focal neurological signs, ataxia, language and behaviour disorder are the most anecdotal. The authors report a case of neurocysticercosis in a 71-year-old man with dysarthria and memory problems. Suspected by computed tomography, diagnosis was confirmed by immunoserologic assays such as enzyme-linked immunosorbent assay (ELISA) or enzyme-linked immunoelectrotransfer blot assay (EITB). This later emphasized on active form of the cyst. Specific treatment used albendazole as antihelminthic drug. Clinical evolution was good: neuroimaging and immunoserology results were normal respectively 2 and 6 months after the drug therapy.

Topics: Aged; Albendazole; Anthelmintics; Dysarthria; Endemic Diseases; Enzyme-Linked Immunosorbent Assay; Epilepsy; Humans; Immunoblotting; Madagascar; Male; Memory Disorders; Neurocysticercosis; Tomography, X-Ray Computed; Treatment Outcome

A general population survey on knowledge, attitudes and practices (K.A.P.) concerning epilepsy was conducted from 1st July to 31st December 1997 in Antananarivo, a region representative of ecological and cultural patterns of the Malagasy "Highlands". The sample, randomly selected according to the two-step cluster method, recruited 1392 men and women aged 18 years and older who were interviewed with a 16-item questionnaire. Knowledge and practices have significantly evolved since 1983, when a similar study was conducted. More natural explanations are given for the condition and health-care seeking is more common. However, popular attitudes towards the epileptic patient remain contradictory: the majority of those interviewed claimed to be tolerant; work and marriage could be envisaged for the epileptic patient, but not total freedom of movement nor regular school attendance. A more active popularisation of the disease thus appears to be necessary. Since some 60% of people had a radio, broadcasting and church involvement would be the most effective means towards this end. Traditional practicer do not seem to have an overwhelming influence; rather, healthcare seeking behaviour was determined by the availability of service, the efficacy of the intervention and cost. To be representative of Madagascar as a whole, our data should be compared to those of other surveys in more culturally enclosed and disadvantaged areas.

Topics: Adolescent; Adult; Attitude to Health; Cluster Analysis; Educational Status; Employment; Epilepsy; Female; Health Education; Health Knowledge, Attitudes, Practice; Humans; Madagascar; Male; Marriage; Mass Media; Needs Assessment; Patient Acceptance of Health Care; Prospective Studies; Surveys and Questionnaires; Urban Health

To assess the impact of cysticercosis on public health in Madagascar, we compared patients > 15 years with late-onset epilepsy to non-epileptic controls in a matched case-control study. The association between epilepsy and cysticercosis was studied by enzyme-linked immunoelectrotransfer blot (EITB) assay for antibodies specific to Taenia solium. The EITB assay was performed on 104 pairs of sera specimens and on 95 pairs of cerebrospinal fluid (CSF) specimens. Depending on whether we consider the results obtained from sera or from CSF, we obtain for the population attributable risk percent of cysticercosis in late-onset epilepsy two slightly different estimates: 22.3% and 17.6%. Therefore cysticercosis is a major aetiological factor of late-onset epilepsy in Madagascar. In the control group, the frequency of positive results, especially in CSF specimens (7.4%), confirms the existence of asymptomatic cases of neurocysticercosis.

Topics: Adolescent; Adult; Aged; Animals; Antibodies, Helminth; Case-Control Studies; Cysticercosis; Epilepsy; Female; Humans; Immunoblotting; Madagascar; Male; Middle Aged; Risk; Seroepidemiologic Studies; Taenia

Neurocysticercosis (i.e. cerebral localization of the metacestode larvae of Taenia solium) is believed to be a major cause of late onset epilepsy in non-Muslim developing countries. To define its role in childhood epilepsy in Madagascar, analysis of serological markers of cysticercosis was performed in 256 children with unexplained epilepsy and in 113 controls. Sera were considered positive when high titres in ELISA were present together with at least one of the bands 13, 14, 18, 21, 24 or 32 kD on Western blot. Altogether, 17.6% of the patients versus none of the controls were seropositive using these criteria. When analysing the bands of the Western blot, those of 13, 14 and 18 were significantly more frequently detected in sera of epileptic children than in sera of controls. Neurocysticercosis can be considered the main cause of secondary childhood epilepsy in our country, Madagascar being one of the most important foci in the world.

Topics: Adolescent; Biomarkers; Blotting, Western; Brain Diseases; Child; Child, Preschool; Cysticercosis; Enzyme-Linked Immunosorbent Assay; Epilepsy; Humans; Infant; Madagascar

Topics: Anxiety; Culture; Depression; Epilepsy; Female; Hospitals, Psychiatric; Humans; Madagascar; Male; Mental Disorders; Occupational Therapy; Psychopathology; Recreation; Rehabilitation, Vocational; Schizophrenia