FEATURES, MANAGEMENT AND COST OF ILLNESS OF EPILEPSY IN AHMADU BELLO UNIVERSITY TEACHING HOSPITAL (ABUTH), KADUNA: A TWO YEAR RETROSPECTIVE STUDY
FEATURES, MANAGEMENT AND COST OF ILLNESS OF EPILEPSY IN AHMADU BELLO UNIVERSITY TEACHING HOSPITAL (ABUTH), KADUNA: A TWO YEAR RETROSPECTIVE STUDY
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Date
2006-03
Authors
OMONIWA, ADUKE ELIZABETH
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My warm gratitude and appreciation to my colleague kehinde Aimola, whose
contribution to the success of this work can not be quantify. I am very grateful and I
pray your dreams will come true. Thanks to my other colleagues; Mrs. S.B. Anafi, Mr
Yakubu Telta, Mr. M. Yerima who contributed in so many ways to make my stay in
Zaria a memorable one. Thanks also to Mr Ayoola Onifade (Compute-Rite), for his
assistance, cooperation and support to make my study a success.
My appreciation goes to Ms Titi lnukan, Mr and Mrs. B. Olure, Mrs. M. Tolufase, Mr.
O. Ipingbemi, Mr. H. Abimbola, Mr. and Mrs. A. Dambola, Mr and Mrs Dare Ajayi,
Dr. and Mrs. J.I. Wilson, Dr. Femi Ehinmidu, Mr Sesan David, Kemi Inukan and Mrs.
Kwem for their support and encouragement.
I am very grateful to my fathers in the Lord: Pastor H. Igbadun, Pastor S. Olorunleke ,
and Pastor J.T. Opatola, for their prayers and encouragement. I also extent my
gratitude to my friends: Omoniyi, Jumoke, Jummai, Mrs Okomohwo Z., Lillian,
Agatha, Hannah, Bayo, Ayo, Tunde, Mrs Agbaje, Akinbiyi, Boma, Steven, Mrs
Olowoeyo ,Idowu and others that can not be listed here because of space.
To everyone who had contributed in one way or the other to the success of my study, I
say thank you and God bless you.
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Abstract
Epilepsy is one of the most common neurological disorders worldwide with
prevalence varying from place to place. In Nigeria, the prevalence is between 0.53%
and 3.7% of the population depending on several factors including the part of the
country and its respective development/available healthcare facilities. There is limited
information with regards to epilepsy and indeed other mental/neurological disorders
in this part of the country. This study was aimed at documenting features (including
cost of treatment) and management of epilepsy in Ahmadu Bello University Teaching
Hospital (ABUTH) Kaduna.
A retrospective approach using patients’ folders and other hospital records of patients
attending psychiatry clinic between January 2003 and December 2004 was used. A
sample comprising of epileptics who had attended clinic for at least six times during
the study period (total being 91), was studied in detail using a structured data based
instrument. Data was analysed using Statistical Package for the Social Scientist
(SPSS). The five most common mental/neurological disorders identified at ABUTH
were schizophrenia (46.6%), depression (13.7%), seizure/epilepsy (12.1%), anxiety
(8.0%) and bipolar affective disorder (7.5%).
There were more male epileptics (52.7%) than female (47.3%) and while half of the
patients were below 20 years at first contact with orthodox facilities, a larger
proportion (74.5%) were less than that age at onset of epilepsy. Most patients were
single (71.9%) and only 18.0% had advanced beyond junior secondary school.
Common risk factors identified for epilepsy in this study were febrile convulsion
(52.6%) and family history (23.7%). Signs and symptoms presented by these patients
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included tonic-clonic muscle contraction and relaxation (76.0%), loss of
consciousness (67.0%), psychic symptoms (30.8%), frothing in the mouth (19.8%)
and urinary incontinence (17.6%). Relevant laboratory investigations included
electroencephalography (EEG), computerized tomography (CT) scan and skull X-ray.
Generalized seizures accounted for 59.3% of the patients, partial seizures for 25.3%
and 15.4% for others (mixed and unclassified). Mental/neurological comorbid
disorders were uncommon (23.0%) and included anxiety, psychosis, mental
retardation and abnormal behaviour (personality changes). These various indices are
similar to what has been reported for other parts of Africa and elsewhere.
Pharmacological management of these patients included the use of antiepileptic drugs
(AEDs), adjuncts, drugs to treat comorbid states and drugs to treat side effects. AEDs
used were carbamazepine (91.2%), benzodiazepines (49.4%), barbiturates (24.2%),
phenytoin (7.7%), sodium valproate (4.4%) and ethosuximide (1.1%). Adjuncts
included vitamin B complex, folic acid and pyritinol, while comorbid
disorders/diseases were treated with trifluoperazine, thioridazine, chlorpromazine,
haloperidol, amitriptyline, imipramine and diverse agents (antihelmintics,
antimalarias, antihypertensives, antifungals and vitamin E). Side effects reported
included headaches (20.4%), forgetfulness (20.4%), body weakness (18.2%),
dizziness (13.6%), restlessness (13.6%), skin rashes (9.1%) and are traceable to the
prescribed drugs for these patients. Side effects were managed by withdrawal of the
drugs and replacing indicated drugs with those having less side effects and/or
administration of drugs to remedy side effects. Overall, there was sound
pharmacological basis for the drug treatment of these epileptic patients and the
management of side effects although it was observed that the newer, more efficacious
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but more expensive AEDs were not used at all in these patients. Nonpharmacological
management procedures employed were mainly counseling of
patients by doctors and psychotherapy conducted by a psychologist.
The rate of attainment of remission increased with increase in years since first contact
with orthodox facilities. Non-compliance to therapy and follow-up were the main
contributing factors to failure of achieving remission in some of the patients. The type
of seizures (generalized and partial) did not have a significant effect on attainment of
remission (p<0.05). Longer duration (>1 year) between first seizure attack and
medical intervention did not affect attainment of remission. Onset of epilepsy before
the age of 10 resulted in lower remission rate. An average of N30, 986.67 per patient
was spent per year on AEDs while the mean cost of total drugs was N33, 697.10 per
patient per year. Cost increased with increase in clinic attendance, but decreased with
increase in years since first contact with orthodox facilities. There was no significant
difference in cost of total drugs or AEDs used as regard the type of seizure. The
overall cost of treatment of epilepsy as seen here is considered high in relation to
Nigeria’s very low per capital income and especially as most of these patients (66.7%)
were unemployed and were dependant on caregivers.
Description
IN PARTIAL FULFILLMENT FOR THE AWARD
OF MASTER DEGREE OF SCIENCE IN
PHARMACOLOGY.
Keywords
FEATURES,, MANAGEMENT,, COST,, ILLNESS,, EPILEPSY,, AHMADU,, BELLO,, UNIVERSITY,, UNIVERSITY,, TEACHING,, HOSPITAL,, KADUNA:,, TWO,, YEAR,, RETROSPECTIVE,, STUDY.