Prevalence and mortality of epilepsies with convulsive and non-convulsive seizures in Kilifi, Kenya

• Published in: Seizure (London, England) Vol. 89; pp. 51 - 55
• Main Authors: Kariuki, Symon M, Ngugi, Anthony K, Kombe, Martha Z, Kazungu, Michael, Chengo, Eddie, Odhiambo, Rachael, Nyaguara, Amek, Neville, Brian G, Newton, Charles RJC
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-07-2021
• Subjects: Convulsive seizures; Epilepsy; Low- and middle-income countries; Mortality; Non-convulsive seizures; Prevalence; Non-convulsive seizures; Convulsive seizures; Prevalence; Low- and middle-income countries; Epilepsy; Mortality
• ISSN: 1059-1311; 1532-2688
• DOI: 10.1016/j.seizure.2021.04.028

•Many reports do not detect epilepsy with non-convulsive seizures and this affects allocation of resources.•Trained clinicians can identify both non-convulsive and convulsive seizures.•Epilepsies with non-convulsive and convulsive seizures are common and are associated mortality.•Both non-convulsive and convulsive seizures should be identified to optimise treatment.
The prevalence of all epilepsies (both convulsive and non-convulsive seizures) in Low- and Middle-Income Countries (LMIC), particularly sub-Saharan Africa is unknown. Under estimation of non-convulsive epilepsies in data from these countries may lead to inadequate and sub-optimal allocation of resources to control and prevent epilepsy. We determined the prevalence of all types of epilepsies and compared the mortality between convulsive seizures and non-convulsive seizures in a resource limited rural area in Kenya.
Trained clinicians identified cases of epilepsy in a randomly selected sample of 4,441 residents in the Kilifi Health and Demographic Surveillance System site using a cross-sectional survey design. Seizure types were classified by epileptologists using the current guidelines of the International League Against Epilepsy (ILAE). We estimated prevalence for epilepsy with convulsive seizures and non-convulsive seizures and for epilepsy with non-convulsive seizures only and compared premature mortality between these groups of seizures.
Of the 4441 people visited, 141 had lifetime epilepsy and 96 active epilepsy, which is a crude prevalence of 31.7/1,000 persons (95% CI: 26.6-36.9) and 21.6/1,000 (95% CI: 17.3-25.9), respectively. Both convulsive and non-convulsive seizures occurred in 7% people with epilepsy (PWE), only convulsive seizures in 52% and only non-convulsive seizures in 35% PWE; there was insufficient information to classify epilepsy in the remainder 6%. The age- and sex-adjusted prevalence of lifetime people was 23.5/1,000 (95% CI: 11.0-36.0), with the adjusted prevalence of epilepsy with non-convulsive seizures only estimated at 8.2/1,000 (95%CI:3.9-12.6). The mortality rate in PWE was 6.3/1,000 (95%CI: 3.4-11.8), compared to 2.8/1,000 (2.3-3.3) in those without epilepsy; hazard ratio (HR) =2.31 (1.22-4.39; p=0.011). The annual mortality rate was 11.2/1,000 (95%CI: 5.3-23.4) in PWE with convulsive and non-convulsive seizures and none died in PWE with non-convulsive seizures alone.
Our study shows that epilepsy with non-convulsive seizures is common and adds to the prevalence of previously reported estimates of active convulsive epilepsy. Both epilepsy with convulsive seizures and that with non-convulsive seizures should be identified for optimising treatment and for planning resource allocation.