神经系统疾病

Etiologies of Non-Genetic Epilepsies of Adults Newly Diagnostic in Ouagadougou in Burkina Faso

Abstract

Lompo Djingri Labodi, Cisse Kadari, Dao Ben Aziz, Diallo Ousseini, Ouro Sia Aida, Millogo Athanase

Introduction: Epilepsy is a common disease in sub-Saharan Africa. The etiological diagnosis of epilepsies is still based on interrogation and clinical examination, due to a lack of means of complementary diagnostic investigations, electroencephalogram (EEG), computed tomography (CT) or magnetic resonance imaging (MRI). The aim of our study was to determine the etiological varieties of non-genetic epilepsies of adults, newly diagnosed in Ouagadougou, according to diagnostic, clinical, EEG and neuroradiological criteria (encephalic CT and/or MRI). Patients and methods: This was a prospective, cross-sectional, descriptive study that ran from September 1 to August 31, 2017, and included patients diagnosed with non-genetic epilepsy in adults, newly diagnosed in Ouagadougou, Burkina Faso. For each of the patients included in the study, the etiological diagnosis was based on the results of CT and /or brain MRI, in addition to the electroclinical criteria of non-genetic epilepsy. Results: We collected 137 patients; the average age was 41.8 ± 17.6 years, with 51.8% men (71 patients). The average age of onset of seizures was 34.3 years and the average duration of seizures was 7.3 years. Of all patients, 87.5% had focal seizures, 5.2% generalized seizures and 7.3% non-classifiable seizures. All of our patients had EEG and brain scan, only 11.8% had brain MRI. EEG was normal in 13.1%; there were inter-critical epileptic paroxysms in 86.9%. Localized atrophy associated with underlying parenchymal hypodensity with 48 cases (35%), porencephalic cavities with 16 cases (11.8%), circumscribed cortico-subcortical hypodense without contrast enhancement with 14 cases (10.2%), brain tumors with 12 cases (8.8%), were the most representative neuroradiological abnormalities. The structural causes and unknown causes were found respectively in 54% and in 46% of cases. CNS infections (16.8%), sequelae of stroke (11.7%), sequelae of cranioencephalic trauma (10.9%), brain tumors (8.7%), sequelae of Perinatal encephalopathy (4%) and cerebral vascular malformations (cavernoma) (1.5%) were the epileptogenic structural abnormalities found. Conclusion: Our results confirm the predominance of infectious and post-traumatic causes and the emergence of cerebrovascular causes in sub-Saharan Africa. Some epileptogenic lesions, such as certain brain tumors, focal cortical dysplasias, hippocampal sclerosis, have been under diagostized because of the poor availability and accessibility of cerebral MRI.