Epilepsy and other convulsive disorders in Saudi Arabia: a prospective studv of 1.000 .. consecutive cases d

Al-Rajeh S , Abomelha A, Awada A, Bademosi 0, Ismail H. Epilepsy and other convulsive disorders in Saudi Arabia: a prospective study of 1,000 consecutive cases Acta Neurol Scand 1990: 82: 341-345. The pattern of epilepsy and other convulsive disorders in 1,000 consecutive Saudi nationals is described. These disorders were common with a hospital frequency rate of 8 per 1,000. Men were more frequently affected than women and 60% of the patients were under 10 years old at the onset of their illness. The epilepsies were the commonest type (74%). Febrile convulsions (20%) presented mainly between the ages of one and five years. Isolated seizures (3%) and acute symptomatic convulsions (3 2) were uncommon. In the epileptic group, generalised seizures (71 %) were more frequent than partial (29 %) and complex partial seizures occurred mainly in those above 21 years old. Absences (4%), infantile spasms (3 %) and atonic seizures (3%) were uncommon. No specific etiology of the epilepsy was determined in the majority of the cases (63%). The identified major etiologic factors of the epilepsies were perinatal encephalopathy (21 %), cerebral trauma (1 I %), sequelae of meningitis or encephalitis (2%), brain tumors (0.5%), and vascular lesions such as stroke and arteriovenous malformation. Perinatal encephalopathy accounted for 40 % of the epilepsies in children less than 5 years old, and trauma for 20% of those above 20 years old. A family history of epilepsy in close relations was obtained in 23% of the cases, and the consanguinity rate among the parents was 53 %. The high incidence of associated perinatal encephalopathy found in this study suggests that perinatal factors play a major role in the pathogenesis of epilepsy in Saudi Arabia. The high frequency of cerebral trauma was also striking. Although consanguinity of the parents appeared not to be a major factor in the genetics of convulsive disorders in this environment, it might have potentiated the tendency of familial aggregation of convulsive disorders in this community. Consanguinity may be an important factor in the production of some of these disorders but its precise role has not

/

S. Al-Rajeh’, A. Abomelha’, A. Awada’, 0. Bademosi H. Ismail’

’,



Departments of Neurology, * Pediatrics, College of Medicine and Medical Sciences, King Faisal University, Dammam

Key words: convulsive disorders: patterns; etiology; Saudi Arabia Dr. Saad Al-Rajeh, Department of Neurology, College of Medicine and Medical Sciences, King Faisal University, P.O. Box 21 14, Dammam 3 145 1, Saudi Arabia Accepted for publication June 14, 1990

Epilepsy and other convulsive disorders are a major health care problem in all parts of the world. They are one of the commonest neurological disorders, and their prevalence rates in the developed countries have been estimated at 3-9 per 1,000 population (1). Although the prevalence rate in Saudi Arabia is as yet undetermined, the reported hospital frequency rate for seizures among Saudi Arabian children was 7.8/1,000 with a male to female ratio of 1.2: 1 (2). However, the description of the seizure types in that retrospective study was limited to children and based entirely on clinical assessment. In order to obtain a more comprehensive picture, this prospective study was undertaken to evaluate all the individuals with

seizures referred to our hospital using clinical and electroencephalographic (EEG) assessment. Patients and methods

All patients with seizure disorders and a presumptive diagnosis of epilepsy referred to the Neurology Department and Neurodiagnostic Laboratory, King Fahd Hospital of the University (KFHU), Al-Khobar between 1984 and 1987 constituted the sample population. KFHU, Al-Khobar (a university hospital providing both secondary and tertiary care) is the referral hospital for the Eastern Province of Saudi Arabia with an estimated population of 1.2 341

Al-Rajeh et al. million inhabitants. Only Saudi nationals were studied. All the cases were administered a questionnaire to obtain basic demographic data including the age at onset of illness, detailed clinical description of the seizure/convulsion, provocative and predisposing factors, past medical history, family history for seizure disorders, degree of consanguinity of the parents, and previous or current drug therapy. Ancillary investigations performed included computerized axial tomography (CT), scan of the brain, biochemistry and microbiological examination of the cerebrospinal fluid (CSF) and routine laboratory tests such as serum electrolytes, urea, calcium, alkaline phosphatase, transaminases, magnesium, and blood sugar. Urine examination including chromatography, as well as blood and CSF serology were also performed when indicated. None of the patients had magnetic resonance imaging (MRI) of the brain. An inter-ictal EEG recording was obtained on all patients on a 16-channel Nihon Koden EEG machine using both bipolar and monopolar montages according to the 10-20 international system. Awake recordings were obtained for patients more than six years old. Sleep recordings were undertaken for children up to six years old after sedation with either chloral hydrate or promethazine; in some instances, parented injection of diazepam (Valium)

was used when our standard sedation proved ineffective. Activation procedures, done when possible or practicable, included photic stimulation and hyperventilation. In appropriate cases, sleep deprivation and recording with nasopharyngeal leads were used. The EEG findings were described as normal or abnormal. The criteria for an abnormal EEG were focal or generalized paroxysmal spikes, polyspikes, sharp waves, sharp wavelspike and slow-wave complexes at 2-4Hz or at mixed 2-4 and 5-7 Hz ranges. The patients were grouped into four categories, Epilepsy, Isolated, Acute symptomatic, and febrile convulsions respectively using a modification of the classification proposed by Hauser and Kurland (3). The diagnosis of epilepsy was accepted on the basis of two or more episodes of unprovoked seizures that were not the immediate result of an acute cerebral insult. The types of epileptic seizures were classdied using the International Classification of Seizures and Epilepsy (4) into Generalised and Partial. The diagnosis of partial epilepsy was based on the clinical features and focal epileptiform activity of EEG, and included cases with secondary generalization of the seizures. The epilepsy was classified as idiopathic when no known etiological factor was identified.

-TOTAL

POPULATION

-VALES c 3FE flAL ES

-

'v-.-.-.+

Epilepsy and other convulsive disorders in Saudi Arabia: a prospective study of 1,000 consecutive cases.

The pattern of epilepsy and other convulsive disorders in 1,000 consecutive Saudi nationals is described. These disorders were common with a hospital ...
361KB Sizes 0 Downloads 0 Views