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

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 8 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 9 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.

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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