Authors :
Presenting Author: Ieme Garrez, MD – Ghent University Hospital, Ghent, Belgium
Dirk Teuwen, MD – Department of Neurology – Ghent University Hospital, Ghent Belgium; Fidèle Sebera, MD-PhD – Department of Neurology – Ndera Neuro-psychiatric Teaching Hospital, Kigali, Rwanda; Sylvestre Mutungirehe, MD – Department of Neurology – Ndera Neuro-psychiatric Teaching Hospital, Kigali, Rwanda; Arlène Ndayisenga, MD – King Faisal Hospital, Kigali, Rwanda; Delphine Kajeneza, MD – Centre Hospitalier Universitaire Kigali, Rwanda; Georgette Umuhoza, Ms. – Department of Neurology – Ndera Neuro-psychiatric Teaching Hospital, Kigali, Rwanda; Jeannine Kayirangwa, Ms. – Ruhengeri Referral Hospital, Musanze, Rwanda; Josiane Umwiringirwa, Ms. – Department of Neurology – Ndera Neuro-psychiatric Teaching Hospital, Kigali, Rwanda; Peter Dedeken, MD – Heilig Hart Ziekenhuis, Lier, Belgium; Paul Boon, MD-PhD, FEAN – Department of Neurology – Ghent University Hospital, Ghent Belgium
Rationale: Up to 85% of people living with epilepsy reside in low and middle income countries. In sub-Saharan Africa (SSA), lifetime prevalence of epilepsy is 16%.
1 In Northern rural Rwanda, a 47.7‰ prevalence was reported.
2 As a possible variation in prevalence across geographical areas might apply, we established the prevalence in Southern rural Rwanda by using the same robust methodology as applied in the North.
Methods: We undertook a prospective cross‐sectional, door‐to‐door survey in a rural village in Southern Rwanda from June 2022 to April 2023. First, trained enumerators screened villagers for epilepsy using the validated Limoges epilepsy screening questionnaire. Second, neurologists examined persons who had screened positively to confirm epilepsy diagnosis.
Results: Enumerators screened 1,745 persons (54.4% female, mean age: 24 ±19.3 years). A total of 304 persons (17.4%) screened positively. Epilepsy diagnosis was confirmed in 133 (52.6% female, mean age: 30 ±18.2 years) and active epilepsy in 130 persons. Lifetime epilepsy prevalence was 76.2‰ (95%CI: 64.2-89.7‰). The highest age-specific rate occurred in the 29-49 age group (Figure 1). No significant gender-specific differences were noted. The seizure onset occurred before 18 years of age in almost 60% (Figure 2). The diagnosis and treatment gap were 79.4% and 92.2%, respectively. In 19.5% of the cases, only non-motor seizures occurred.
Conclusions: We report one of the highest epilepsy prevalence estimates documented, with almost 20% non-motor seizures which are often underdiagnosed in rural Africa. In line with two previous Rwandan reports,
2,3 we reiterate the burden of the disease in the country, with prevalence rates more than three times the estimated prevalence in SSA. Geographic variation in prevalence throughout Africa may result from differences in risk and etiological factors. Urgent case-control studies are underway to understand such differences in order to further clarify pathophysiological mechanisms and propose adapted epilepsy prevention policies.
References:
1 Dedeken P, Sebera F, Mutungirehe S, Garrez I, Umwiringirwa J, Van Steenkiste F, et al. High prevalence of epilepsy in Northern Rwanda: Exploring gender differences. Brain Behav. 2021;11(11):e2377
2 Owolabi LF, Adamu B, Jibo AM, Owolabi SD, Isa AI, Alhaji ID, et al. Prevalence of active epilepsy, lifetime epilepsy prevalence, and burden of epilepsy in Sub-Saharan Africa from meta-analysis of door-to-door population-based surveys. Epilepsy Behav. 2020;103(Pt A):106846
3 Sebera F, Munyandamutsa N, Teuwen DE, Ndiaye IP, Diop AG, Tofighy A, et al. Addressing the treatment gap and societal impact of epilepsy in Rwanda--Results of a survey conducted in 2005 and subsequent actions. Epilepsy Behav. 2015;46:126-32.
Funding: The study was supported by Fracarita Belgium and VLIR UOS. Ieme Garrez is supported by the Fund for Scientific Research Flanders (FWO). Peter Dedeken has received consultancy fees from Merck, UCB Pharma and Novartis. Paul Boon received consultancy fees from UCB Pharma and grants through his institution.