Epilepsy common in urban setting, with significantly high diagnostic gaps

Key takeaways:

• In Kenya, epilepsy prevalence was highest for those separated or divorced.
• 80% of those with epilepsy and 100% with non-convulsive epilepsy were not previously diagnosed.

Epilepsy was common in two urban Kenyan settings and diagnostic gaps were substantially high, demonstrating a need for targeted interventions, according to research in The Lancet Global Health.

“There are few studies of epilepsy prevalence in low-resource urban settings in Africa,” Daniel M. Mwanga, MSc, a senior data scientist with the African Population and Health Research Center, and colleagues wrote. “Most studies have focused on active convulsive epilepsy, yet non-convulsive epilepsies can contribute to up to 50% of all epilepsy cases.”

Mwanga and fellow researchers sought to estimate the prevalence and distribution of all forms of epilepsy within two lower-income, low-infrastructure urban settlements (Viwandani and Korogocho) in Nairobi, Kenya.

Their cross-sectional study was split into two stages. In the first, the researchers interviewed 56,425 individuals between September 2021 and December 2021, utilizing a 14-item epilepsy screening questionnaire that included a range of sociodemographic information, to yield 1,126 persons as possible cases.

In the second, any individual identified as one who may have seizures, as well as a portion of those who screened negative for seizures, were invited to local clinics for comprehensive neurological assessments. Diagnoses in this cohort were defined as either epilepsy, not epilepsy or unknown. From that pool of 873 individuals examined between April 2022 and August 2022, 528 had a confirmed epilepsy diagnosis.

The study’s primary outcome was the total prevalence of epilepsy within the two settlements by estimating the total confirmed cases, divided by number of participants screened from stage 1, broken down by marital, employment or educational status. The secondary outcome was an estimation of the diagnostic gap, where the researchers determined the proportion of participants with epilepsy (both convulsive and non-convulsive) who previously did not know their status.

The overall epilepsy prevalence was highest for those who were either separated or divorced at 20.3 cases per 1,000 (95% CI, 15.9-24.7); followed by those who were unemployed at 18.8 cases per 1,000 people (95% CI, 16.2-21.4); individuals with no formal education at 18.5 cases per 1,000 (95% CI, 16.3-20.7); and in adolescents aged 13 to 18 years at 15.2 cases per 1,000 (95% CI, 12-18.5), according to the researchers.

Data additionally showed there were 6.6 cases of convulsive epilepsy per 1,000 and 2.8 cases of non-convulsive epilepsy per 1,000.

Further, the researchers reported that 80% of those with epilepsy and 100% of those with non-convulsive epilepsy did not know about their diagnosis before the study, revealing “large diagnostic gaps,” Mwanga and colleagues wrote.

“Targeted interventions are needed in informal settlements for early detection of epilepsy and prompt treatment to prevent future adverse social and economic consequences,” they wrote.