Authors :
Presenting Author: Ieme Garrez, MD – Department of Neurology, 4Brain, Ghent University Hospital, Ghent (Belgium)
Dirk E Teuwen, MD – Department of Neurology, 4Brain, Ghent University Hospital, Ghent (Belgium)
Fidèle Sebera, MD-PhD – Department of Neurology, Ndera Neuro-Psychiatric Teaching Hospital, Kigali (Rwanda); Department of Internal Medicine, University Hospital Center, Kigali (Rwanda)
Eric Achten, MD-PhD – Department of Radiology (Neuroradiology), Ghent University Hospital, Ghent (Belgium)
Arlène Ndayisenga, MD – Department of Neurology, King Faisal Hospital, Kigali (Rwanda)
Ann Mertens, MD-PhD – Department of Neurology, 4Brain, Ghent University Hospital, Ghent (Belgium)
Jean-Jacques Nshizirungu, MD – Department of Radiology, King Faisal Hospital, Kigali (Rwanda)
Sebastien Heyndrickx, MD – Department of Neurology, 4Brain, Ghent University Hospital, Ghent (Belgium)
Jeannine Kayirangwa, BSW – Ruhengeri Referral Hospital, Musanze (Rwanda)
Uta E Düll, MD – Medicalized Health Center, Gikonko, Rwanda
Peter Dedeken, MD-PhD – Department of Neurology, 4Brain, Ghent University Hospital, Ghent (Belgium); Department of Neurology, Heilig Hart Ziekenhuis, Lier (Belgium)
Paul AJM Boon, MD-PhD – Department of Neurology, 4Brain, Ghent University Hospital, Ghent (Belgium)
Rationale:
In sub-Saharan Africa (SSA), lifetime epilepsy prevalence is 16‰ (1). In Southern rural Rwanda, a 76.2‰ prevalence was reported (2). As a first in SSA, this community-based study integrated risk factors, electrophysiological profiles, and magnetic resonance imaging (MRI) findings to investigate the high prevalence.
Methods:
We conducted a prospective cross-sectional, nested case-control study in rural Southern Rwanda from December 2022 to May 2024. A three-stage door-to-door survey screened 1,745 individuals and identified 133 epilepsy cases (52.6% female, mean age 30 ± 18.2 years) (2). Age- and gender-matched controls were selected from the same population (1:1). Risk factors were assessed by structured interviews and blood samples. Epilepsy was classified based on clinical, electroencephalogram (EEG), and MRI findings per the International League Against Epilepsy guidelines.
Results:
Risk factors associated with epilepsy included a family history of epilepsy (first-degree: OR 3.43, 95% CI 1.58–7.44, p=0.002), history of febrile seizures (OR 3.64, 95%CI 1.25–10.61, p=0.02), and history of central nervous system infections, including malaria (OR 2.81, 95%CI 1.08–7.29, p=0.03). Clinically, seizure onset was generalized in 7.5% of cases (10/133), focal in 55.6% (74/133), and unknown in 42.1% (54/133). Abnormal EEGs were found in 57.1% (76/133) with 48.7% (37/76) presenting focal features. Epileptiform discharges occurred in 30.3% (23/76) with 52.2% (12/23) focal. MRI abnormalities were noted in 53.5% (69/129) with 50.7% (35/69) potentially epileptogenic. MRI findings included cerebral atrophy (13.2%), non-specific white matter lesions (11.6%), neurocysticercosis (10.9%), small vessel disease (9.3%), cerebellar atrophy (9.3%), post-traumatic (8.5%), and perinatal ischemic lesions (4.7%). Based on semiology, EEG and MRI, epilepsy was classified as focal in 71.4%, generalized in 10.5%, and unknown in 18.0%.
Conclusions:
High epilepsy prevalence in rural Rwanda is associated with identifiable, preventable risk factors (e.g., infections). The significant occurrence of focal epilepsy and MRI abnormalities underscores a need for preventive strategies and early epilepsy identification in resource-limited settings. Future research should expand these findings and explore the interplay of genetic and environmental factors in epilepsy etiology.
Funding:
References
1. Owolabi LF 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
2. Garrez I et al. Very high epilepsy prevalence in rural Southern Rwanda: The underestimated burden of epilepsy in sub-Saharan Africa. Trop Med Int Health. 2023. https://doi.org/10.1111/tmi.13963
Disclosure
Grants were obtained from Fracarita Belgium and VLIR UOS. The Fund for Scientific Research Flanders (FWO) supported Ieme Garrez. Peter Dedeken received consultancy fees from Merck, UCB Pharma and Novartis. Paul Boon received consultancy fees from UCB Pharma & grants through his institution.