PubMed TFC PAMELA KAMBA ENGLISH

HIGHER AND UNIVERSITY EDUCATION
HIGHER INSTITUTE OF MEDICAL TECHNICAL OF LUBUMBASHI

BP 4748
LUBUMBASHI

THE PERCEPTION OF CHILD EPILEPSY IN
THE COMMUNITY OF LUBUMBASHI
"Case of the commune of Rwashi"

By MILOLO KAMBA Pamelas
End-of-cycle work presented and defended with a view
to obtaining the degree of graduate in medical techniques
Section: Nursing Sciences
Department: Pediatrics

Academic year 2019-2020

HIGHER AND UNIVERSITY EDUCATION
HIGHER INSTITUTE OF MEDICAL TECHNICAL OF LUBUMBASHI

BP 4748
LUBUMBASHI

THE PERCEPTION OF CHILD EPILEPSY IN
THE COMMUNITY OF LUBUMBASHI
"Case of the commune of Rwashi"

By MILOLO KAMBA Pamelas
End-of-cycle work presented and defended with a view
to obtaining the degree of graduate in medical
techniques
Section: Nursing Sciences
Department: Pediatrics
Director: Assistant Dr VINCENT NSAMBI

December 2020

~i~

EPIGRAPH

There is no disease other than
epilepsy
in
which
social
prejudices are more serious than
the disease itself.

Lennox

~ ii ~

IN MEMORIUM

To my late aunt
I would like to see you today and offer you this present work at
the end of strengthening the bonds that unite us and share this
long-awaited joy, but Jesus Christ of Nazareth decided otherwise
and we know that you are with us all. days of our life. May the
land of our ancestors be sweet to you and our wish is that your
soul rest in peace!

~ iii ~

FOREWORD

Since the dawn of time we have lived with this disease called epilepsy in our different
cultures and civilizations, in our society and community.
Epilepsy is a very old disease, since ancient times we were already talking about this
disease. We have lived with this disease having unreal information about it; some have considered
it to be a disease of supernatural causes and others it is considered a contagious disease and that
for quite a while.
This is how our medical bodies and in the name of science we did not let ourselves be
influenced by our ignorant feelings, we wanted to establish a field of perceptions, research and
knowledge on the aforementioned disease in order to finally shed light on and extract the Lushoise
population and more particularly that of the commune of Rwashi in ignorance about epilepsy.

~ iv ~

DEDICATION
I dedicate this work:
To Jesus Christ of Nazareth, the Merciful, the Merciful, for granting me life, health and
allowing this study to be carried out. To you I give all my existence, some died during this
academic year but you led us to the end of this long stay of studies as well as this work whose
merit goes to you. Blessed be for all your blessings.
To you my very dear mother LEYA KANKU; your sense of responsibility, of education
marked your children forever; you cultivated in us honesty, humility, respect, rigor and hard work.
This work is the fruit of your dedication to the success of your children, the fruit of your precious
advice, your prayers and sacrifices of all kinds. Thank you for putting me in school. Find here very
dear mother by this present work my gratitude and the expression of my affection towards you. I
don't deserve this honor but you deserve it mom.

~v~

THANKS
Nothing is given in life, but at the end of the effort is success. To almighty Jesus Christ of
Nazareth for making us who we are today.
At the threshold of this work at the end of the graduate cycle, it behooves us a moral duty
to express our gratitude to all those who, from far or near, have contributed to the realization of
this edifice.
Our thanks go first to all the Professors, Heads of Work and Assistants of ISTM
Lubumbashi, particularly those of the Department of Pediatrics for the intellectual training they
have given us.
We would then like to thank the assistant Dr Vincent NSAMBI, who despite his many
occupations kindly supervised us in the drafting of this work. It is thanks to you that this work was
able to see the light of day and come to an end. We were marked by your simplicity; We will not
know how to express our gratitude and admiration to you. May he find here the expression of our
deep gratitude.
To you my very dear Dr. Bienvenu KONGOLO; from you I have acquired new knowledge
which has enlightened me in the realization of this work; I would like to thank you and tell you
how proud I am of you.
I would also like to express here my deep gratitude to all those who have provided their
help and support during the various stays in Lubumbashi: Kyungu HONORE LUC Albert
KABONDE WA KABONDE, Idrissa MUFAUME HASSAN, Amani DJUMA AMANI and
Fidèle MUTOMBO LULU. Thank you to all of you for helping me during such a long job and for
allowing access to so much, sometimes sensitive data.
We are also grateful to all our teachers, both elementary and secondary. May they find the
culmination of their dedication in the outcome of this essay.
To My brothers and sisters ALBERT KAMBA, JOEL KAMBA, BRAYAN KAMBA,
JINAH KAMBA, ANAIS KAMBA for your moral support and for your encouragement
throughout these years. My success is also yours.
We cannot forget to thank our friends and fellow fighters: BETY KALALA, RUTH
TSHISWAKA, RAPHAEL MUKUNA and FRANCK KANKONDE.
Finally, thank you to all those who will have the will and the courage to read and use this
work.
MILOLO KAMBA Pamelas

~ vi ~

ABBREVIATIONS
CBZ
CLB
BFNC
CZP
DZP
EEG
EGCF +
EMG
EMJ
ESM
FBM
GABA
GBP
IEC
LEV
LICE
LTG
NMDA
NZP
WHO
ORL
OXC
PDS
PGB
PVD
DRC
RFN
SLI
STM
Please
TGB
TPM
VGV
HIV
VPA

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Carbamazepine
Clobazam
Benign Familial Neonatal Convulsion
Clonazepam
Diazepam
The electroencephalogram
Generalized epilepsy with febrile seizures plus
Electromyogram
Juvenile myoclonic epilepsy.
Ethosuximide
Felbamate
Gamma aminobutyric acid
Gabapentin
ACE inhibitor
Levetiracetam
International League against Epilepsy
Lamotrigine
N-methyl-D-aspartic acid
Nitrazepam
World Health Organization
Otorhinolaryngology
Oxcarbazepine
Paroxysmal depolarization shift
Pregabalin
Developing Countries
Democratic Republic of Congo
Rufinamide
Intermittent light stimulation
Sulthiane
Stiripentol
Tiagabine
Topiramate
Vigabatrine
Human Immunodeficiency Virus
Valproate

~ vii ~

summary
Epilepsy is one of the most common neurological diseases. Epilepsy occurs at any age,
but the causes, clinical expression, complications and social impact depend on the age of the
subjects. It is often the subject of misunderstanding, prejudice and stigma. In the Democratic
Republic of Congo, epidemiological data, data on schooling and the impact of epilepsy in children
are not readily available. The objective of this study is to assess the degree of perception of
childhood epilepsy in the Lushoise community.
The study was conducted in the Democratic Republic of Congo (DRC) in the HautKatanga province in Lubumbashi in the commune of Rwashi. One hundred and twenty-five (125)
respondents of both sexes were subjected to a 10-item questionnaire made up of closed and open
questions. The data was processed by Epi info (version 7.2.2.6 Fr).
The average age was 29 years with a minimum age of 14 and a maximum of 73 years.
The male sex represents 55%. The majority of our respondents reside in the Luano district, i.e.
34%. Artisans constitute 44% and 70% have a secondary level of education. Those who know
epilepsy represent 100% including 86% through those around them. More than half of those
surveyed consider that epilepsy corresponds to supernatural causes. The disease is considered very
serious by 58.40% and 33% claim to have had recourse to prayer.
Prejudice, myth and misunderstanding surround the disease. The socioeconomic level and
knowledge of epilepsy are the main players in the use of maraboutage and non-medical practices.
Knowledge and attitudes towards epilepsy depend largely on the socio-cultural identity of the
individual.
Compared to studies carried out in sub-Saharan Africa and other countries; It emerges
from this that the Lush community is very poorly informed about the disorder presented by their
relatives, that the care of patients remains anchored in its socio-cultural aspect. Lifting the taboo,
improving knowledge and rectifying attitudes can only be conceived through awareness-raising
and health education programs within the Lushoise community.

TFC: ISTM / Nursing Sciences / Pediatrics - Year 2020

KEY WORDS: Perception, Epilepsy, Child Hood, Community, Lushoise
HIGHER INSTITUTE OF MEDICAL TECHNICAL / LUBUMBASHI
Section: Nursing Sciences
Department of Pediatrics

1

INTRODUCTION
Problematic
Subject statement
Epilepsy is defined as a chronic condition of various etiologies characterized by the
repetition of epileptic seizures. These seizures are manifestations of an excessive and synchronous
discharge of brain neurons(1). It is the leading chronic neurological disease due to its incidence
and affects 50 million people, including 10 million in Africa. The World Health Organization
(WHO) estimates at around 50 million the number of epilepsy in the world in 1998(1).
In the United States of America the prevalence of epilepsy is estimated at 0.5% (A Gasset
1968). In Germany this prevalence is 0.4%. In France by account the number of epilepsy varied
between 300,000 and 500,000 in 2000(1). It is considered that 3 to 10 million Africans have
epilepsy and that 80% of them are deprived of care (WHO 2000). Epilepsy is a real public health
problem in Africa(1). In Nigeria the prevalence of epilepsy is estimated between 0.5 and 0.8%(1).
In Mali, hospital studies show that epilepsy accounts for around 67% of seizures during the first
year of life.(1). A mass survey in rural areas in Mali shows a prevalence of 4.41% 0(1).
The epidemiological surveys carried out in 2000 in Mali gave an overall prevalence of
epilepsy at 13.35% out of 5,243 inhabitants examined.(1).
In Bamako A study carried out in 1999 in two communes (II and IV) noted a prevalence
of 11.7 per 1000 inhabitants whose average age was between 8.24 + 3.9 years(1).
Several factors explain this prevalence of epilepsy compared to western regions.
Sociocultural factors seem to play a determining role. African tradition considers epilepsy to be a
disease caused by a "spirit", a curse or an evil spell cast. The affected subject is often the object of
isolation and rejection(1).
The importance of these socio-cultural factors has a negative effect on care, making it
difficult to campaign against this disease.
Epilepsy occurs at any age, but the causes, clinical expression, complications and social
impact depend on the age of the subjects. Epilepsy is one of the oldest diseases known to mankind,
at very high frequencies in certain parts of the world whose prevalence would be around 8.2 per
thousand in the whole population, its annual incidence would be about 50 per 100,000(2). It
occupies a special place among the diseases known to the general public. It is a chronic

2

neurological condition that imposes a significant burden on individuals and society as a
pathology(3). The choice of antiepileptic treatment is based on the precise diagnosis of the type of
seizure and, if possible, of the epileptic syndrome.
The comprehensive management of epilepsy requires knowledge and understanding
beyond the common practices of modern medicine. Populations show many variations in cultural,
economic, political, intellectual and educational levels, as well as urban or rural lifestyle. Indeed,
the public attitude towards epilepsy reflects the knowledge of the population vis-à-vis the disease,
and the lack of information seems to prevent families of patients from providing appropriate help
and support to their loved ones. . Thus, acting on behavior implies a change in knowledge, attitudes
and intentions. To do this, several studies around the world have been conducted to quantify the
knowledge of populations and their attitudes towards epilepsy,

Research question
Epilepsy remains a health problem in the DRC and in particular in Lubumbashi, despite
the knowledge and existence of effective therapies, budgetary resources are necessarily directed
to diseases perceived to be more important than epilepsy, such as diabetes, high blood pressure,
depression, etc. (4). A large proportion of people with epilepsy do not receive treatment. The
obstacles are not limited to a particular sector, because if ignorance, under medicalization and
poverty seem the main causes, other problems are more radical in relation to the ignorance of the
causes and the possibilities of treatment of the disease. epilepsy, due to lack of education, lack of
information and lack of awareness and information of the Congolese population(3).
How is this disease perceived by relatives of patients in a socio-cultural context like ours?
It is around this question that our reflection will be spread.
The stigmata, from the Latin stigma which means trace or mark, fear, incomprehension,
stigma and social discrimination caused by epilepsy often push patients to "hide in the shadows".
The social consequences of epilepsy may vary from country to country or culture to culture, but it
is certain that around the world they are often more difficult to bear than the seizures
themselves.(1). The resulting problems are encountered in particular in the area of interpersonal
relations and sometimes even in legislation. These problems interfere with the treatment of
epilepsy(1).
Indeed, social acceptance represents a real problem for epilepsy and their family. It largely
depends on different popular thoughts about the disease(1). Recent work has shown, whether in

3

developing countries or in developed countries, that these prejudices contribute to the increase in
the appearance of psychiatric disorders such as anxiety and depression; social exclusion, and the
deterioration of the quality of life of the epileptic(1).

Research questions
▪

What would be the perception of childhood epilepsy in the Lush community?

▪

What is the attitude of the population of Lush in the face of an epileptic crisis?

▪

What would be the level of knowledge?

Hypothesis
Lack of knowledge of the causes and treatment options for epilepsy, lack of education,
could be the cause of the marginalization of people with epilepsy in a country like ours where the
health system is weak. insufficient, a rate with several religious and cultural denominations. Much
work has however been carried out in developing countries on neurological pathologies in general
and epilepsy in particular. However, certain parameters such as the methodology and definitions
used, the origin of the population, or the small size of the geographical area studied do not allow
the extrapolation of the expected results to the whole of a region or a state.(5).
For many years, numerous studies conducted around the world have focused on the
knowledge, attitudes and preconceptions that exist with regard to epilepsy and people with
epilepsy in various populations (18).
Many of these studies noted an overall trend of improving knowledge, attitudes and beliefs
about epilepsy, although misconceptions still persisted. Among this work, some have made it
possible to point out differences in perception of the disease between industrialized and developing
countries. Beliefs about the contagiousness of epilepsy, its assimilation to a kind of mental
retardation or its supernatural aetiology would persist more in developing countries. A 2005
Brazilian study (19), based on a survey of 29 children of around ten, found that the perceptions
that epilepsy aroused in them had a negative connotation where prejudices persisted. They
described epilepsy as a disease "of the head", "where you can swallow your tongue", "Serious",
"contagious", "which can kill". This study assumed that the vision of children could reflect that of
Brazilian society in general, less concern for “political correctness”.
Other studies were more particularly interested in the social restrictions which popular
dogma sometimes tends to impose on people with epilepsy. Thus epilepsy is still frequently
perceived as a reason for limiting marriage or an obstacle to employment, and this is more

4

prevalent in developing countries. Indeed, there seems to be an improvement in social behavior
towards people with epilepsy in developed countries. For many people, epilepsy is no longer a
barrier to dating, forming friendships, getting married, or claiming the same job as someone
without epilepsy.
While certain beliefs and attitudes towards epileptics diverge, knowledge of the disease is
far from perfect in developed countries. An Italian study from 2010 (18) notably compared the
results of 3 national surveys carried out in 1983, 2005 and 2010 to assess the knowledge and
attitude of the population regarding epilepsy. It turns out that knowledge of the possible causes of
the disease has greatly deteriorated over the course of the surveys, the absence of a known cause
for the disease increasing from 16% in 1983, to 33% in 2005 and then 50% of those polled in 2010.
The general public has relatively little knowledge of epilepsy and is exposed to it, through
painting, literature or the media, in many frightening forms. Only the generalized tonic-clonic
seizure is described, a distorted and stereotypical representation of epilepsy. In a 2003 American
study (20), carried out on the basis of the annual Health Styles survey, it appeared that half of the
respondents had already witnessed an epileptic seizure and that a third of them knew someone with
epilepsy. However, less than a third of those surveyed felt able to manage an epileptic seizure and
only 25% of them felt they were well informed about the disease. This feeling of lack of
information was predominant among subjects aged 18-24.
Epilepsy therefore appears to be a widely known pathology but which, in the end, remains
little understood, regardless of the requested population.

Choice and interest of work
Based on the observation made on the contempt and stigmatization of children with epilepsy in
the Lush community, our work has the following interests:
▪

From a scientific standpoint, this work will allow us to provide knowledge relating to this
very important situation.

▪

On the social level, this work will not only allow parents or families with epileptic children
but also the entire community to take hold of this situation by providing some knowledge
of modern attitudes and practices in care (measures first aid) for children with epilepsy in
the Lush community.

5

Goals
Main objective
Study the perception of childhood epilepsy by the Lush community.
Specific objective
In this present work we have set ourselves the following specific objectives:
▪

Evaluate the knowledge of the population on the origin of epilepsy;

▪

Determine the knowledge of the population of Lush on the mode of contamination of
childhood epilepsy

▪

Collect the knowledge of the Lush community on the management of epilepsy;

▪

Appreciate the knowledge of Lush populations on the prognosis

Subdivision of work
Apart from the introduction, the conclusion and some suggestions this work has five
chapters namely:
 The first will focus on generalities,
 The second is devoted to childhood epilepsy,
 The third will talk about the methodology,
 The fourth will focus on the presentation of results
 And the fifth will be devoted to the discussion of the results.

6

PART I THEORETICAL CONSIDERATIONS

7

CHAPTER I. GENERAL
I.1. DEFINITION OF KEY CONCEPTS
Perception: it is the activity by which a subject experiences objects or properties present
in his environment. This activity is usually based on information delivered by his senses.
In humans, perception is also linked to the mechanisms of cognition(6).
Epilepsy: is a chronic disease characterized by the recurrence or repetition, usually
spontaneous, in the medium and long term of epileptic seizures. The notion of recurrence
is defined by the appearance of at least two attacks, more than 24 hours apart(5).
Child: which relates to early childhood.
Community: state of what is common to several people, group constituting a company.
Lushoise: the name of the population living in Lubumbashi.
I.2. ANATOMOPHYSIOLOGICAL RECALL OF THE CENTRAL NERVOUS SYSTEM
I.2.1. CONSTITUTION OF THE CENTRAL NERVOUS SYSTEM
The central nervous system includes the brain as well as the spinal cord.
a. The encephalon corresponds to the three organs which are located in the cavity of the
cranium which are the brain, the cerebellum and the brainstem.
 The brain: situated entirely in the supratentorial space, and formed of two right and
left hemispheres, incompletely separated from one another by the interhemispheric
fissure marked by the scythe of the brain, and united one to the 'other to their central
part
 The cerebellum, located like the brainstem in the posterior fossa and therefore
separated from the brain by the tent of the cerebellum. It is formed by two right and
left hemispheres, united by the vermis. They are connected to the brainstem on the
right as well as on the left by the upper, middle, and lower cerebellar peduncles.
 The brainstem, which emerges from the underside of the brain, and has three parts
from top to bottom: the right and left cerebral peduncles, the annular protuberance,
and the medulla oblongata. From the brainstem emerge all the cranial nerves except
the optic nerve and the olfactory nerve located entirely above the tent of the
cerebellum.
b. The spinal cord is located in the spinal canal which results from the overlapping of the
vertebrae of the spine. It extends the brainstem and the medulla oblongata. It begins
immediately below the foramen magnum. It is located entirely in the spinal canal that it
does not occupy over its entire height, because the marrow ends approximately at the level
of the first lumbar vertebra (L1). From the marrow and at each intervertebral space emerge

8

the spinal nerves made up of an anterior motor root and a posterior sensitive root. Below
L1 and up to the sacrum, the spinal canal is occupied by the roots of the spinal nerves
originating from the lumbar cord; all of these roots form what is called by resemblance
"the ponytail".
I.2.2. ROLE OF THE CENTRAL NERVOUS SYSTEM
These organs of the central nervous system are centers of integration which analyze and interpret
sensory information in order to give motor commands based on the individual's experience, on
reflexes as well as on the conditions prevailing in the external environment. The central nervous
system plays the role of receiving, recording, interpreting the signals that arrive from the periphery,
and organizing the response to be sent.
1. The brain has a main function of controlling the actions of the organism from the sensory
information which reaches it. Thus, through the central role it exercises in capturing
external stimuli, the brain occupies the central role in creating responses to the
environment. It also has a role in hormonal regulation.
2. The cerebellum is involved in the coordination of movements, walking and standing and
toning
3. The brainstem has several functions including maintenance of consciousness, biological
cycles, control of respiration and heart rate.
4. Spinal cord plays several roles namely:
 Relay role between the brain and the nerves
 Receives information from peripheral receptors (pain, limb position, etc.). It sends them
back to the brain where this information will be integrated
 Also receives information from the brain (order of movement, etc.) and sends it to the
effectors (muscles)
 Also used for certain reflexes: information coming from the periphery generates a
response that does not pass through the brain
I.3. CULTURAL ASPECTS OF EPILEPSY
I.3.1. History of epilepsy
The term "Epilepsy" means "to take by surprise" in history we do not find the exact date of
the onset of epilepsy, this disease recognized but poorly understood for a long time was the source
of many prejudices and is still our days(1).
In the Middle Ages, sickness had been equated with demonic possession. This approach to
the disease was favored by the spread of monotheistic religions, the devil and the moon were

9

incriminated as responsible for the occurrence of certain crises. Considered contagious, epileptics
were marginalized from society.
At the time of the Renaissance and the Enlightenment (18th century), epilepsy was
considered to be linked to genius, and any exceptional person was suspected of epilepsy. The end
of the 18th century saw the emergence of a realistic scientific approach to epilepsy.
During the nineteenth century, significant progress had been made on the terminology and
neuropathology of epilepsies which were very gradually separated from mental illnesses, in
particular from hysteria. By the end of this century it was clear that there are different forms of
epilepsy; some being idiopathic, others related to a localized cerebral lesion operable in certain
cases.
During the 20th century, thanks to the development of medical technologies, that is to say
advances in therapy and diagnostics (the international classification of seizures and epileptic
syndromes), new advances in the knowledge of epilepsies were made.
I.3.2. African picture of epilepsy
In Africa, a mosaic of peoples with diverse cultures, epilepsy is a disease of the individual but
also of society. It has always existed and would come under the mystical, the mythical and its
cause of metaphysics: the geniuses of the bush, a spell cast, a "job" of an enemy or even a
punishment of an ancestor following bad behavior, etc. This procession of prejudices transmitted
from generation to generation has consecrated the rejection of the epileptic, a point common to all
African cultures.
Indeed, the epileptic child does not have the right to schooling because very often hidden by
the family; he is excluded from recreational activities, cannot get married because of the risk of
contamination, he is at work a primary disqualified; which poses serious problems for the social
integration of epilepsy in Africa(7).

10

CHAPTER II. CHILD EPILEPSY
II.1.

DEFINITION OF EPILEPSY

Epilepsy is a chronic neuro-disease characterized by the recurrence or repetition, generally
spontaneous, in the medium and long term, of epileptic seizures of various etiologies. The notion
of recurrence is defined by the appearance of at least two seizures, more than 24 hours apart, which
are due to excessive discharges of a population of cortical neurons.
II.2.

CLASSIFICATION OF EPILEPSIES

A classification of epilepsies was carried out on the basis of the electroclinical manifestations
encountered, their similarity and their reproducibility.
This classification of epilepsies and epileptic syndromes initially based on detailed
observations and the opinion of experts has been brought to evolve due to the evolution of
knowledge on electroclinical manifestations, the most frequent ages of onset as well as their
predictions. Thus we distinguish a 1989 classification of the International League against Epilepsy
LICE in acronym. (See board 1)
Board 1. Classification of epilepsies and epileptic syndromes (LICE 1989)

Epilepsy and focal epileptic syndromes
Idiopathic, age-related:
Benign epilepsy of childhood with Rolandic paroxysms,
Benign epilepsy of childhood with occipital paroxysms,
Primary reading epilepsy
Symptomatic: depending on the location and etiology
Cryptogenic: when the etiology remains unknown
Epilepsies and generalized epileptic syndromes
Idiopathic, age-related, with in chronological order:
Benign familial neonatal seizures, benign neonatal seizures
Benign myoclonic epilepsy of childhood, epilepsy-absences of childhood
Adolescent epilepsy-absences, juvenile myoclonic epilepsy
Grand Mal seizure epilepsy upon awakening, others
Cryptogenic and / or symptomatic, with in particular:
Infantile spasms (West syndrome), Lennox - Gastaut syndrome
Epilepsy with myoclonic astatic seizures, epilepsy with myoclonic absences
Symptomatic
Without specific etiology:
Early myoclonic encephalopathy, early childhood encephalopathy
with suppression, bursts, or others
Specific syndromes: metabolic or degenerative etiologies

11

Epilepsies whose focal or generalized nature is not determined
Association of generalized and partial seizures with in particular: severe
myoclonic epilepsy, epilepsy with continuous peak-waves during slow sleep,
epilepsy with acquired aphasia (Landau-Kleffner syndrome)
Without generalized or definite focal character
Special syndromes
Occasional attacks, linked to a transient epileptogenic situation:
Febrile convulsions
Seizures only precipitated by a toxic or metabolic factor
Isolated crisis, isolated state of evil
II.2.1. MAIN EPILEPTIC SYNDROMES SPECIFIC TO CHILDREN
Syndromic classification has also brought considerable progress in the diagnosis,
management, treatment and pathophysiological approach of childhood epilepsy.(1).
Thus, we can already notice that the classification of seizures can be carried out on the sole
basis of clinical diagnosis by a trained practitioner. The precise classification of epilepsies and
epileptic syndromes requires the use of additional examinations (see board 2).
Board 2: classification of electroclinical syndromes and other epilepsies (LICE 2009)

Electroclinical syndromes classified by age of onset of seizures
Neonatal period:
Benign familial neonatal convulsions,
Early myoclonic encephalopathies
Ohtahara syndrome
Childhood:
Benign epilepsy of childhood with Rolandic paroxysms,
Benign epilepsy of childhood with occipital paroxysms,
Primary reading epilepsy
Symptomatic: depending on the location and etiology
Cryptogenic: when the etiology remains unknown
Generalized epilepsy and epileptic syndromes
Idiopathic, age-related, with in chronological order:
Benign myoclonic epilepsy of childhood, epilepsy-absences of childhood
Adolescent epilepsy-absences, juvenile myoclonic epilepsy
Grand Mal seizure epilepsy upon awakening, others
Cryptogenic and / or symptomatic, with in particular:
Infantile spasms (West syndrome), Lennox - Gastaut syndrome
Epilepsy with myoclonic astatic seizures, epilepsy with myoclonic absences
Symptomatic
Without specific etiology:
Early myoclonic encephalopathy, early infantile encephalopathy with
suppression bursts, others
Specific syndromes: metabolic or degenerative etiologies

12

Epilepsies whose focal or generalized nature is not determined
Association of generalized and partial seizures with in particular: severe
myoclonic epilepsy, epilepsy with continuous peak-waves during slow sleep,
epilepsy with acquired aphasia (Landau-Kleffner syndrome)
Without generalized or definite focal character
Special syndromes
Occasional attacks, linked to a transient epileptogenic situation:
Febrile convulsions
Seizures only precipitated by a toxic or metabolic factor
Isolated crisis, isolated state of evil
II.3.

EPIDEMIOLOGY

There are no geographic, racial or social boundaries to the disease. Anyone can be affected
by it. Epilepsy can strike both sexes at any age, but especially in infancy, childhood, adolescence
and old age. In reality, everyone, and up to 5% of the world's population, can have a unique seizure
at some point in their life.
However, the diagnosis of epilepsy is reserved for people who have repeated seizures, at
least two recurrent seizures. According to numerous studies carried out around the world, this
would be around 8.2 per 1000 in the general population. However, this may be an underestimate,
as some studies from developing countries (Colombia, Ecuador, India, Liberia, Nigeria, Panama,
United Republic of Tanzania and Venezuela, for example) suggest a prevalence higher, greater
than 10 per 1000. There are therefore around 50 million epileptics in the world. The lifetime
prevalence of epilepsy, that is, the number of people around the world who currently have epilepsy,
have had it in the past (in childhood, for example) or suffer from it in the future (during their old
age, for example), could amount to nearly 100 million people. In Morocco, this prevalence is
estimated at 1.1%(2).
Regarding incidence, studies conducted in developed countries suggest an annual incidence
of epilepsy of about 50 per 100,000 for the general population. However, studies in developing
countries suggest that this figure is close to 100 per 100,000 (i.e. double)(2). The main reasons for
the higher incidence of epilepsy in developing countries are the higher risk of brain infections.
These risks include neurocysticercosis, meningitis, malaria, pre- and postnatal obstetric
complications and malnutrition.
As for mortality, studies are rare, but in the United Kingdom death rates from epilepsy in
young adults are three times higher than all-cause death rates by age.

13

ETIOLOGY

II.4.

II.4.1. GENETIC FACTORS
Are indisputably present in many epilepsies, without it being always possible to assess their
importance.
Identifying the genes responsible for certain epileptic syndromes is an essential step in
understanding the physiopathological mechanisms of these conditions and allows us to consider
improving patient care. From a genetic point of view, epilepsies are complex diseases for several
reasons(1):
❖ Polygenic and multifactorial originmost often: in these cases epilepsy is dependent on
genetic and environmental factors. We can cite in this case:
▪

Photosensitivity: the subject only has a seizure when subjected to intermittent light
stimulation.

▪

Febrile seizures: If he hadn't had a febrile episode, a child with the susceptibility would
not have such a seizure.

❖ Rarer monogenic epilepsy: They are rarer but easier to study. We can cite :
▪

Benign familial neonatal convulsions

▪

Certain febrile convulsions (especially in the context of GEFS + syndrome)

Certain epilepsies of the external temporal lobe (with auditory phenomenon)
Autosomal dominant frontal nocturnal epilepsies.
Epilepsy can be associated with diseases resulting in chromosomal abnormalities:
 Down's syndrome
 Fragile X syndrome
 Angelman syndrome
 Unverricht-Lundborg disease
 Lafora disease
 Nordic epilepsy
 Ceroid lipofuchinosis

▪

14
II.4.2. ACQUIRED FACTORS
II.4.2.1.

PRE AND PERINATAL FACTORS

These include cerebral malformations, vascular accidents, CNS infections (toxoplasmosis
and cytomegalovirus) and intoxications occurring during intrauterine life.
During the neonatal period, it would be ischemic or hypoxic encephalopathies, contusions
or cerebral haemorrhages (mainly obstetric trauma), cerebromeningeal infections (listeriosis,
herpes consumption of certain sedatives by the mother during pregnancy.
When the lesions are severe, the epileptic seizures are expressed early, if the lesions are
more discrete, the onset of partial epilepsy in adulthood is possible.
II.4.2.2.

POST-TRAUMATIC EPILEPSY

Defined by the existence of recurrent seizures that appear secondarily after a head trauma
and are due to the lesions caused by the latter.
Epileptic seizures can occur early after a head trauma (in the week following the trauma)
and in this case will not necessarily repeat, or late (up to two years after the accident), and then
achieving post-trauma epilepsy. traumatic. Characterized by secondarily generalized focal
seizures(1).
II.4.2.3.

VASCULAR EPILEPSY

It concerns crises linked to more or less long term to a brain injury of ischemic or
hemorrhagic origin.
II.4.2.4.

EPILEPSY AND CEREBRAL VASCULAR MALFORMATIONS

Arteriovenous aneurysm is the model for cerebrovascular malformations associated with
epilepsy. AV C. Angiomatous malformations can be the cause of epileptic seizures.
II.4.2.5.

METABOLIC EPILEPSY

Epileptic seizures of metabolic origin are mainly generalized tonic-clonic seizures. They
can be related to hypoglycemia, hypo / hypercalcemia ...

15
II.4.2.6.

EPILEPSY OF INFECTIOUS ORIGIN

Cerebral parenchymal disorders (viral encephalitis, bacterial meningoencephalitis, cerebral
abscesses) are particularly epileptogenic. Meningitis, tuberculosis, meningococcal meningitis and
neurosyphilis are particularly incriminated in developing countries. During HIV infection,
epileptic manifestations reflect virus neurotropism, or an opportunistic condition promoted by
immunosuppression (eg, toxoplasmosis). Certain parasitoses are the cause of epileptic seizures,
especially in developing countries. Cerebral malaria is thought to lead to febrile convulsive
seizures in children (regardless of the type of plasmodium), seizures associated with acute
encephalopathy (pernicious access or sequelae of malaria cerebral damage)(8).
Neurocysticercosis due to the intracerebral localization of Tænia solium larvae is
considered to be a frequent cause of late epilepsy, in non-Muslim developing countries, certain
microfilariae (onchocerciasis, loiasis) are the cause of late seizures(1).
Extracerebral febrile illnesses (ENT viral infections, eruptive fevers, etc.) can cause (under
the influence or not of a genetic predisposition) hyperthermic convulsions.(1).
In the acute phase of meningitis testifying to its seriousness, associated with a brain abscess
...
II.4.2.7.

TUMOR EPILEPSY

The clinical expression of which is variable, the seizures being more often partial than
apparently generalized. Very rare in children and adolescents, they can be the cause of epilepsy in
adults and the elderly, mainly manifested by secondarily generalized partial seizures.(1).
II.4.2.8.

ALCOHOLIC, DRUG AND METABOLIC EPILEPSY

Excessive ingestion of alcohol can cause accidental epileptic seizures (convulsive
intoxication) in a chronic alcoholic or promote the onset of seizures during libations in genuine
epileptics. Alcoholic epilepsy itself is characterized by the occurrence in an adult without a history
of epilepsy, of recurrent generalized seizures, the only possible etiology being chronic alcohol
intoxication.
Psychotropic drugs during an overdose (neuroleptics, anti-depressants, etc.) or withdrawal
from the consumption of benzodiazepines and barbiturates are liable to trigger epileptic seizures.
Certain non-psychotropic drugs (isoniazid, theophylline) as well as certain drugs (cocaine,

16

amphetamine) are potentially epileptogenic. Acute poisoning by lead, methanol and
organophosphates are epileptogenic.
Among the epileptogenic metabolic changes, we retain disorders of glycemic balance, hypo
natremia, hypocalcaemia.
II.4.2.9.

SYMPTOMATIC EPILEPSIES

They are the consequence of damage to the brain (eg head trauma, meningitis, encephalitis,
etc.).
II.4.2.10. CRYPTOGENIC EPILEPSIES
They correspond to seizures where no examination can attribute a specific cause to the
epilepsy.
II.4.2.11.

IDIOPATHIC EPILEPSIES

They correspond to seizures where there is no detectable brain damage. On the other hand,
a genetic predisposition is most often at the origin according to the latest genetic advances
according to Dr Fabienne Picard cf. table I.(9) :
II.5.

PHYSIOPATHOLOGY

From a pathophysiological point of view, all epileptic seizures are the translation of the same
phenomenon: the hyper-synchronous and self-sustaining paroxysmal discharge of a more or less
extensive population of hyperexcitable cortical neurons.
II.5.1. Initiation of epileptic discharge
The epileptic activity is characterized by a massive paroxysmal depolarization (Paroxysmal
depolarization shift = PDS), which generates bursts of action potentials (= burst) within a
population of neurons (cf. FIG. 1).
These PDS, which can be recorded on nerve cells inaccessible in current practice, are
expressed for the clinician in the form of a “peak” on the electroencephalogram of an epileptic
patient.
On the cell recording, we notice that after the phase of massive depolarization, a strong
hyperpolarization appears. This phenomenon is even more marked in neighboring cells, which
would allow the discharge to be "surrounded" and thus prevent it from spreading and repeating
itself immediately.(9).

17

According to one of the models, the hyperexcitable neurons that produce a lot of PDS are at
the center of what is called the epileptic focus. Surrounding this center is an area of hyperpolarized
cells. To explain the origin of these PDS, there are two hypotheses:
▪

The first is called the neuronal hypothesis, which is explained by a disorder of the ion
channels, causing a lack of permeability in the membrane of the neuron, which would
disrupt its balance.

▪

The second is called the synaptic hypothesis, which would be explained by giant excitatory
postsynaptic potentials. According to this hypothesis, the behavior of the neuron would be
normal or only slightly altered.

In people with epilepsy, these electrical manifestations are found between seizures (intercritical
anomalies), without there being any symptoms. Indeed, the propagation of repetitive action
potentials is normally prevented by the integrity of the hyperpolarization following the PDS and
the existence of a surrounding zone of inhibition created by inhibitory neurons.(9).
Figure 1. Intracellular recording on surgical resection piece of human epileptic
cortex.(After Schwarzkroin, 1987).

II.5.2. Spread of epileptic discharge
During sufficient activation, there is a recruitment of surrounding neurons. Indeed, if there
is a mobilization of a sufficient number of neurons, the inhibitory system surrounding the focus
will be exhausted, thus allowing the synchronization and propagation of the epileptic discharge to
neighboring structures, through local cortical connections. or to more distant areas, through the
commissural fibers. Symptoms depend on the cortical area affected by the epileptic discharge.

18
II.5.3. End of epileptic discharge
There are several mechanisms which can, it is believed, stop the discharge. In these
mechanisms intervene the accumulation of cellular waste secondary to the crisis, the astrocytes
(cells supporting neurons) which have a role in the reuptake of potassium and finally inhibitory
neurotransmitters.
II.6.

CLINICAL MANIFESTATIONS

Epilepsy is defined by the repetition, generally stereotyped in the same subject, of
spontaneous seizures. The manifestations of this disease are very varied, which is why the
International League against Epilepsy has proposed a classification of seizures, so that all health
professionals speak the same language (see table 1).
About 10% of all epilepsies occur within the first three years of life. Early-onset epilepsies
are frequently associated with significant cognitive and behavioral disorders requiring rapid
seizure recognition and syndromic diagnosis(10). Early diagnosis and well-managed treatment
would lessen the effects of seizures on children's brain development.(11).
II.6.1. Parents questioning
He must specify: the family history of epileptic seizure or epilepsy which may point to a
genetic origin:
 The mother's pathological history before and during pregnancy,
 Abnormalities of childbirth (dynamic or mechanical dystocia, anoxic neonatal ischemia),
 Neonatal conditions,
 The psychomotor development of the child,
 The semiology of the seizure (or seizures), in particular the type of seizures, the existence
or not of vegetative manifestations, automatisms, sensitive and / or sensory signs, the mode
of onset of the seizures, the location, the duration, the circumstances of occurrence and
evolution.

19
II.6.2. Physical examination
It should include:
 The search for a sometimes discreet dysmorphia related to a chromosomal anomaly,
 The measurement of the cranial perimeter and other anthropometric parameters (weight,
height) which will be assessed according to the age of the child,
 Neurological assessment which will depend on the child's age (muscle tone, archaic and
tendinous reflexes, eye contact, existence of nystagmus, tremors, ataxia),
 A skin examination looking for neuroectoderma (tuberous sclerosis of Bourneville,
neurofibromatosis, Sturge-Weber disease, Ito hypo melanosis)
II.6.3. Status epilepticus
It corresponds to seizures, whatever their nature, recurrent without recovery of
consciousness between seizures, or to a single seizure lasting more than thirty minutes.
The classification of status epilepticus depends on the type of seizure that occurs. Thus,
we find tonicoclonic, tonic or clonic states of evil.
The prognosis depends on the duration and cause of status epilepticus. However,
whatever the type, it is always very serious and constitutes a medical emergency.

20

Board 3: Classification of epilepsies and epileptic syndromes (in row: etiopathogenic axis and in column: symptomatological axis). (After Thomas &
Arzimanoglou, 2000)

Electroclinical syndromes and other epilepsies grouped by diagnostic specificity
Electroclinical syndrome
An example of the organization of syndromes: by typical age of
presentation





New born
Benign neonatal crises
Benign familial
neonatal epilepsy
(BFNE)
Early myoclonic
encephalopathy
(EME)
Ohtahara syndrome










Infant
Feverish attacks, more
feverish attacks
Benign epilepsy in infancy
Benign familial epilepsy in
infancy
West Syndrome
Dravet syndrome
Infant Myoclonic Epilepsy
(MEI)
Myoclonic encephalopathy of
non-progressive conditions
Infant epilepsy with
migrating seizures

Child
 Febrile seizures, febrile seizures plus (FS +)
 Panaylotopoulos syndrome
 Myoclonic-atonic seizure epilepsy
(previously astatic)
 Childhood epilepsy (CAE)
 Benign epilepsy with Centro temporales
(BECTS)
 Autosomal dominant nocturnal frontal
epilepsy (ADNFLE)
 Late-onset occipital seizure epilepsy
(Gastaut type)
 Epilepsy with myoclonic absences
 Lennox-Gastaut syndrome
 Epileptic encephalopathy with continuous
wave peaking during sleep (CSWS) +
 Landau-Kleffner syndrome (LKS)

Distinct constellations / Surgical syndromes
Distinct constellations / Surgical syndromes
 Mesial temporal epilepsy with hippocampal sclerosis
 Rasmussen syndrome
 Gelastic attacks in hypothalamic hamartoma
 Hemi convulsion-hemiplegia-epilepsy








Adolescent-Adult
Adolescent Absence
Epilepsy (JAE)
Juvenile myoclonic epilepsy
(JME)
Predominantly generalized
tonicoclonic seizure epilepsy
Epilepsy with seizures with
autosomal dominant
auditory symptomatology
(ADEAC)
Other forms of familial
temporal epilepsy

Epilepsy with less specific age
of onset
 Focal familial epilepsy with
variable focus (children and
adults)
 Progressive myoclonic
epilepsy
 Reflexive epilepsies

Non-syndromic epilepsies
Epilepsy related to a structural-metabolic cause
 Malformations of cortical development
(hemimegalencephaly, heterotopias, etc.)
 Neurocutaneous syndromes (Tuberous sclerosis,
Sturge-Weber, etc.)
 Tumor, infection, trauma, Angioma
 Perinatal suffering, Vascular accident, Etc.

Epilepsies of unknown causes

21

II.7.

PARACLINIC EXPLORATIONS

II.7.1. Biological examinations
A blood ionogram, supplemented by calcemia and glycemia, may be carried out to
eliminate a metabolic disorder which may itself be linked to an innate metabolic abnormality.
A blood culture and a complete blood count are of little use. They should be considered in
the face of the occurrence of febrile seizures.
The performance of a lumbar puncture is controversial. It is most often indicated in young
children aged 5 to 12 months during febrile seizures.
II.7.2. Electroencephalogram
The electroencephalogram (EEG) does not allow a definite diagnosis of epilepsy. The
absence of intercritical anomaly does not exclude the diagnosis of epilepsy, just as their presence
does not confirm it. The diagnosis of epilepsy is more difficult than that of other chronic diseases
for which the diagnosis is based on well-defined clinical and / or paraclinical abnormalities. There
are different types of EEG recordings, the choice of which depends on the age of the child. The
standard EEG should be interpreted taking into account the clinical expression and course of the
seizures in the child. Stimulation maneuvers could improve the sensitivity of recording spikes
during routine EEG.
Three elements influence the interpretation of the EEG:
 The quality of the recording;
 Stimulation maneuvers (polypnea or hyperpnea test, intermittent light stimulation,
induced sleep);
 The interpreter.
In infants and children, we will opt more particularly for a long recording of wakefulness
and sleep, with stimulation maneuvers. Hyperpnea favors the occurrence of absences and
intermittent light stimulation (SLI) seeks photosensitivity. The EEG makes it possible to search
for rhythmic abnormalities and for critical (concomitant to the seizure) and inter-critical (apart
from the seizure) epileptic anomalies.
Currently, the EEG-video allows to appreciate the electro-clinical correlation especially
when a seizure occurs at the time of recording.
II.7.3. Electromyogram
Coupled with EEG, the electromyogram (EMG) makes it possible to differentiate the
electrical abnormalities of epileptic seizures from spasms and myoclonus not associated with
cerebral manifestations.
II.7.4. Brain imaging
Brain imaging can be structural or functional. It has all its importance in etiological
research. Structural imaging is indicated in all focal epilepsy with the exception of typical Centro
temporales epilepsy. It makes it possible to search for cerebral malformations, cortical dysplasias,

22

lesions acquired following a trauma or infection, cerebral lesions from neurocutaneous syndrome.
Functional imaging searches for the location of an epileptogenic focus and assesses its impact.
II.8.

CLINICAL DIAGNOSIS

The diagnosis of epilepsy and its classification are based on the semiological analysis of
the seizures. The capital stage remains the interrogation, which must review all the semiological
details of the crisis, look for possible triggering factors, specify the brutal nature of the beginning.
It is essential to have the description of any witnesses.
The neurological examination which follows the interrogation is negative in the great
majority of cases. When disturbed, it provides information on the existence and location of a
possibly causal lesion and therefore has an etiological and not a positive interest.
The results of the electroencephalogram (EEG) must be interpreted according to the clinical
context and the absence of anomaly on the EEG can therefore never, on its own, rule out the
diagnosis of epilepsy.
The clinical and electroencephalographic characteristics of an epileptic seizure depend on
the initial site of the epileptic discharge and its possible spread to the rest of the cerebral cortex.
II.9.

DIFFERENTIAL DIAGNOSIS

Various conditions can be confused with epilepsy such as:
 Meningitis or subarachnoid hemorrhage in which there is fever and meningeal stiffness.
 Syncope is a symptom that results from a transient and overall reduction in cerebral
perfusion with associated hypoxia. Loss of consciousness lasts only a few seconds, rarely
a minute or more, and recovery is rapid. We may observe a brief tonic trunk posture or
some clonic twitching of the arms and legs when the cerebral hypoxia is severe enough.
 Basilar migraine, a rare variant, most commonly seen in adolescents and young adults, can
manifest as lethargy, mood disturbances, confusion and disorientation, dizziness, bilateral
visual disturbances and impaired or loss of consciousness.
 Psychogenic seizures are a frequent cause of intractable epilepsy in adults and can
represent 20% of cases referred to a surveillance unit. Diagnosis is made using video /
EEG, although a history of atypical and non-stereotypical psychiatric illness seizures,
complete absence of responses to antiepileptics, and repeated normal interscritical EEGs
suggesting the possibility of psychogenic crises.
 The hysterical attacks which always take place in front of witnesses, less abrupt onset, the
patient has time to lie down, there is no bite of the tongue.
 All causes of convulsions.
 Panic and anxiety attacks with hyper ventilation: Prolonged hyper ventilation twitches or
muscle spasms (tetany) and patients may pass out.
 Narcolepsy and sleep apnea.
 Faced with a generalized crisis, the following elements must be eliminated: - faintness;
 Syncope;
 Functional or organic hypoglycemia;
 A hysterical crisis.

23
 In front of a simple partial seizure, it is necessary to eliminate:
 A transient ischemic attack;
 Abnormal movements (in front of somatomotor crises);
 A migraine attack with aura.
 Faced with a complex partial seizure, it is necessary to eliminate:
 A behavioral or mood disorder;
 An amnesic stroke.
II.10.

THERAPEUTIC ASPECTS AND PROGNOSIS OF CHILD EPILEPSY

The treatment of seizures is one of the aspects of the management of epilepsy in children, but
that of co-morbidities is also crucial. Nowadays, many antiepileptic drugs exist and more are in
development. For some molecules, the mechanisms of action are known and for others, they
remain unknown. Among the best identified mechanisms, we find:






Inhibition of voltage-gated sodium channels;
Inhibition of voltage-gated calcium channels,
The increased inhibitory action of gamma aminobutyric acid (GABA);
Inhibition of the release of glutamate and aspartate, excitatory amino acids;
Inhibition of glutamate receptors.

Tables 4 and 5 summarize the data on antiepileptic drugs.
Board 4: Mechanisms of action, indications and adverse effects of antiepileptics (De Saint Martin et
al., 2006)

DCI
(Abbreviation)

Phenobarbital
(PB)
Phenytoin
(PHT)

Mechanisms of action

Indications

First generation antiepileptics
Epilepsy absence,
GABAergic inhibition
myoclonic epilepsy,
POCS
Inhibition of PA at the level
of voltage dependent Na
Focal epilepsies
channels

Second generation antiepileptics
GABAergic inhibition
Valproate
Inhibition of AP at the level
Focal and generalized
(VPA)
of voltage dependent Na
epilepsies
channels
Inhibition of PA at the level
Carbamazepine
of voltage dependent Na
Focal epilepsies
(CBZ)
channels
Epilepsy absence,
Ethosuximide
Inhibition of dependent Ca
myoclonic epilepsies,
(ESM)
Voltage channels
POCS

Main side effects

Drowsiness, cognitive
impairment, hyperactivity,
skin allergy
Skin allergy, gingival
hyperplasia, balance
disorders, leukopenia

Weight gain, hepatitis,
pancreatitis, tremors
Weight gain,
hyponatremia, skin
allergy, balance disorders
Drowsiness, irritability,
digestive disorders

24

Benzodiazepines
Clonazepam
(CZP)
Clobazam
(CLB)
Diazepam
(DZP)
Nitrazepam
(NZP)

Potentiation of GABA
inhibition

Immediate treatment of
any type of epileptic
seizure

Respiratory distress

Board 5: New antiepileptics, mechanism of action, indication and adverse effects (De Saint Martin et
al., 2006)

Antiepileptics
Lamotrigine
(LTG)

Mechanisms of action
Decrease in excitatory
neurotransmitters and
inhibition of voltage-gated
Na channels
GABA analogue

Indications
Focal and generalized
epilepsies

Main side effects
Skin allergy,
insomnia, headache

Focal epilepsies

Topiramate
(TPM)
Oxcarbazepine
(OXC)
Vigabatrin
(VGV)
Levetiracetam
(LEV)

Weak inhibitor of brain
carbonic anhydrase
Voltage dependent Na and
Ca channel inhibitors
GABA transaminase
inhibitor
Unknown

Focal and generalized
epilepsies
Focal epilepsy

Felbamate (FBM)

NMDA receptor antagonist

Drowsiness, weight
gain, balance
disorders
Drowsiness, weight
loss, kidney stones
Vertigo, drowsiness,
diplopia
Concentric reduction
of visual field
Drowsiness,
irritability, emotional
lability
Acute hepatitis,
aplastic anemia

Sulthiane (STM)

Selective inhibition of brain
carbonic anhydrase
Potentiation of GABAergic
transmission and inhibition
of the metabolism of
antiepileptic drugs
Voltage dependent Ca
channel inhibitor

Gabapentin
(GBP)

Stiripentol (STP)

Pregabalin (PGB)

Infantile spasms, focal
epilepsies
Focal and generalized
epilepsies
Focal and generalized
epilepsies Lennox -Gastaut
syndrome
Centro temporales
epilepsy
Dravet syndrome

Focal epilepsies in
combination with another
antiepileptic

Hyperpnea,
paresthesias
Neutropenia

Balance disturbances,
weight gain,
drowsiness

25

Rufinamide
(RFN)

Voltage dependent Na
channel inhibitor

Tiagabine (TGB)

Increased brain and synaptic
GABA

II.10.1.

Lennox-Gastaut syndrome
in combination with other
treatments
Focal epilepsies

Drowsiness, dizziness

Dizziness, tremors,
fatigue, drowsiness;
depression, emotional
instability

Principles of processing

Without treatment, with first or second line monotherapy, 60 to 70% of children could see their
seizures decrease or disappear(12). The other 30 to 40% would represent epilepsies with favorable
evolution or refractory epilepsies which would require long-term combination therapy(12). As the
causes of childhood epilepsy are varied, each child should have an assessment tailored to their
diagnosis. Children with epilepsy should be classified into two groups:
 Children with genetic or suspected genetic epilepsy.These epilepsies generally have a
good therapeutic response to antiepileptics and the associated behavioral or neurocognitive
disorders are rarely severe.
 Children who have structural or metabolic epilepsy. For these epilepsies, the therapeutic
response is most often mixed. Children present with comorbidities that result from the
interaction between the underlying causes, seizures and subclinical manifestations.
In the case of genetic / presumed genetic epilepsies, the aim is to achieve seizure control if
possible without antiepileptic treatment, or by monotherapy without noticeable side effects. On
the other hand, for refractory epilepsies, the objective is to obtain a balance between a low number
of seizures and a minimum of undesirable effects in order to preserve a good quality of life.(12).
II.10.2.

Initiation of antiepileptic therapy

It is based on the clinical state of the child, the characteristics of the epilepsy and the
pharmacological properties of the available antiepileptics. This choice is a capital therapeutic
decision because it will be able to obtain a remission of the seizures without forgetting that the
child will be able to remain under treatment for several years. The choice will be oriented towards
antiepileptics that can offer a good therapeutic response at low doses, good tolerance and
preservation of quality of life.(13). The start of treatment does not take place until the diagnosis
has been made. In epileptology, there is no therapeutic test with diagnostic value. Children who
have febrile seizures and mild epilepsies are not often put on treatment. However, in the event of
frequent and prolonged attacks, the initiation of treatment is justified. This treatment is often
instituted after the occurrence of two unprovoked attacks because the risk of recurrence becomes
high. The start of treatment may be delayed when seizures are infrequent and when a suspected
syndrome has not yet been confirmed. However, in the event of cortical dysplasia and before
electroencephalographic abnormalities suggestive of a high risk of recurrence, treatment can be
started after the first episode of unprovoked seizures.(12).
Monotherapy is the first choice in the treatment of epilepsy. If seizures persist, it is
preferable to reach the maximum tolerated dose before introducing another antiepileptic
monotherapy. The dosage of the new antiepileptic should be increased gradually, that of the first

26

one will be gradually reduced once the effective dose of the newly introduced antiepileptic is
reached.(5). Side effects are usually the cause for stopping treatment. The failure of the first
monotherapy is certainly a sign of a poor prognosis, but the probability of achieving remission
after failure of a second treatment is less than 10%(12).
When two or three well-conducted treatments (in monotherapy) fail, combination therapy
should be offered to the child. Combination therapy is possibly initiated from the start if there is
suspicion or certainty of a specific syndrome such as Dravet syndrome or Lennox-Gastaut
syndrome, even if the effectiveness of combination therapy remains poorly documented in these
cases. case. For other epileptic syndromes, combination therapy will be preferable to monotherapy.
Combination therapy will be chosen as a last resort. Its objective will be to improve the efficacy
of the treatment, its tolerance or both. The choice of antiepileptics to combine is based on the
absence of interaction and a good efficacy / toxicity ratio. However, the mechanisms involved in
the efficacy of the combination of antiepileptics are not fully understood. Today there is little
evidence of the superiority of one combination of antiepileptic drugs over another. Animal testing
has not been conclusive(12). Some evidence gathered during non-randomized therapeutic trials
showed that certain combinations would have a synergistic effect, in particular valproate and
Ethosuximide in the treatment of absences, valproate and Lamotrigine in the treatment of absences
and myoclonus. In these cases, these combinations would be more effective than increasing the
dose of each of the antiepileptics prescribed as monotherapy(12). The combination of
antiepileptics with a major sedative effect should be avoided, but the combination can be done
with a broad-spectrum antiepileptic in children with several types of seizures.
II.10.3.

Interruption of treatment

The decision to discontinue antiepileptic therapy depends on the relationship between the
risk of relapse and long-term side effects(12). Often, antiepileptic therapy is continued for at least
two years after the seizures have stopped.
However, there is no optimal time to interrupt it. (8). The epileptic syndrome appears to be
the main determinant of the duration of treatment and the risk of seizure recurrence after
discontinuation of treatment. In the same vein, antiepileptics can be withheld early in children with
age-dependent epileptic syndrome such as mild child seizures.(12)while the suspension will be
delayed or never considered for children with juvenile myoclonic epilepsy in whom the risk of
seizure recurrence following discontinuation of treatment is high. Other factors such as the
existence of several types of seizures, the age of onset, the duration of the epilepsy, the existence
of brain damage, the presence of neurological abnormalities on clinical examination and the type
of EEG abnormalities should be taken into account when deciding to discontinue treatment. In
sum, it should be recognized that it is difficult to predict the outcome after discontinuation of
antiepileptic therapy.(2). Resetting treatment cannot guarantee rapid seizure control either.
II.10.4.

Surgical treatment

In children, the indication for the surgical treatment of epilepsy has obviously evolved over
the past decades thanks to the development of techniques for locating epileptogenic foci: EEGvideo, morphological and functional neuroimaging. The surgery is aimed at pharmaco-resistant
focal epilepsies. It is increasingly recommended early once drug resistance is proven due to

27

cerebral plasticity and the negative impact of epilepsy on the developing brain.(12). The aim of
surgery is to control seizures but also to minimize the appearance or worsening of cognitive and
behavioral disorders. There are two types of surgery:
 Curative surgery which aims to extirpate or isolate the cortex responsible for seizures. It
can be limited (lesionectomy, gyrectomy, à la carte cortectomy) or extensive (lobectomy,
hemispherectomy)(12);
 Palliative surgery, the objective of which is to interrupt or limit the spread of seizures in
order to obtain a reduction in their frequency and severity.
II.10.5.

Evolution and prognosis

The evolution is variable; some forms will last a few years and disappear (on average 12
to 13 years) and others will last a lifetime. It depends on the following factors:






Age of onset of seizures;
Frequency of seizures;
Response to treatment;
Presence or not of an underlying neurological impairment;
Impact on the patient's behavior.
II.10.6.








Elements of poor prognosis

An early onset age;
A known cause;
The existence of clinical or neuroradiological signs of encephalopathy;
High frequency of attacks;
The association of several types of seizures;
A long delay between the onset of epilepsy and the initiation of adequate treatment.
II.10.7.

Global patient care

It requires a good doctor-patient relationship and must allow regular medication. Advice must be
given for work (studies, active life) and acts of daily life (cleaning, driving a vehicle). Interventions
are sometimes necessary with teachers, employees, supervisory authorities to facilitate the
acceptance of these epileptics(14).

28

PART II PRACTICAL CONSIDERATIONS

29

CHAPTER III. METHODOLOGICAL FRAMEWORK
III.1.

Description of the research location

III.1.1. History of the commune of Rwashi
It was created in 1956 to respond to the growing urbanization of the city. The Commune
of Ruashi is one of the seven Communes that make up the city of Lubumbashi. It is a decentralized
territorial entity endowed with a legal personality and enjoying free administration, according to
the constitution of 08/02/2006 and in accordance with the organic law N ° 08/016 of 07/10/2008.
This town derives its name from the “LWASHI” stream, whose source is located at the
level of the Ruashi Mining embankments and flows into the Luano river.
Its creation dates back to 1955, the year in which the housing problem arose sharply in
the copper capital. To solve these problems, the colonial authorities forced the employers of the
Enterprises to house their workers.
This decision will give birth to the cities of NYANSHI today Kenya, Albert today
Kamalondo and Katuba, with the help of the fund Advance Fund. But for the RUASHI district,
the houses were built by the organization "Office des Cites Africaines", acronym OCA, created in
our country by the decree of May 30, 1952.
The construction works began in 1954 with Quarters I and II which form the Bendera I
and II Quarter and V Quarter called today Matoleo I. The Houses thus built were leased to blacks
through the colony. It was in 1955 that the Ruashi Quarters hosted their first inhabitants on June
25, 1955, the Order of the Provincial Governor created the Ruashi Quarter. The administration of
this new city was entrusted to a Belgian subject, in the person of Mr. Jean Jacques DHONT. IN
1956, by the Decree of November 15, the Provincial Governor at the time will subdivide the Extra
Customary Center of Elisabeth City (CEEC in acronym) into four Districts namely: Kamalondo
(Albert), Kenya (NYANSHI), Katuba and Ruashi.
Regarding the development plan, the builder of the Ruashi was based on the plan of the
Belgian town planner, Mr. NOEL VAN MALLECHEN.

30

A special fact to remember is that Ruashi was a former acclimatization camp of the
mining union of Haut Katanga, which consisted of accommodating workers recruited outside
Katanga province, in order to allow them to adapt to the climate of the region before going down
to the factories and workshops. This is the case of workers from Bas Congo and Northern Rhodesia
(Zambia) who were acclimated to the current location of Ruashi commune.
After Independence, the defunct Office National de Logement (ONL) took care of the
management of the houses left by the Office des Cités Africaines (OCA). Ruashi has experienced
rapid population growth, which rose from 3,176 in 1950 to 12,408 at the end of 1998. A few years
after its birth, the commune of Ruashi was given the SOLVAY association for the purpose of its
social services.
In application of the decree-law of May 26, 1957 relating to the organization of the towns
of the Congo, the Provincial Governor at the time will sign the decree N ° 11/160 of October 17,
1957 which consecrated the birth and the delimitation of the municipalities Elisabeth
(Lubumbashi), Albert (KAMALONDO), Kenya (NYANSHI), RUASHI, KATUBA and from the
annexed zone since the decree of March 26, 1957.
As mentioned above, the commune of RUASHI, when it was created, had only three
Quarters, namely: Quarters I, II and V. Over time the number of Quarters has increased from 3 to
7 Quarters namely: Bendera , Congo, Kalukuluku, Luano, Matoleo, Kawama AND Shindaika.
III.1.2. Geographic location
Rwashi, also written Ruashi, is an urban commune in the northeast of the city of
Lubumbashi, in the Democratic Republic of the Congo with several neighborhoods and an
estimated population of 148,399 inhabitants.
III.1.3. Organization of the commune of Rwashi
Following the extension of certain Quarters and the population explosion, a
dismemberment of six Quarters was operated and the number of Quarters increased from 7 to 14
Quarters including: Bendera I, Bendera II, Congo I, Congo II, Kalukuluku I, Kalukuluku II,
Kawama I, Kawama II, Kawama III, Luano I, Luano II, Matoleo I, Matoleo II and Shindaika. The
Luano II Quarter, given its length of ± 15 kilometers, must undergo a division. This will allow us
to have on this side 2 Districts including: Luano RVA and Kanamba.
At the head of this commune is a bourgmestre by the name of Mrs. BRIGITTE
BYAMUNGU and at the head of all these 14 districts is a district chief.

31

III.2.

Type of study
We conducted a prospective cross-sectional study with a descriptive aim in the

Democratic Republic of Congo (DRC) in the Haut-Katanga province in Lubumbashi in the
commune of Rwashi.
III.3.

Work delimitation

Our study was spread over a period of 9 months, from January 20 to October 20, 2020.
III.4.

Sampling
Our study population consists of 125 respondents of both sexes residing in the commune

of Rwashi.
III.5.

Inclusion criteria
All persons residing in Rwashi commune who accepted the interview were included.

III.6.

Exclusion criteria
Not included any person residing in the commune of Rwashi:
 Not having accepted the interview and those not residing in this commune.
 Those who were absent during our survey
 Those who did not want to answer all the questions

III.7.

Conduct of the investigation
Recruitment was done using an individual survey sheet made up of closed and open

questions, after explaining the interest of the study to the participants and obtaining their
agreement, they were interviewed in French and in Swahili.
In all cases, we managed to meet at least 10 among the 125 surveyed to whom we found
epileptic children.

32

III.8.

Data entry and analysis

The data was gathered through searches carried out mainly via PubMed, Google Scholar and
Google. Regarding data processing, it was done in three phases:
 The first is the counting phase which was done manually,
 The second is the phase of transmission of the results or of the entry which was made from
the World software version 2019, and finally
 The third phase is the analysis, the encoding of the data and the creation of the survey
questionnaire made on the software Epi info 7.2.2.6 Fr and Excel version 2019 allowed us
to present the graphs through which we treated methodologically information and
testimonies that presented a certain degree of depth and complexity.
III.9.

Encountered difficulties

During the course of our work we encountered several difficulties that we cannot ignore without
expressing them, here are some of them:
✓ The Covid-19 pandemic which has destabilized almost everything whether it is on the
financial, economic and scientific level.
✓ The difficulties of easily reaching all of our respondents following the financial means and
economic crisis.
✓ The difficulties linked to the lack of knowledge of the disease which negatively favored
some respondents to refuse the interview, some even believed that via the interview
consistent with epilepsy, they could be affected by epilepsy because they considered our
coming as being the contribution of an epileptic wind in their household.

33

CHAPTER IV. PRESENTATION OF THE RESULTS
IV.1.

Overall results

Over a 9-month period from January 20 to October 20, 2020, we carried out a prospective study
on 125 people residing in the commune of Rwashi in the city of Lubumbashi.
IV.2.

General knowledge of epilepsy

This section of the questionnaire groups together 10 questions, the answers to which are listed
below.
1. “Have you ever heard of epilepsy? "
In response to this question (Q1), 100% of the subjects surveyed answered positively.

Yes
100%

Figure 2. Answer to question Q1: '' Have you ever heard of epilepsy? ''

2. “How did you hear about epilepsy? "
Board 6: Distribution of responses according to Q2
Mode of knowledge

Frequency

Percentage

Entourage

107

86%

Internet

2

2%

Reading

7

6%

Media

2

2%

Medical staff

7

6%

Total

125

100%

The participants who answered favorably to the previous question were asked to indicate the mode
of knowledge of epilepsy by word of mouth, represented by "the entourage", constitutes the most
widespread mode of knowledge.
Thus, among the 100% who answered "yes" to Q1, around 86% admit to having heard about it
from those around them.

34
3. "What do you think the origin of epilepsy is? "
To the same group of people, that is to say those claiming to know epilepsy, a third question
(Q3) was submitted to them in order to determine, according to them, the contingent in
which epilepsy falls.
More than half of the group considers that epilepsy corresponds to supernatural causes, ie
56% at the time when 30% of them think it has its origin in the mental level.
Stress
2%

Alcoholism
4%

Other
2%
Alcoholism

Mental disease
30%

Other
Supernatural
cause
56%

Heredity
5%

Supernatural cause
Madness
Heredity
Mental disease
Stress

Madness
1%

Figure 3. Answers to Q3: "What do you think is the origin of epilepsy?"

4. "Is epilepsy contagious? "
In response to this fourth question (Q4), 52% of our respondents consider that epilepsy is
contagious.

No
48%
Yes
52%

Figure 4. Answers to Q4: "Is epilepsy contagious?"

No
Yes

35
5. "Have you ever witnessed an epileptic seizure"
In response to this question (Q5), crisis assistance was encountered by more than half of
the participants. Only 41% of them say they have not used it.

No
41%

Yes
59%

No

Yes

Figure 5. Answers to Q5: "Have you ever witnessed a crisis?"

6. "What was your attitude to an epileptic seizure ? "
In response to this question (Q6), we notice that 36% of subjects surveyed recognize that
they do nothing.
Call for help
19%
Do nothing
36%
Assistance to the
person in crisis
13%

Call for help

Escape
32%
Assistance to the person in crisis

Escape

Do nothing

Figure 6. Answers to Q6: "What is your attitude towards an epileptic seizure?"

36
7. “Can we treat epilepsy? "
In relation to this question (Q7), more than three quarters of respondents affirm that
epilepsy can be treated. Only 2% of them say that there is no cure for epilepsy.
No
2%

No
Yes

Yes
98%

Figure 7. Answers to Q7: '' Can we treat epilepsy ''

8. “What are the possible means of treatment? "
Board 7: Answers to Q8: "What are the means you used?"
Q10
The two associated treatments
Medical practice
Pray
Nothing
Traditional treatment

Effective
26
22
41
4
32

Percentage
21%
18%
33%
3%
26%

Total

125

100%

The answers to this question (Q8) describe different methods. We notice that the majority of the
group, 33% resort to prayer. 18% resort to a medical practice against 3% who have nothing to
resort to.
9. "In your opinion, is the epilepsy mild, severe, or very severe? ? "
Board 8: Answers to Q9: "In your opinion, is the epilepsy mild, severe, or very severe"
Q5
Frequency
Percent
Benign
3
2.40%
Serious
49
39.20%
Very serious
73
58.40%
Total
125
100%
In response to this question (Q9), 58.40% of the subjects surveyed consider that epilepsy
is very serious, 39.20% consider it serious.

37
10. "From what you know, epilepsy rather affects"
Board 9: Q10 "From what you know, epilepsy rather affects"
Q6
Children
Adult women
Adult males
Disadvantaged people
The elderly
All age groups of the population
Total

Frequency
4
3
28
10
7
73
125

Percent
3.20%
2.40%
22.40%
8.00%
5.60%
58.40%
100%

In response to this question (Q10), we notice that 58.40% of the subjects surveyed say that epilepsy
affects all age categories of the population.
IV.3. Socio-demographic data
IV.3.1.
Age
Board 10: Breakdown of data by age group
Age
14-33 Years
34-53 Years
54-73 Years
Total

Frequency
72
40
13
125

Percentage
58%
32%
10%
100%

In our sample, the group aged between 14 and 33 is more widely represented with 58%. The
average age is 29 years with a minimum age of 14 and a maximum of 73.
IV.3.2.

Sex

The male sex is clearly predominant in our study. It represents 55% of the subjects surveyed with
a sex ratio of 1.23.

F
45%
M
55%

F

Figure 8: Gender distribution

M

38
IV.3.3.

Residence district

Board 11: Distribution of subjects according to the district of residence
District
Bendera
Congo
From the Rwashi
Kalukuluku
Kawama
Luano
Matoleo
Shindaika
Total

Frequency
8
9
4
8
40
42
7
7
125

Percentage
6%
7%
3%
6%
32%
34%
6%
6%
100%

The majority of our respondents live in the Luano district, i.e. 34%. On the other hand, the minority
of the subjects questioned reside in the Rwashi district, ie 3%.
IV.3.4.

The profession

Board 12: Distribution of subjects by profession
Profession
Artisan
Trader
Assimilated worker
Police officer
Scientific profession
Total

Frequency
55
2
51
7
10
125

Percentage
44.00%
1.60%
40.80%
5.60%
8.00%
100%

44% of the subjects surveyed were craftsmen. On the other hand, the minority of the subjects
questioned were traders, ie 1.60%.
IV.3.5.

Educational level

Board 13: Distribution of subjects by level of education
Educational level

Frequency

Percentage

Illiterate

23

18%

Primary

3

2%

Secondary

87

70%

University

12

10%

Total

125

100%

70% of those surveyed reached the secondary level of education and 18% never integrated an
education system. Only 10% went on to university.

39

CHAPTER V. DISCUSSION AND COMMENTARY
No study has been carried out on the perception of childhood epilepsy in Lubumbashi to
date. The objective of this survey is to assess the degree of perception of childhood epilepsy in the
Lushoise community. This is, to our knowledge, the first study of this kind in Lubumbashi and in
the other cities of the DRC aiming to give an idea on the way in which this group perceives
epilepsy, and therefore, to possibly give to Through this pilot sample, an idea of the perception of
epilepsy by the general population in order to better identify information gaps.Perception of
childhood epilepsy by the subjects surveyed

V.1. General knowledge of the disease
During our study, we found that 100% of our respondents claimed to know epilepsy. This
figure is much higher than those of studies carried out across the world in countries of the Muslim
faith, Arab or not (Table 15), or in Western countries (Table 16).
Board 14. Comparison with Muslim or Arab-Muslim countries
Our study

WATER

Jordan

Pakistan

Malaysia

100%

75%

88%

87.5%

86.5%

92

97

91.8

99

87

93

95

90

Finland

Germany

USA

China

Taiwan

India

Korea

96

Denmark

98

Hungary

New
Zealand

89

Burkina
Faso

100% 87.6

Austria

Brazil

Our study

Board 15. Comparison with countries other than Arab or Muslim.

95

This low rate of knowledge is said to be the consequence of the low level of education
and schooling and of crushing illiteracy (55.6% of Moroccans over 25 according to the High
Commission for Planning). It would also be related to the difficulties of access to the health care
system and consequently to basic health education.
On the other hand, our percentage is higher than those of certain studies. Only 54%
answered "yes" to this question in a work carried out in Vietnam but in rural areas.(2).
In Hong Kong, this figure did not exceed 59%. The authors of this work attribute this low
rate to the fact that the inhabitants of this province do not like participating in this kind of
survey.(2).

40

Relative to the source of epilepsy informationour study reveals that 86% of respondents
had been informed by those around them and think that epilepsy corresponds to the supernatural
while those who know that epilepsy is a mental one learned in a way other than those around them.
For example in educated people who know epilepsy better or simply in doctors and nurses. The
same observation is made by other studies. In Pakistan, only a small minority, the one who seems
to be the most knowledgeable about the disease, knew about it through sources other than the
friends-family circle.(2). In Korea, entourage predominates other sources of information with a
percentage exceeding 78% of cases(2). Among Italians too, most participants get their information
from those around them.(2).
Speaking of the origin of epilepsy more than half of our respondents consider that
epilepsy corresponds to supernatural causes, i.e. 56%. Prejudice and misunderstanding of epilepsy
is still rife in our society and it is annoying to see that more than half of our sample refers to the
supernatural to define the origin of the disease (Fig. 3).
Indeed, our percentage far exceeds those of studies carried out in other countries including
Arab Muslims and even some countries of sub-Saharan Africa. Only 13.8%, 14.6% and 5.3%
respectively of Emiratis, Jordanians and Malaysians(15)think that epilepsy is due to possession by
an evil "jinn" spirit or to bewitching. Similarly, in the Hindu and Sikh communities, epilepsy is
seen as the result of sins committed in a previous life.(2). This belief is more widespread among
Omanis, 65% of whom link epilepsy to supernatural forces (jinn)(2).
Several studies conducted in developing countries have reported that parents of patients,
as well as the general population continue to believe that the epileptic seizure is due to possession
by evil spirits.(2). In Laos, a large part of the community links epilepsy to the supernatural (42.2%).
It was also often considered (more than 37% of cases). In Zambia, in a survey of the clergy, a
quarter of the participants consider that the disease is nothing but a form of possession by the
demon or the spirits. Its cause was attributed in 33.5% and 6.5% respectively to bewitching and a
god's curse.(2)
In Senegal, there is a strong belief which interprets epilepsy as the result of the patient's
untimely encounter with the supernatural world of the spirits. Thus, a third of the participants in a
Senegalese survey conducted among teachers linked epilepsy to supernatural phenomena(2). On
the other hand, among their Zimbabwean and Thai colleagues, respectively only 0.6% and 0.9%
of the teachers evoked a supernatural origin.(2). While the idea of the spiritual and the supernatural

41

remains rooted in some cultures, it is not the same in other countries such as Denmark, Canada,
New Zealand and Austria, to name a few. than those(2).
Speaking about epilepsy contamination52% of our respondents say that epilepsy is
contagious. According to a study carried out by TIDIANE FOFANA in 2008, 59% of the subjects
questioned say that epilepsy is contagious. Which is not similar with ours.
Speaking of assistance to the person in epilepsyour study shows that 59% of
respondents who have already provided assistance with an infantile epileptic crisis. According to
a study carried out in Mali in 2008 by TIDIANE FOFANA, 33% of the subjects questioned
provided assistance in the face of a crisis by performing first aid measures. This is much lower
with our study.
Regarding the attitude taken in the face of an epileptic seizure only 13% of our
respondents know what to do in the face of a crisis while in Turkey, the United States and Thailand
for example, respectively 25%, 20% and 11.4% of the interviewees mentioned appropriate
measures (do not block the body, ventilate the subject, clear dangerous objects) (16).
In Laos and Jordan, the majority of participants were familiar with the first aid measures
to be provided in the event of an epileptic seizure(17). Given the halo of beliefs and prejudices
surrounding epilepsy, crisis behavior is usually one of the mystical, religious and quackery.
Different practices are identified by our survey. The recourse to other practice, always returns
either in read only, or in association with other means.
Speaking of treatment, our study showed that more than three quarters of respondents
who say that we can treat epilepsy. According to a study carried out in Mali in 2008 by TIDIANE
FOFANA, 72% of the subjects questioned say that epilepsy is treatable. This is inconsistent with
our study.
Regarding the possible means of treatmentonly 33% of those surveyed believe that
prayer is better for controlling seizures while 22% equally trust traditional treatment in
combination with medical treatment. This is because our society considers epilepsy to be a spell
cast by geniuses, or ancestors.
Speaking of the severity of epilepsythe majority of our respondents find that epilepsy
corresponds to a very serious (58.40%) or even serious (39.20%) disorder. This does not agree
with the results of other countries such as Jordan where 34% of interviewees think it is a very
serious disease(15). This figure rises to 39% in Italy. In this same country, more than a third