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A door-to-door survey was used to determine the prevalence of epilepsy among 4500 people within the Pikine Health District (population 480,000) Senegal. Prevalence was 14.2/1000, and 23.4% of all people with epilepsy had never received appropriate treatment. Figures for the prevalence had increased since a previous survey in 1989. In parallel a study of knowledge attitude and practice was performed in the same district. Salient findings were that: two-thirds of interviewees had at some time witnessed a seizure, 51% agreed when asked if epilepsy is caused by evil spirits, 35% said epilepsy is contagious, only about 18% said that traditional therapy is best, 60% would not mind their child to play with a child with epilepsy but only 32% would agree if their child would want to marry a person with epilepsy.

One of the leading brain disorders in developing countries is represented by epilepsy. It is estimated that 80% of people suffering from epilepsy around the world, reside in developing world such as Africa. Many perinatal and postnatal causes are brain-stressers in people suffering from malnutrition and low economical conditions. This context is characterised by long delay before modern treatment, reduced number and financial inaccessibility to anti-epileptic drugs (AEDs) and limited human and technical resources for epilepsy. Cultural interpretation also contributes to exclude epileptic patients from the educational and productive fields, aggravating the burden they face and favouring a treatment gap estimated to 80%. To fight against this dramatic reality, a partnership has been built between the International League against Epilepsy, the International Bureau for Epilepsy and the World Health Organisation, named the "Global Campaign Against Epilepsy" "Epilepsy Out of the Shadows" to reduce treatment gap and social and physical burden, educate health personnel, dispel stigma, support prevention.

A follow-up study was performed in 33 patients with proven (ictal EEG-CCTV) psychogenic, non-epileptic seizures (PNES). These patients received a questionnaire to evaluate seizures, treatment and rehabilitation. The response group consisted of 21 females (80% response) and seven males (100% response). Follow-up after diagnosis varied from 23-67 months. Seven patients (25%) reported that seizures had ceased and of the patients not seizure-free seven did report a seizure-free period after diagnosis of an average 6.7 months. Eight patients were on antiepileptic drugs again. Of 13 patients referred for psychotherapy, who also did receive treatment, six became free of seizures and seven did not. Of seven patients also referred, but who did not receive psychotherapy, all continued to have seizures. On a self-rating scale to compare "overall function" at the time of diagnosis and follow-up, 75% considered themselves to have "improved", but no improvement could be detected in psychosocial functioning., (Copyright 1999 BEA Trading Ltd.)

Diagnosing psychogenic non-epileptic seizures (PNES) is a clinical challenge. There is neither a standard in diagnosing PNES nor a comprehensive theoretical framework for this type of seizure. The diagnosis of PNES must be made by excluding epilepsy. However, epilepsy cannot always be determined and PNES and epileptic seizures may coexist. In this study, the characteristics of PNES and patients are discussed. The diagnosis of PNES and epileptic seizures was facilitated by the simultaneous recording of seizures on video tape and EEG. Seizure provoking techniques, hormonal indices, and psychological methods were also used. The benefits and limitations of these techniques are discussed and proposals are made for clinical guidelines.

Aetiology and outcome of status epilepticus in children are different in comparison with adult patients. The main characteristics of status epilepticus in 112 children (age 6 months-15 years) are presented, with special attention to age, duration of status epilepticus, causes, medical complications and therapy. The greater part of these children was known to have had prior epilepsy, a considerable number with mental retardation. Outcome in convulsive status epilepticus is influenced by cause, duration, age, the occurrence of medical complications and quality of treatment. Outcome in nonconvulsive status epilepticus is good and does not seem to be influenced by the treatment strategy. The use of a therapy protocol may prevent unnecessary delay and contribute to a better outcome.

In this pilot study hypnosis was used in an attempt to provide evidence of a psychogenic component of pseudo-epileptic seizures. The criterion for psychogenesis was the reversal of the amnesia, which is often present in epileptic- and pseudo-epileptic seizures. The technique has been validated by a semi-blind referral of cases for analysis after the clinician had been able to make a firm diagnosis based on electro-encephalic corroboration of the nature of the seizure. In eight out of nine patients (of the original 13 patients, three patients dropped out and one patient was not evaluable), the experimental diagnosis corresponded with the clinical diagnosis. As pseudo-epileptic seizures can be characterized by their dissociative nature, a reasonable hypothesis is that patients with pseudo-epileptic seizures are more responsive to hypnosis than patients with epileptic seizures. Measurements of hypnotizability among seven patients with epileptic seizures and six patients with pseudo-epileptic seizures supported this supposition.

Pharmacological studies form an important adjunct to epilepsy monitoring and conversely long-term EEG and video recording are of value for assessing antiepileptic drug (AED) effects. Clinical estimates of the incidence of brief frequent seizures as absences is often difficult but greater reliability can be achieved by long-term monitoring of the seizures themselves or of the associated EEG discharges. There are, however, very marked spontaneous short-term fluctuations in discharge rates and the amounts of ictal epileptiform activity in short conventional EEGs rarely provide any useful index of AED action. Acute investigations are of value for assessing new AEDs or experimental methods of administration and for pharmacokinetic studies. For this purpose either spontaneous EEG discharges or photosensitivity may provide quantitative measures of antiepileptic effect. Long-term AED monitoring by means of an indwelling catheter indicates the time course of blood drug levels to be more complex and variable than might be expected from simple pharmacokinetic models. Short-term fluctuations in AED concentrations have little effect on epileptiform EEG activity or seizure control but are often responsible for intermittent side-effects. Conversely diagnostic EEG and monitoring studies may be required to classify seizures as an aid to determining appropriate medication and may explain apparent resistance to therapy, due to pseudo-seizures, reflex or self-induced epilepsy. Finally a case is presented for combined pharmacological EEG and video-monitoring in the preliminary assessment of new AEDs in order to improve the design of subsequent clinical trials.

The time relations of epileptic events have been studied in 3 sets of data: (I) counts of individual epileptiform discharges in twelve 48 h EEG recordings, (IIa) seizure calendars of 30 therapy-resistant outpatients participating in a drug trial, (IIb) seizure calendars of 10 mentally subnormal epileptic patients resident in a long-stay unit. The EEG data I were characterized most often by a Poisson distribution of intervals between discharges and the occurrence of marked periodicities, particularly at night. The periods of rhythmic nocturnal events ranged from 13 to 142 min and did not appear to correspond to the REM/non-REM cycle. In the seizure data IIa and b a Poisson distribution of intervals between events was found in half the patients. Periodicities occurred only in group IIa and did not correspond to weekly or monthly cycles. A stochastic process is considered to be the model which best fits these data.

EEG and driving behaviour were monitored in 6 patients with subclinical focal and generalised epileptiform EEG discharges during 420 km of actual motorway driving in a suitably instrumented vehicle. Evidence of impaired driving performance during subclinical discharges was significant in 3 subjects (P less than 0.025 or less than 0.05) and was suggestive (P less than 0.1) in 1. The two patients with greatest impairment had active epilepsy, whereas the others had been seizure-free for upwards of 4 years. No other features appeared to be predictive of altered driving behaviour during discharges.