Chapter Spotlight: Nigeria

History of ILAE in Nigeria

In March 2007 we got an approval from the ILAE secretariat to establish a chapter in Nigeria. Thus was born the Nigeria National Chapter of ILAE with its secretariat at the University of Nigeria Teaching Hospital Enugu. Prior to the genesis of the Chapter there had been no active organization dealing with issues of epilepsy in Nigeria. Decades earlier, there had existed an ‘Epilepsy Society of Nigeria’ whose activities and influence were restricted because peculiar logistic and economic problems in the Nigeria. The society could not be sustained for long.

From the start it was a big challenge to build up the membership of the Chapter. Our goals were:

awareness creation
Research
Advocacy
Training

Specialists and other personnel involved in the management of epilepsy are few and scattered in cities all over the country. However, for a start we approached the Nigerian Society for Neurological sciences for interested doctors- neurologist and residents. Furthermore Fellows from the West African College of Physicians and the National postgraduate medical college of Nigeria- neurologists (including pediatric Neurologist) and psychiatrists were approached for membership. Finally we wrote to the departments of medicine, psychiatry and community medicine in all the secondary and tertiary institutions all over the Federation of Nigeria inviting them for our inaugural scientific meeting which was held on May 29 2009 at Enugu. Our society is also open to all doctors and non-doctors alike.

The attendance was impressive 48 registered delegates excluding students and invited guests. In that conference more than 12 papers were presented (including late entries). The guest lecturers were distinguished neurologists, neurosurgeons and teachers from West African College of Physicians-Prof. A Oguniyi from University college Hospital Ibadan, Nigeria and Prof S C Ohaegbulam, a neurosurgeon of repute and a teacher of many in that field as well as many others.
From the humble beginning we have achieved much: We have had 4 congresses which took place across the country; Enugu-2009, 2010, Owerri -2012 and Benin-2013. With an average of 15 papers and 3 seminars per congress we have started to make an impact of the academic landscape in the country. The society has been represented in 3 international congresses:= Rome, Kenya and Canada.

Awareness
Most of our projects were done as individual activities by members which report to the society ( this has been our goal as we believe it will improve resourcefulness). These include several community epilepsy and research projects, setting up of Agie epilepsy and Care epilepsy foundations. The association has also set up the Nigerian Bureau of epilepsy to enable non doctors and professionals to contribute maximally to the affairs of the society.

Over the years we have consistently had secondary school awareness programs as well as radio programs. Recently in collaboration of the Nigeria medical Association the chapter was given a 2-month long weekly program to talk to the public on epilepsy. Other activities include church and hospital programs across the federation.

Research
We have just finished the draft of an epilepsy register format with inputs from several of our experienced colleagues. The draft is currently undergoing pilot testing in one of the University teaching hospitals in the country. Since 2010 several papers have been published both in international and local journals based of research projects carried out in collaboration with the society.

Advocacy
Our efforts in this area yielded fruit recently when the Nigerian society for neurological sciences (NSNS) early this year gave the association the opportunity to present a seminar. This led to the acceptance by NSNS to give the league a day during its annual conferences. A two month-long radio program from the Nigeria Medical Association as well as joint programs from several drug companies in training doctors and awareness has been carried out. The association is presently planning to use national youth service program of young Nigerian graduates as instruments for the propagation of our message-life without limitation. This project will start later this year.

Training
We have had 3 EEG training sessions, one epilepsy training session since the establishment of our society.
In 2013, the society changed its name from the International league against epilepsy Nigeria chapter to the Nigerian League Against Epilepsy and also established an award for members and those who distinguish themselves in the field.

The Future

Increase membership
Increase support by institutions
Creation of epilepsy ambassadors among radio and TV workers, musicians and other celebrities
Collaborate with agencies and foreign institutions in training program and research.

Review of Epilepsy Services in Nigeria

In Nigeria, epilepsy is the most common serious neurological disorder and is one of the most prevalent noncommunicable diseases. Osuntokun et al found a prevalence of 6/1000 in Western Nigeria. However local experiences suggests that this may be an underestimate considering the high incidence of head injuries, cerebral disorders such as communicable diseases, perinatal insults and other brain stressing factors.

Cultural and religious beliefs are important issues in the management of epilepsy in Nigeria. They influence the value placed by society on chronic disorders such as epilepsy.

Local beliefs on the causes of epilepsy is the reason most patients first seek advice from traditional therapists and healers. This choice of method of treatment is also connected with religious inclination of the family involved.

Throughout the Federation infrastructure and manpower has improved over the past few years however, they are mainly concentrated in the urban areas. The 2010 directory of neuroscientists (neurologists, neurosurgeons and psychiatrists) shows that we have 193 qualified specialists in these fields and most are directly or indirectly involved in the management of epilepsy.

The number of CT scanners has increased dramatically and still increasing. Presently there are more than 25 CT scan machines in the country. (For example Enugu has 3 CT scanners and Lagos more than 5). Again these facilities are not evenly distributed and many are privately owned making them more expensive. The country has between 6-10 MRI machines. EEG laboratories are few. The total number is not known but has increased. Enugu has 3, Lagos 1, Benin 1, Kano 1 and few other privately owned establishments may have between 3and 5.

There more than 100 state owned tertiary institution and about 36 teaching Hospital in the federation. Primary and secondary health care centers may be above 1000. We have 774 local governments and each has at least and some 2 or more primary health centers. General hospitals are also distributed in a similar manner but are fewer. Private hospital and clinics are common place and some offer tertiary medical services. In theory each of these centers should offer some form of care but the actual number of centers that do so is unknown.

Wherever there is a doctor ( primary health centers do not have regular doctors) epilepsy can be managed, but the quality of care is questionable because doctors often receive inadequate exposure in epileptology in medical schools resulting frequently in overdiagnosis of epilepsy and unnecessarily prolonged antiepileptic drug therapy. Training facilities in epileptology are not available in all the teaching hospitals but two centers (Lagos and Ibadan) serve as training centers for residents in epileptology. The presence of professional organizations of epilepsy specialists such as ILAE is an important aspect of the provision of the highest quality of care and well-being for people with epilepsy or other related seizure disorders. The number of organizations is now growing.
No centers in Nigeria offer epilepsy surgery. Neurosurgeons do treat causes of secondary seizures such as tumours and post-traumatic scars, which cause seizures.

Our chapter is open to all involved in the management of epilepsy from technicians to professors and private practitioners who wish to improve their knowledge in the field. Our last meeting showed 12 neurologists and pediatric neurologists, 19 residents, 1 medical officer, 1 EEG scientist, 3 neurosurgeons, 6 nurses, and 4 psychiatrists. We hope as time goes on more people will come on board.