The role of computerized tomography in the diagnosis and management of epilepsy: a study at Kenyatta National Hospital in Nairobi, Kenya

Abstract

Epilepsy is a common neurological disorder in Kenya, affecting many people especially those below the age of 20 years. The highest number of cases are concentrated below 10 years of age. other age groups are also affected but to a lesser degree. All epileptic patients who underwent comput:erized tomography examinations of the brain at Kenyatta National Hospital for convulsive disorders since the installation of the Tomoscan CXQ machine on 11th November 1992 up to 31st July 1996 were retrospectively reviewed. A total of 484 patients were included in the study. computerized tomography (C1) was4found to be of extreme value in screening and evaluation of seizure patients. In this study 56.4% of the total number of patients were found to have abnormal CT scan findings. CT scan examination is a quick, simple, non invasive method of evaluating patients with intracrania.l abnormalities. The diagnostic accuracy of CT scan examination i~ high. The commonest abnormal or positive finding was brain atrophy. Diffuse brain atrophy was more common than focal brain atrophy. Intracranial tumours were the second commonest abnormal CT scan fhiding. These were all primary brain tumours. The predominant type of brain tumours found in the study were gliomas with (55.3%). The main seizure pattern in these tumours was the generalized convulsive type. The third commonest abnormal CT scan finding were cases of infections. Brain abscesses were the commonest abnormal CT scan finding among cases of infections, with a total of 58.6%. Trauma cases were fourth in CT scan abnormal findings. The role of CT scan in the dignosis of head injury patients presenting wi th convulsions is remarkable. This mode of investigation has virtually replaced cerebral angiography .. since no false negative or false positive results have been observed. other important abnormal CT scan findings were cases of hydrocephalus. Communicating type of hydrocephalus had the highest abnormal, findings in this group. Cases of hydrocephalus and cerebral infarcts occupied the 5th position of the CT scan abnormal findings. Patients with a short duration of seizures (less than 6 months) had the highest CT scan abnormal findings. Patients above 65 years of age also had a high number of abnormal CT scan findings. The above findings correlated well with findings in other studies, except in the age group below 10 years as described in the text.