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Dr. Kathryn Davis from Penn Epilepsy Center present on new treatment devices and clinical trials for epilepsy. From the 2014 Epilepsy Education Exchange.
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This presentation reviews the evidence regarding use of early polytherapy in patients with epilepsy with regards to seizure control and adverse effects. The advantages and disadvantages of polytherapy compared to monotherapy is addressed.
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Overview of intravenous anti-epileptic drugs, including benzodiazepine(BZD), phenytoin, valproate, levetiracetam, phenobarbital, lacosamide and general anesthetics.
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Serotonin Syndrome is an increasingly prevalent, life-threatening problem. It is caused when herbs, over the counter medications or prescriptions which increase serotonin increase serotonin levels too much causing agitation, high fever, confusion, loss of motor control and many other symptoms. DXM (dextromethorphan) overdose often causes serotonin syndrome. Other OTC supplements of concern include SAM-e, 5HTP, St. Johns Wort. Any of these alone or in combination with alcohol can dangerously increase serotonin levels.
Epilepsy is the disease which has prevalence in India more than 1 %
Of population. This is topic of research for young medicine practioner and pharmacist.
Aceclofenac 200mg CR Tablets Taj Pharma SmPCTajPharmaQC
Aceclofenac 200mg CR Tablets Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Aceclofenac Dosage & Rx Info | Aceclofenac Uses, Side Effects Vecuronium bromide: Indications, Side Effects, Warnings, Aceclofenac-Drug Information –Taj Pharma, Aceclofenac dose Taj pharmaceuticals Aceclofenac interactions, Taj Pharmaceutical Aceclofenac contraindications, Aceclofenac price, Aceclofenac Taj Pharma Aceclofenac SmPC-Taj Pharma Stay connected to all updated on Aceclofenac Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SmPC.
Overview of intravenous anti-epileptic drugs, including benzodiazepine(BZD), phenytoin, valproate, levetiracetam, phenobarbital, lacosamide and general anesthetics.
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Serotonin Syndrome is an increasingly prevalent, life-threatening problem. It is caused when herbs, over the counter medications or prescriptions which increase serotonin increase serotonin levels too much causing agitation, high fever, confusion, loss of motor control and many other symptoms. DXM (dextromethorphan) overdose often causes serotonin syndrome. Other OTC supplements of concern include SAM-e, 5HTP, St. Johns Wort. Any of these alone or in combination with alcohol can dangerously increase serotonin levels.
Epilepsy is the disease which has prevalence in India more than 1 %
Of population. This is topic of research for young medicine practioner and pharmacist.
Aceclofenac 200mg CR Tablets Taj Pharma SmPCTajPharmaQC
Aceclofenac 200mg CR Tablets Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Aceclofenac Dosage & Rx Info | Aceclofenac Uses, Side Effects Vecuronium bromide: Indications, Side Effects, Warnings, Aceclofenac-Drug Information –Taj Pharma, Aceclofenac dose Taj pharmaceuticals Aceclofenac interactions, Taj Pharmaceutical Aceclofenac contraindications, Aceclofenac price, Aceclofenac Taj Pharma Aceclofenac SmPC-Taj Pharma Stay connected to all updated on Aceclofenac Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SmPC.
Epilepsy Management: Key issues and challengesPramod Krishnan
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"Navigating Anti-Epileptic Drug Choices with Dr. Ganesh"
🌟 Greetings, friends! Welcome back to the channel. I'm Dr. Ganesh, and today we're delving into a crucial topic: the selection of Anti-Epileptic Drugs (AEDs). If you or someone you know is dealing with epilepsy, understanding the choices and considerations involved in AEDs is vital for effective management.
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Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
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Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
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Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
2. Introduction
A study carried out by Yifat Roth on an evaluation of pharmacist knowledge
on treatment with antiepileptic drugs without consulting reference books
indicate the need for improving pharmacists’ education regarding epilepsy.
Excerpts from the study shows
Only 12% identified correctly all situations requiring urgent physician
consultation.
27% could not identify any of them.
Patients generally know more about epilepsy in general than about their
own condition.
Another study revealed that an estimated 30-60% of patients with epilepsy
are not adherent with their treatment regimen.
• Control of seizure & quality of life are of utmost importance…
3. Definitions
• Seizures is simply the clinical manifestation of disturbed electrical
activity where the excitatory transmission supersedes the inhibitory
transmission.
• Epilepsy refers to a disorder comprising a collection of recurrent
seizures that differ in cause, symptoms, severity, treatment and do
occur unprovoked.
• A person is considered to have epilepsy after having two or more
unprovoked seizures.
• Hence, people with isolated seizures or seizures that are due to
secondary causes such as hypoglycaemia, alcohol withdrawal, high
fever are not categorised to be suffering from epilepsy.
4. Epidemiology
• Approximately 50 million people worldwide live with epilepsy and about 40
million in developing countries
• Most common non-infectious neurologic disease in developing African
countries including Nigeria
• 5.3-37 persons per 1000 in Nigeria
• Febrile seizure in children is the most commonly treated form in WGH
mostly due to cerebral malaria(prevalence: 18%(WGH), comparative to
Enugu(21.5%) although lower in other places such as Jos(8.1%)
• The reason for most visits to the neurology clinic at OAUTHC
• About 1000 people die each year from epilepsy related causes
• Increased risk of mental health problem in persons with uncontrolled
epilepsy, especially depression
5. Types of seizures
Based on cause of seizure
Idiopathic (6/10): the cause is unknown
Secondary/symptomatic epilepsy: causes of such include
Brain damage from prenatal/perinatal causes
Congenital abnormalities
Severe head injury
Stroke
Brain infection
Genetic syndromes
Brain tumour
6. Types of seizures(cont’d)
Based on Origin and further broken down based on description
• Focal (formerly called partial) seizures
Focal aware
Focal impaired awareness
Focal may spread to both sides eventually (secondary generalised seizures)
• Generalised seizures
Tonic-clonic
Tonic
Atonic
Myoclonic jerks
Absence
7. Management
Pharmacologic (70-80%): about 25 AEDs in the following categories
oValproic acid
oGABA analogues such as pregabalin and the likes
oEthosuximide
oPhenytoin
oCarbamazepine
Up to half experience adverse effects
Based on National Institute for Health and Care Excellence(NICE) guidelines,
monotherapy is recommended although more than one may be needed
sometimes. Co-morbidity is also a significant factor that could lead to drug-
drug interactions
Special consideration: women of child bearing age and patients of Asian
origin( Chinese& Thai)( carbamazepine is contraindicated in them)
8. Seizure
type
First line drugs Second line/
adjunct
therapy
Warning Note
Focal *Carbamazepine/lamotrigine/*Lev
etiracetam/Oxcarbamazepine/
*sodium valproate
vigabatrin-irreversible effects on
visual fields
Generalised
tonic-clonic
*Sodium
valproate/Lamotrigine/*carbamaze
pine/oxcarbamazepine
Lamotrigine aggravates myoclonic
seizures.
Carbamazepine/oxcarbamazepine
worsens myoclonic/absence
seizures
Absence Ethosuximide/sodium
valproate/Lamotrigine
Do not consider
gabapentin/phenytoin/pregabalin/ti
agabine/vigabatrin/carbamazepine/
oxcarbamazepine
Tonic/atonic Sodium valproate lamotrigine Do not consider
gabapentin/pregabalin/tiagabine/vi
gabatrin/carbamazepine/oxcarbama
zepine
9. Seizure type First line drugs Second line/ adjunct
therapy
Warning Note
Myoclonic *Sodium
valproate/*levetirace
tam/topiramate
Do not consider
gabapentin/phenytoi
n/pregabalin/tiagabi
ne/vigabatrin/carba
mazepine/oxcarbama
zepine/lamotrigine
Topiramate has a less
favourable side-
effect profile
Infantile spasms due to
tuberous sclerosis
Steroid(prednisolone
/tetracosactide)/
vigabatrin
Assess risk-benefit
ratio
Status epilepticus Lorazepam/*diazepa
m/*midazolam
*Phenobarbital/*phe
nytoin/*propofol
* The asterisk shows the drugs that are commonly used in OAUTHC
Non-pharmacologic management including surgery, vagus nerve stimulation therapy
and ketogenic diet(20-30%)
10. Roles of pharmacists
The roles are the drug-related obligations to both the physician, the patient and relatives,
namely:
Identifying potential and actual adverse effects
Lamotrigine-induced rash, levetiracetam-induced suicidal thoughts and seizure
aggravation, valproate-teratogenicity, memory impairment,
Dose verification/proposal of changes in prescription
If an AED has failed because of adverse effects or continued seizures, a second
drug should be started (which may be an alternative first-line or second-line
drug) and built up to an adequate or maximum tolerated dose and then the first
drug should be tapered off slowly
Brand substitution: risk/benefits
If using carbamazepine, offer controlled-release carbamazepine preparations
11. BROAD SPECTRUM CLASSIFICATION OF AEDs
DRUG(BRAND) INITIAL ADULT
DOSING
MAX DAILY
DOSE
COMMENTS
Clonazepam(Klonopin) 0.5 mg qd 20 mg Toxic serum conc greater than 80 ng/mL
Felbamate(Felbatol) 400 mg tid 3600 mg Need informed consent from patient and physician. Renal dose
adjustment
Lamotrigine(Lamictal) 100 mg bid 500 mg Hepatic and drug interaction dose adjustment. Black box warning:
severe and potentially life-threatening skin rashes: risk increases
with coadministration of valproic acid, high starting doses, and
rapid dose titration
Levetiracetam(Keppra) 500 mg bid 3000 mg Renal dose adjustment
Rufinamide(Banzel) 200 mg bid 3200 mg Not recommended in severe hapatic impairment
Topiramate(Topamax) 25 mg bid 400 mg Renal dose adjustment. Caution: risk for metabolic acidosis,
nephrolithiasis, weight loss
Valproic acid(Depakote) 15 mg/kg/day 60 mg/kg Hepatic and renal dose adjustment: serum concentration 50-150
mcg/mL. Black box warning: life-threatening pancreatitis
Zonisamide(Zonegran) 100 mg qd 600 mg Hepatic and renal dose adjustment. Caution: risk for
nephrolithiasis
12. NARROW SPECTRUM CLASSIFICATION OF AEDs
DRUG(BRAND) INITIAL ADULT
DOSING
MAX DAILY
DOSE
COMMENTS
Carbamazepine(Tegretol) 220 mg bid 2400 mg Serum concentration 4-12 mcg/mL. Black box warning:
potentially fatal blood cell abnormalities: do not use for patients
with HLA-B 1502 genotype. Caution: risk for hyponatremia
Ethosuximide(Zarontin) 500 mg qd 1500 mg Serum Conc 40-100 mcg/mL. Caution: renal/hepatic dysfunction
Gabapentin(Neurontin) 300 mg tid 3600 mg Renal dose adjustment
Lacosamide(Vimpat) 50 mg bid 400 mg Hepatic and renal dose adjustment
Oxcarbamazepine(Trileptal) 300 mg bid 2400 mg Renal dose adjustment. Caution: risk for hyponatremia
Phenobarbital(luminal) 50 mg bid 300 mg Serum concentration 20-40 mcg/mL. Syncope, bradycardia and
hypotension risk
Phenytoin(Dilantin) 300 mg qd ER
or 100 mg tid
900 mg Serum concentration 10-20 mcg/mL. Syncope, arrhythmias, and
hypotension risk with Iv use. Dose-related: drowsiness, lethargy,
cognitive impairment, nystagmus, ataxia. Non-dose related:
gingival hyperplasia, coarsening of facial features, hirsutism,
acne, rash
Pregabalin(Lyrica) 50 mg tid or
75 mg bid
600 mg Renal dose adjustment. Life-threatening angioedema risk:
rhabdomyolysis risk
Vigabatrin(Sabril) 500 mg bid 3000 mg Renal dose adjustment.
13. Roles of pharmacists(cont’d)
Drug interaction (particularly enzyme induction and inhibition)
Lamotrigine-valproic acid
Phenytoin-tacrolimus
AEDs and contraceptives, pregnancies, menopause such as
• Lamotrigine-contraceptives= possible treatment failure
• Enzyme-inducing AEDs needs higher dose progestogen implant(levonorgestrel
is preferred) else, pregnancy may occur
14. Roles of pharmacists(cont’d)
Patient education and counselling( IUD, pregnancy, consistency of
time of administration,
Depo-provera® is preferred.
However for patients on valproate, IUD is preferred
Consultation by patient
Adherence monitoring
Pharmacotherapeutic follow-up/therapeutic drug monitoring(esp
valproic acid, phenytoin adjustments, pregnancy)
Referral to physician (poor seizure control, adverse drug reaction,
pregnancy)
15. Recent discoveries/progress
• In march 2018, MHRA issued a warning that sodium valproate must
no longer be used in any woman or girl able to have children unless
she has a pregnancy prevention plan in place. 4 in 10 babies are at
risk of developmental disorders and approximately 1 in 10 are at risk
of birth defects
• Perampanel(FYCOMPA®) is the first AMPA receptor antagonist
designed to block glutamate pathway and is particulaurly indicated
for focal seizures as well as primarily generalised and secondarily
generalised toni-clonic seizures. The starting dose is 2mg for those
that are not other enzyme-inducing AEDs while it is 4mg for those
taking those inducers such as carbamazepine, phenytoin and the likes
16. Conclusion
The mainstay in managing seizures is pharmacotherapy and
pharmacists have important roles to play. Hence, pharmacist should be
actively involved in the care of people living with seizures concerning
their drug-related needs.
17. References
• Stephen C. Schachter (2013) Pharmacists: What role do pharmacists play in the care of patients with epilepsy?
www.epilepsy.com/learn/diagnosis/you-and-your-healthcare-team/pharmacists
• Yifat Roth et al. (2016) An evaluation of pharmacist knowledge on treatment with antiepileptic drugs
www.sciencedirect.com/science/article/pii/S10591311115002794 retrieved on 05/03/2019
• Epilepsy society(2018) Epilepsy For Pharmacists www.epilepsysociety.org.uk/epilepsy-pharmacists#.XH2o1KA080M retrieved on
05/03/2019
• Pharmacy times(2017) www.pharmacytimes.com/publications/issue/2017/september2017/r867_september2017
• Hien Ha (2013) Epilepsy: Treatment and Management www.uspharmacist.com/article/epilepsy-treatment-and-management
retrieved on 05/03/2019
• National Institute for Health and Care Excellence(2018) Epilepsies: diagnosis and management www.nice.org.uk/guidance/cg137
retrieved on 08/03/2019
• Akinsulore Adesanmi and Abiodun Adewuya(2010), Psychosocial aspects of epilepsy in Nigeria: A review, African Journal of
Psychiatry, Vol 13, page 351-356
• Olubosede A. o. et al(2015) Prevalence, etiology and Outcome of Febrile Convulsions at the Wesley Guild Hospital, Ilesa, South-
West Nigeria, BJMMR, Vol 8, issue 5, page 470-476
• Ngugi, A.K.,Kariuki, S.M., Sander, J.W.(2014), Prevalence and potential causes of epilepsy in Nigeria, Epilepsy Research,
http://dx.doi.org/10.1016/j.eplepsyres.2014.04.015