Diagnostic and treatment practices for psychogenic nonepileptic and epileptic seizures in Namibia

Epilepsy Behav. 2018 Jun;83:92-102. doi: 10.1016/j.yebeh.2018.03.005. Epub 2018 Apr 14.

Abstract

Purpose: Information about existing healthcare resources for the management of seizures in developing countries is lacking. These countries are often poorly equipped to deal with the immense burden of costs, mortality, stigma, seizure-related disability, and comorbidities presented by seizure disorders. This study aimed to contribute to the goals of the International League Against Epilepsy (ILAE) by investigating the resources available for patients with seizure in Namibia.

Methods: Two separate surveys on the diagnostic and treatment practices for epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES) were administered to private healthcare practitioners (HCPs) in Namibia.

Results: The findings are based on 50 responses from HCPs involved in the management of seizures. The responses indicate that HCPs have less confidence in their ability to manage PNES than ES. Psychological/psychiatric assessments are seldom utilized. Although HCPs engage in face-to-face communication of diagnoses, they seldom refer patients to additional sources of information. Healthcare practitioners follow up patients with ES more regularly than those with PNES. Healthcare practitioners indicated their willingness to collaborate and recognize the role of traditional health practitioners (THPs) in a supportive capacity when it comes to the management of seizures. Financial constraints, limited availability of specialized equipment, and lack of knowledge and awareness regarding seizure disorders among both HCPs and patients were mentioned as major obstacles in accessing healthcare services.

Conclusion: The findings of this study add to the current literature by demonstrating some of the particular characteristics of HCPs from a lower middle-income African country regarding the diagnosis and treatment of PNES and ES.

Keywords: Epilepsy; Healthcare providers; Namibia; Psychogenic nonepileptic seizures; Standard medical care; Traditional health practitioners.

MeSH terms

  • Adult
  • Developing Countries
  • Female
  • Health Services Accessibility* / trends
  • Humans
  • Male
  • Middle Aged
  • Namibia / epidemiology
  • Professional-Patient Relations
  • Psychophysiologic Disorders / diagnosis*
  • Psychophysiologic Disorders / epidemiology*
  • Psychophysiologic Disorders / therapy
  • Seizures / diagnosis*
  • Seizures / epidemiology*
  • Seizures / therapy
  • Social Stigma
  • Surveys and Questionnaires*
  • Treatment Outcome