Status epilepticus in sub-Saharan Africa: New findings *†‡Charles R. Newton and *‡Symon M. Kariuki *Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, Kilifi, Kenya; †Neurosciences Unit, Institute of Child Health, University College London, London, United Kingdom; and ‡Department of Psychiatry, University of Oxford, Oxford, United Kingdom SUMMARY Status epilepticus (SE) is common in sub-Saharan Africa, particularly in children. Most cases in chil- dren are caused by infections, particularly malaria in endemic areas. The outcome is worse than in the West, probably because of delays in initiating treatment, and lack of skills and facilities for the management of SE. However some of the causes, for example, falciparum malaria, offer challenges in the diagnosis and the treatment of SE. Exposure to falciparum malaria increases the risk of SE. Much of the SE in Africa could be prevented by reducing the incidence of infections. The outcome could be improved through education, develop- ment of locally appropriate guidelines, and provi- sion of appropriate facilities. KEY WORDS: Acute seizures, Falciparum malaria, Kenya. Status epilepticus (SE) occurs either in the context of febrile seizures, acute symptomatic seizures, or as a com- plication of epilepsy. In sub-Saharan Africa (SSA), acute symptomatic seizures and epilepsy are more common than in resource rich countries; and in each of these conditions, SE appears to be more frequent, although there are few published data. Infections are important causes of SE. This article briefly reviews recent studies on status epilepticus in SSA, with a particular emphasis on the role of parasitic infections. Definition of Status Epilepticus The definition of status epilepticus in SSA is often prob- lematic, since many people do not have watches or clocks, and the culture can influence the perception of time. Although the duration of seizures can be measured accu- rately in patients admitted to the hospital, assessing the dura- tion of seizures prior to admission is often difficult. Thus the definition of SE may consist of those who fulfill the Interna- tional League Against Epilepsy (ILAE), but also those with a history suggestive of probable SE (Sadarangani et al., 2008). Recall bias of duration of seizures is common, but the use of culturally accessible events, for example, boiling a pot of maize, may help (Kariuki SM, unpublished data). Burden of Epilepsy in SSA The prevalence of epilepsy in SSA is twice that of other continents, such as Europe, Asia, and North Amer- ica (Preux & Druet-Cabanac, 2005; Ngugi et al., 2010). The larger burden is thought to be caused by an increase in the incidence of risk factors such as perinatal insults and parasitic diseases (Newton & Garcia, 2012). A recent study of five sites across Africa has identified neonatal insults and parasitic infections as major risk factors for epilepsy on this continent (Ngugi et al., 2013). Neonatal insults were responsible for one third of the cases in chil- dren and parasitic diseases for one third in adults. Burden of Status Epilepticus There are few epidemiologic studies of SE of other con- tinents, such as SSA. One study in Kilifi on the coast of Kenya, recorded a minimum incidence of convulsive SE (CSE) as 35/100,000/year in children (0–13 years) based on hospital admissions (Sadarangani et al., 2008), which is 2–8 times (depending upon the definition used) that found in London (Chin et al., 2006). This rate is the mini- mum incidence, since a proportion of children will die in SE before reaching hospital, and others will be treated in private clinics. In this study, 15% died in hospital, but 21% died after being discharged from hospital (Sadaran- gani et al., 2008), often from another episode of SE (Prins A, Mung'ala Odera ECV, Sadarangani M, Holding CSP, Fegan G, Newton CR, unpublished data). Seventy-one percent of the cases of SE were caused by infections, Address correspondence to Professor Charles Newton, Centre for Geographic Medicine Research (Coast), Kenya Medical Research Insti- tute, PO Box 230, Kilifi, Kenya. E-mail: cnewton@kemri-wellcome.org Wiley Periodicals, Inc. © 2013 International League Against Epilepsy 50 Epilepsia, 54(Suppl. 6):50–53, 2013 doi: 10.1111/epi.12277 STATUS EPILEPTICUS 2013