The Vanderbilt Institute for Global Health (VIGH) has received a new research grant from the National Institute of Neurological Disorders and Stroke and Fogarty International Center of the NIH to establish a large childhood status epilepticus (SE) cohort in northern Nigeria with key partners Aminu Kano Teaching Hospital (AKTH) and Bayero University, and with the Sydney Brenner Institute for Molecular Bioscience at the University of the Witwatersrand (Wits) in South Africa.
SE, a prolonged seizure lasting more than five minutes or two or more seizures within a five-minute period without the person returning to normal between them, is common and can be a life-threatening emergency with a high risk of death and disability among survivors. A $3.5 million, five-year project, Childhood Status Epilepticus and Epilepsy Determinants of Outcome (SEED) will enroll children diagnosed with SE in pediatric emergency rooms in Nigeria and examine clinical and genomic predictors of drug resistance, death, disability and subsequent development of epilepsy.
Umar Sabo, MBBS, MPH, a pediatric neurologist at AKTH, Michèle Ramsay, professor and director of the Sidney Brenner Institute for Molecular Bioscience at Wits, and Edwin Trevathan, MD, MPH, professor of Pediatrics and Neurology, Amos Christie Professor of Global Health and director of VIGH at Vanderbilt University Medical Center, will lead the study. Trevathan served as a mentor to Sabo for his recent Vanderbilt-Emory-Cornell-Duke (VECD) Fogarty Global Health Fellowship, which generated the preliminary data for this grant application.
“The SEED project addresses a series of critically important issues related to childhood SE, including the need to determine modifiable risk factors for the high SE-associated mortality rate, and the need to characterize the SE phenotype among Nigerian children,” said Dr. Sabo. Professor Ramsay cited the SEED as “the first major project to bring the power of genomics to the study of childhood seizures in Africa, where there is more genomic diversity than in the rest of the world combined.”
Dr. Trevathan emphasized that SEED “will combine innovative clinical interventions, such as point-of-care EEG-video studies, proven epidemiology methods, and powerful genomics tools to address this important cause of childhood morbidity and mortality in northern Nigeria.”
A team of specialists working together at AKTH and VUMC will utilize video exams, EEG-video, detailed histories and brain MRIs to perform deep phenotyping on this cohort of about 1,800 children with SE. This study will include an innovative approach to capacity-building by incorporating community health extension workers who will be specially trained in basic epilepsy care and point-of-care EEG technology.
The NIH-funded Human Heredity and Health in Africa (H3Africa) consortium, which is working to yield insights into genomic factors of common human diseases across the African continent, will provide controls for genome-wide association studies (GWAS) of SE as part of this study.
“In addition to determining clinical and genomic predictors of SE-associated outcomes, we also aim to determine the clinical and genomic predictors of the development of epilepsy (repeated seizures) among children who survive SE as their first seizure,” said Trevathan.
SEED is preparing to launch enrollment within the next couple of months.
This work is supported by the National Institute of Neurological Disorders and Stroke and the Fogarty International Center of the National Institutes of Health under Award Number 1R01NS118483-01.