Management
-Intravenous Phenytoin loading and maintenance, Oral Carbamazepine 400mg twice/day and tonics
Hospital course:
The patient showed remarkable improvement in his cognitive function and started to communicate with his family.
He had been referred back to his country as the combination therapy Nifurtimox-Eflornithine for African Trypanosomiasis treatment is not available in Sudan after separation.
Discussion
In our case we suspected late second stage African Trypanosomiasis with neurological complications such as non convulsive state as the patient presented with progressive decline of his cognitive function and our suspicious was confirmed by EEG, and supported more by remarkable cognitive improvement with Anti Convulsant thearpy.
Conclusion
Our case highlights that late second stage African Trypanosomiasis with neurological complications such as non convulsive status epilepticus should be suspected in any patient who developed progressive cognitive decline and behavioral changes following long standing history of African Trypanosomiasis and routine Electro-encephalogram EEG is the best tool to diagnose non convulsive status epilepticus.
Medical health professionals should suspect second stage African Trypanosomiasis with neurological complications such as non convulsive status epilepticus in any patient who have history of African Trypanosomiasis and developed progressive cognitive decline.
Early referral of the patients with second stage African Trypanosomiasis with progressive cognitive decline to Neurology Centers with Elector-encephalogram EEG facility might help to diagnose non convulsive status epilepticus in conjunction with early clinical suspicion of the condition will enhance the improvement of the prognosis.Further reporting of such cases is recommended.