Objective
Epilepsy care in developing countries is challenged by the paucity of trained specialists, diagnostic tools, and antiepileptic drugs (AEDs). We retrospectively evaluated how epilepsy was managed in a Nigerian tertiary referral center, with the goals of determining diagnostic accuracy by comparing clinical and electroencephalography (EEG) diagnoses, the appropriateness of prescribed therapy by clinician specialization, and the association between therapy and patient outcomes.

Methods
We examined the medical records of 372 patients diagnosed with epilepsy in the center over a 6-month period from 2011 to 2012. Data were obtained on methods of diagnosis, clinician specialization, therapeutic care, and patient self- or caregiver-reported outcome on follow-up visits. Interrater agreement was assessed using Cohen's ? coefficient, and the diagnoses made by nonspecialist and specialist clinicians compared using the chi-square test.

Results
Of 372 patients diagnosed with epilepsy, only one had a brain computerized tomography (CT) scan. Seventy-six were differentially diagnosed for generalized or partial epilepsy by both clinical presentation and EEG. Low interrater agreement (? = 0.05) was found between these methods of diagnosis. Of the 76 patients, 53 (69.7%) received therapies judged as appropriate, with no significant difference in prescription rates for appropriate therapy between nonspecialists and specialists (p = 0.536). Specific syndromic diagnoses were made only in 4% of patients, and only in patients who underwent EEG. Only three first-generation AEDs were prescribed, with 97.6% of patients receiving carbamazepine.