Clinical characteristics of children with epilepsy managed at an urban hospital in Africa: a retrospective study

Samia, Pauline; Barr, Arwen; Levi, Subira B; Donald, Kirsten A.; Wilmshurst, Jo M; Newton, Charles R.

doi:10.17724/jicna.2019.162

Cited by 4 publications

(4 citation statements)

References 34 publications

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“…Epileptic seizures were found to be more common in males (60.9%) than in females (39.1%). This is in line with a study done in Kenya [ 25 ]. Less than half of the patients (40.2%) belonged to the age group 10 to 15 years.…”

Section: Discussionsupporting

confidence: 93%

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Seizure control status and associated factors among pediatric epileptic patients at a neurologic outpatient clinic in Ethiopia

Adal¹,

Alemu

Muche

2021

PLoS ONE

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Background Childhood epilepsy is a major public health problem worldwide. Even though anti-seizure medications (ASM) have been demonstrated to control seizures, children with epilepsy continue to have frequent seizures. There is a scarcity of data on seizure control status among pediatric epileptic patients in Ethiopia. The aim of this study was to assess seizure control status and associated factors among pediatric epileptic patients. Methods A hospital based cross-sectional study was done on 261 pediatric epileptic patients being followed up at the University of Gondar Comprehensive and Specialized Hospital, Northwest Ethiopia, from May 11 to August 11, 2019. The data were collected through caregiver interviews and patients’ medical records. All independent variables with p value of ≤ 0.2 in univariate analysis were taken to multivariable analysis. Adjusted odds ratio (AOR) with a 95% confidence interval was computed to see the predictors of seizure control status. Level of statistical significance was declared if p-value < 0.05. Result From a total of 261 patients, 159 (60.9%) were males and had a mean age was 10.16 ± 4.62 years. More than half (57.1%) of participants were urban dwellers. Almost all (98.5%) were diagnosed with generalized tonic-clonic seizures. Majority (75.1%) of the patients were on mono-therapy. Forty-six (17.6%) of the patients reported adverse effects related to ASMs. Two hundred-three (77.8%) of the patients were adherent to their medications. Nearly half (49.0%) of the patients had controlled seizures. Urban residency (AOR: 2.12; 95% CI: 1.15–3.89; P = 0.016), adherence to medication (AOR: 3.92; 95% CI: 1.84–8.36; P < 0.001), use of combined ASM(AOR: 0.29; 95% CI: 0.14–0.59; P = 0. 001), durations of ASM use [2–5 years (AOR: 5.81; 95% CI: 2.89–11.70; P <0.001) and >5years (AOR: 4.80; 95% CI: 1.91–12.09; P = 0.001)]were significantly associated with seizure control status. Conclusion Inadequate numbers of pediatric epileptic patients’ at the Ethiopian neurologic clinic achieved seizure control. Coming from a rural area, non-adherence to ASMs, use of multiple ASMs, and the use of ASMs for <2years were found to have a significant association with poorer seizure control, needing special attention to get control of seizure. Caregivers should closely monitor and address any barriers that contribute to ASM non-adherence and adverse drug events.

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Section: Discussionsupporting

confidence: 93%

“…Less than half of the patients (40.2%) belonged to the age group 10 to 15 years. This is different from the other studies carried out in Malaysia, Kenya and India in which a majority of children fall in the age group of 6 to 10 year [ 14 , 25 , 26 ].…”

Section: Discussioncontrasting

confidence: 84%

Seizure control status and associated factors among pediatric epileptic patients at a neurologic outpatient clinic in Ethiopia

Adal¹,

Alemu

Muche

2021

PLoS ONE

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“…In this study, it was found that 53.5% of children reporting epilepsy were male. This is in accordance with the data from another developing African country where 61.0% of children with epilepsy coming to a pediatric neurology clinic were male [14]. As in this study, the majority of the children (62.8%) children belonged to rural areas of residence [14]; cultural and social beliefs might be the reason behind this male predominance among children with epilepsy who are brought to healthcare centers for treatment.…”

Section: Discussionsupporting

confidence: 92%

Clinical Characteristics and Etiology of Epilepsy in Children Aged Below Two Years: Perspective From a Tertiary Childcare Hospital in South Punjab, Pakistan

Rehman¹

2022

Cureus

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BackgroundEpilepsy is described as an enduring disposition toward recurrent unprovoked seizures and by the neurobiological, cognitive, psychological, and social consequences of this condition. This study aimed to find the clinical characteristics and etiology of epilepsy in children aged below two years. MethodologyThis cross-sectional study was conducted at the department of pediatric neurology, the Children's Hospital and Institute of Child Health, Multan, Pakistan, from February 2021 to July 2021. During the study period, a total of 226 children of both genders, aged below two years, presenting with epilepsy and who underwent electroencephalography (EEG) were included. Socio-demographic and clinical data along with clinical features and radiological/imaging findings were noted. ResultsIn a total of 226 children, 121 (53.5%) were male and 105 (46.5%) female. Overall, the mean age was calculated to be 14.6±5.2 months while 107 (47.3%) children were aged between 13 to 24 months. Residential status was found to be rural in 142 (62.8%) children. Generalized seizures (both primary and secondary) were reported in 205 (90.7%) children while the remaining 21 (9.3%) children had focal seizures. The most common etiology of epilepsy was noted to be structural/metabolic in 122 (54.0%) children. Abnormal EEG findings were observed among 150 (66.4%) children. Developmental delay (p=0.0016), hypotonia (p<0.0001), microcephaly or macrocephaly (p<0.0001), abnormal brain CT or MRI (p<0.0001), and abnormal EEG findings (p=0.0161) were found to have a significant association with etiology of epilepsy. ConclusionGeneralized seizures like tonic-clonic and clonic types were the most common findings among children below two years of age with epilepsy. Structural abnormalities were the most common etiology in children with epilepsy. Age between one to two years was the commonest age of onset of seizures among young children.

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“…Access to neuroimaging (MRI and CT scans) and neurophysiological testing [electroencephalography (EEG)] is typically concentrated in large urban centers in SSA (11,12). Accordingly, there are few studies that have provided a description of imaging findings in children with epilepsy in SSA.…”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Imaging Findings in Childhood Epilepsy at a Tertiary Hospital in Kenya

et al. 2021

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Background: Neuroimaging is important for determining etiology and guiding care in early childhood epilepsy. However, access to appropriate imaging in sub-Saharan Africa is modest, and as a consequence, etiological descriptions of childhood epilepsy in the region have been limited. We sought to describe MRI findings in children with epilepsy presenting to a tertiary hospital in Nairobi, Kenya, over a 6-year period of routine care.Materials and Methods: We undertook a retrospective review of MRI findings of children aged between 0 and 18 years with a diagnosis of epilepsy presenting to the pediatric neurology department of Aga Khan University Hospital in Nairobi, Kenya, between January 2014 and July 2020. Over this period, the hospital had 1.5T MRI machines (GE1.5T Signa Excite and GE 1.5T Signa Explorer) and a 3T MRI machine (Philips 3T Ingenia). MRI images were independently reviewed by two study radiologists, and the findings were summarized and categorized into a study database. Related clinical and electroencephalographic (EEG) details were extracted from patient records. Categorical data analysis methods were applied to investigate for relationships between clinically relevant neuroimaging findings and key clinical and EEG observations.Results: Over the study period, 288 children with a confirmed diagnosis of epilepsy had an MRI. They were of median age of 6 [interquartile range (IQR) 2–11] years. Ninety-five (33%) children had abnormal findings on imaging. The most common findings were encephalomalacia related to chronic infarcts (n = 18: 6.3%), cerebral atrophy (n = 11: 3.8%), disorders of neuronal migration (n = 11: 3.8%), periventricular leukomalacia (n = 9: 3.1%), and hippocampal sclerosis (n = 8: 2.8%). Findings related to infectious etiology were only observed in four children. Clinical comorbidity and inter-ictal epileptiform activity on EEG were independently associated with abnormal findings on imaging.Conclusion: Up to a third of the children who underwent an MRI had a positive yield for abnormal findings. Imaging findings related to infectious etiologies were little observed in our cohort, in contradistinction to etiology studies in similar settings. At the time of the study, comorbidity and inter-ictal epileptiform activity on EEG were associated with abnormal findings on imaging and should be considered in informing prioritization for imaging in childhood epilepsy in this setting.

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Clinical characteristics of children with epilepsy managed at an urban hospital in Africa: a retrospective study

Cited by 4 publications

References 34 publications

Seizure control status and associated factors among pediatric epileptic patients at a neurologic outpatient clinic in Ethiopia

Seizure control status and associated factors among pediatric epileptic patients at a neurologic outpatient clinic in Ethiopia

Clinical Characteristics and Etiology of Epilepsy in Children Aged Below Two Years: Perspective From a Tertiary Childcare Hospital in South Punjab, Pakistan

Magnetic Resonance Imaging Findings in Childhood Epilepsy at a Tertiary Hospital in Kenya

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