Clinico-Etiologic Profile of Children and Adolescents with Drug-Resistant Epilepsy in a low-Resource Setting: 10 Years’ Experience

Abstract

Purpose: Nearly 25% to 30% of children with epilepsy develop drug-resistant epilepsy. Etiology of epilepsy, including drug-resistant epilepsy, varies with geographical region. Identifying paucity of etiologic data on drug-resistant epilepsy from our region and similar low-resource settings, we aimed to describe the clinical and etiologic profile of children and adolescents with drug-resistant epilepsy, to better inform region-specific concerns. Methods: A chart-based retrospective review covering 10 years (January 2011–December 2020) was conducted. Participants between 1 months and 18 years of age who fulfilled International League Against Epilepsy (ILAE) definition of drug-resistant epilepsy were enrolled. Clinical details, perinatal history, electroencephalography (EEG), magnetic resonance imaging (MRI), and other evaluation-based data were analyzed. Results: Five hundred ninety-three children (52.3% males) were enrolled. The median age at presentation was 63 (interquartile range [IQR] 12-72) months and median age at onset was 12 (IQR 2-18) months. The most frequent seizure type was generalized (76.6%). Of these, epileptic spasms (48.1%) were most frequent. Focal seizures comprised 22.9%. The predominant contributor to etiology was perinatal adverse events, including perinatal asphyxia (37.9%), neonatal hypoglycemic brain injury (15.6%), and neonatal sepsis/meningitis. Electroclinical syndromes were observed in 361 (60.9%) children. Of these, the most frequent were West syndrome (48%) and Lennox-Gastaut syndrome (6.2%). Conclusion: Perinatal brain injury and brain infections were the most common causes of drug-resistant epilepsy identified. These findings indicate an opportunity for reducing the burden of pediatric drug-resistant epilepsy in our region by instituting preventive measures, including improved perinatal care, promotion of institutional deliveries, optimized obstetric and neonatal care, and immunization for vaccine-preventable infections such as bacterial meningitis and Japanese B encephalitis.

Antecedent neonatal hypoglycaemic brain injury, the most common cause of early childhood epilepsy in Indian children

“…A total of 114 (49%) patients presented within the first year, 73 (32%) between 1 and 3 years, and 44 (19%) between 3 and 5 years of age (Table 1). The median (IQR) age at the first visit to the pediatric neurologist was 36 (11,60) months, with a median (IQR) time lag of 10 (2,36) months from seizure onset to the initial pediatric neurology consultation.…”

“…8 Retrospective studies published from low-and middle-income countries have highlighted structural-acquired brain lesions, especially those due to neonatal asphyxial brain injury and neonatal hypoglycaemic brain injury, as common causes of earlychildhood epilepsies. 9,[10][11][12][13][14][15][16] Over the last few years, genetic tests and better neuroradiological techniques have become more readily available in low-and middle-income countries. Consequently, a significant proportion of early childhood epilepsy patients in these countries, previously with a presumed unknown etiology, have now been identified to also have an underlying genetic or congenitalstructural cause.…”