Improving epilepsy control among children with cerebral palsy in rural Bangladesh: a prospective cohort-based study

Abstract

ObjectiveTo define the prevalence and seizure subtypes among children with cerebral palsy (CP) in rural Bangladesh and explore barriers to optimum epilepsy control.DesignProspective cohort study.SettingThe study was conducted in Shahjadpur, a rural subdistrict of Bangladesh.ParticipantsChildren (<18 years) with CP and epilepsy identified using the Bangladesh CP Register (BCPR) in the study site.MethodsAssessments were conducted in three focused epilepsy clinics overseen by a paediatric neurologist between December 2016 and January 2018, with intervening phone and video-conference follow-ups. Details of event type, frequency and medication compliance were collected. Antiepileptic drugs (AEDs) were prescribed based on seizure type, family income, comorbidity and medication availability.Results23.4% (170/726) of the BCPR cohort had a clinical diagnosis of epilepsy of whom 166 were assessed. Following the focused epilepsy clinics, 62.0% (103/166) children were clinically determined to have ongoing epileptic seizures. 62.1% (64/103) had generalised onset tonic clonic seizures, 27.2% (28/103) had focal onset seizures with impaired awareness and 10.7% (11/103) had other seizure types. None of the children with prolonged seizures (31/103) had an emergency seizure management plan. Non-epileptic events were being pharmacologically treated as seizures in 18.1% (30/166) children. Financial constraints were the main reason for non-compliance on follow-up.ConclusionsGaps in optimum epilepsy management in rural Bangladesh are amenable to improvement anchored with local healthcare workers. Training and clinical care focused on recognition of common seizure types, seizure mimics and rationalising use of available AEDs can be facilitated by better referral pathways and telehealth support.

Associated Impairments among Children with Cerebral Palsy in Rural Bangladesh—Findings from the Bangladesh Cerebral Palsy Register

“…Epilepsy: Diagnosis of epilepsy was made based on the history of tonic–clonic seizures by interviewing the primary caregivers and reviewing available medical records. In consultation with a paediatric neurologist, a child was documented as having active epilepsy if s/he presented with a history of one or more unprovoked seizures in the preceding three months of data collection at medical assessment camps and after the neonatal period [ 10 , 13 ].…”

“…The BCPR enabled the first population-based estimation of the prevalence of CP (i.e., 3.4 per 1000 children) and provided an understanding of the epidemiology of CP among children in Bangladesh [ 10 ]. Furthermore, the data enabled the team to tailor need-based services for children with CP in the country [ 11 , 12 , 13 , 14 ].…”

Cerebral palsy registers around the world: A survey

“…For example, case identification via the key informant method is common, 29 and data collected is relevant to hypothesized or identified aetiological pathways locally 30 . Disability awareness, medical, rehabilitation, and social services are perhaps more routinely embedded in the register programme—such as epilepsy management 31 and integrated microfinance/livelihood and community‐based rehabilitation programmes 32 . Registers in LMICs may learn from the experience of other condition‐specific registers, such as cancer registers 33 and congenital anomaly registers 34…”