Pattern of Childhood Epilepsy and Outcome Determinants at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Abstract

Background: Epilepsy is the most common cause of neurologic disability throughout the world. The majority of the cases live in developing countries. In Ethiopia epilepsy is an important public health problem; however, little information is available on childhood epilepsy.

Objective: The objective of this study is to assess the clinical profile and treatment outcome of childhood epilepsy.

Methods: A cross sectional study of 246 epileptic children who were followed up for at least 6 months  in a seizure clinic at Tikur Anbessa Specialized Hospital was conducted over a 6 month period, February1-October 31, 2007. Using a structured and pretested questionnaire, data on Socio-demographic information, age at onset of seizure, frequency of seizures before start of AED ,duration of seizure before start of treatment , description of seizure, risk factors for seizure, EEG reports, and the prescribed treatment were collected, entered and analyzed with SPSS 12.0 software. Adjusted odds ratio with 95% confidence interval and P-value were calculated for predictors of poor seizure remission.

Results: There were149 (60.6%} male and 97(39.4 %) female epilepsy patients with a mean age of 7.1± 2.9.years, and the median age at onset of seizure 3.5± 2.7 years. Fifty-five (22.3%) had   their first seizure at or before 1 year of age. There was a delay before presentation to hospital with mean and median interval of 0.81±1.18 and 0.3 year, respectively. Generalized epilepsy was the most common type of epilepsy present in 171(69.5%) of the patients. Partial seizure and multiple seizure types were seen in (15.9%) and (14.6%) of the patients, respectively. The majority (63%) of the patients were on monotherapy. Eighty-one (32.1%) of the patients had poor seizure remission. Further bivariate analysis revealed that seven factors were independently correlated with seizure remission. These were(1) multiple seizure types(OR=6.76, 95%CI: 3.08-14.82,P=0.0001),(2) a high frequency of seizures(OR=6.75, 95%CI:3.46-13.18, P=0.0001),(3)poor cognitive development(OR=4.35, 95%CI: 2.20-8.61, P=0.006) (4) associated motor abnormality(OR=2.60 95%CI: 1.35-4.97, P=0.004)(5), Cerebral palsy(OR 0.23 CI 0.08-0.66,P=0.006) (6) polytherapy{OR 13.72 CI 7.22-26.06,P=0.0001),and (7) poor compliance to treatment (OR 12.59 CI 6.16-25.73,P=0.0001).                                                                                                            Conclusion and Recommendation: This study shows a high rate of poor seizure remission despite anticonvulsant therapy. The findings confirm the need for more specialized neurological care for children.