Clinical Characteristics, Treatment Outcome and Associated Factors of Epilepsy Among Children at Hospitals of North-West Ethiopia

Abstract

Background

Epilepsy is an important cause of neurological morbidity in children and adolescents. Clinical parameters are the main diagnostic tools, especially in developing countries. Although cost-effective treatments for epilepsy are available, studies have shown that uncontrolled seizures can occur in many patients.

Objective

To assess clinical characteristics, treatment outcomes, and associated factors for controlled epilepsy among children with epilepsy who underwent follow-up at the Debre Markos Comprehensive Specialized Hospital, North-west Ethiopia from October 28, 2020, to April 28, 2021.

Methods

An institutional-based retrospective cohort study was conducted from October 28, 2020, to April 28, 2021. A total of 385 participants who fulfilled the inclusion criteria were included in the study. A pretested, structured, interviewer-administered questionnaire with a chart review was used to collect data. The data were entered into the Epi-data software version 4.4.2.1 and then exported to the Stata version 14 statistical package for analysis. Descriptive statistics were used to describe the sociodemographic and clinical characteristics, treatment profiles, and treatment outcomes of patients with epilepsy. Bivariate and multivariate analyses were used to identify factors associated with treatment outcomes.

Results

The most frequent type of seizure among the 385 respondents was Generalized-tonic-clonic seizures (88.1%). The proximate cause of seizures was identified in 15% of patients, of whom 45 had a perinatal history (8.8%), head injury (3.6%), and CNS infection (2.3%). One-third of patients had poor seizure control. Caregiver relationship (father AOR=0.58; 95th CI:0.35,0.97) and poor adherence (AOR=2.97; 95th CI:1.82, 4.86) were significantly associated with treatment outcome.

Conclusion

One-third of children with epilepsy have poor seizure control. Poor adherence to treatment is implicated in poor control. Counseling caregivers on proper treatment and adherence to anti-epileptic medication is recommended to improve treatment outcome in children.

Keywords:

• children
• epilepsy
• seizure
• treatment outcome
• Ethiopia

Abbreviations

ADR, Adverse Drug Reaction; ASMs, Anti Seizure Medication; AOR, Adjusted Odd Ratio; CBZ, Carbamazepine; CI, Confidence interval; DRE, Drug Resistance Epilepsy; EEG, Electroencephalogram; GTC, Generalized Tonic-Clonic; HIV, Human Immunodeficiency virus; ILAE, International League against Epilepsy; OR; Odd Ratio; PHB, Phenobarbitone; PHT, Phenytoin; SD, Standard Deviation; SNNPR, Southern nations and nationalities people region; SPSS, Statistical Package for Social Science; VPA, Valproic acid; WHO, World Health Organization.

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Ethical Clearance

The study complied with the principles of the Declaration of Helsinki. Ethical approval was obtained from the Debre Markos University School of Medicine's Institutional Research Ethics Review Committee (IRERC) (ethical approval NO: IRERC 076/21). Ethical clearance was granted on Feb 1/2021.

Consent

Written informed consent was obtained from each parent/guardian and child aged > 12 years to participate in the interview and to extract data from their medical charts. Consent was obtained and verified by a research ethics review board. The address of the person mentioned is stated in the ethical clearance letter submitted to the manuscript. Privacy and confidentiality were ensured during the parents/guardians, patient interviews, and medical chart reviews.

Acknowledgment

We would like to acknowledge the participants and data collectors for providing us with consent to share their history and collect the data. We also wish to express our gratitude to Arba Minch University for funding this research and providing ethical clearance.

Disclosure

The authors declare no conflicts of interest regarding the publication of this article.