Prevalence of intractable epilepsy and associated factors among children with epilepsies attending paediatric neurology clinic at m-Muhimbili national hospital, Dar es salaam, Tanzania

Abstract

Background: Epilepsy is one of the most common neurological disorders of childhood. Eighty percent of patients with epilepsy dwell in developing countries with majority (90%) of patients in Sub Sahara Africa (SSA) being younger than 20 years. A quarter of all children with epilepsy will be intractable to medical treatment with higher risk of morbidity and mortality despite state of the art medical management. Locally, there is paucity of data on the magnitude of intractable epilepsy and therefore, this study aimed to establish pediatric specific prevalence of intractable epilepsy and associated factors among children with epilepsies in Tanzania. Objectives: To determine the prevalence of intractable epilepsy and associated factors among patients with epilepsies aged between 3 months to 15 years attending pediatric neurology clinic at Muhimbili National Hospital, Dar es Salaam Tanzania. Method: This was hospital based cross sectional study, which was conducted among children with epilepsies attending pediatric neurology outpatient clinic at Muhimbili National Hospital Dar es Salaam Tanzania. Structured questionnaire was used to collect demographic and clinical information. Seizures and epilepsies were classified using 2017 International League Against Epilepsy (ILAE) classification. Descriptive analysis was summarized using proportions and median with interquartile ranges (IQR). Overall prevalence of intractable epilepsy was calculated with 95% confidence interval. Chi squire and where applicable Fischer’s exact test was used to determine association between categorical variables. Logistic regression was used to determine independent factors associated with intractable epilepsy. Probability value (p) value of < 0.05 was considered statistically significant. Results: A total of 236 children who fulfill the diagnostic criteria of epilepsy and who were on treatment with Anti Epileptic Drugs (AED) for more than 3 months were consecutively recruited in this study. Median age of the participants was 72 months (IQR=42-78). There was slight male preponderance by 56%. Prevalence of intractable epilepsy was found to be 14.8%, 95% CI (10.6-20%). Out of 35 patients with intractable epilepsy, 60% had generalized epilepsy and almost a quarter had a diagnosis of epilepsy syndrome, the commonest being Lennox Gastaut Syndrome (LGS). Eighty percent of all patients with IE had structural lesions which were visualized on MRI, the commonest being cystic encephalomalacia observed in 34% of patients. At least half (54.4%) of patients with focal intractable epilepsy had lesions that could be amenable to curative epilepsy surgeries. Independent factors associated with intractable epilepsy were; onset of seizures during the first months of life (OR =3.5; 95% CI 1.2-10; P= 0.02) and high initial seizures frequency (OR=4.2; 95% CI 1.8-9.6; P=<0.001). Conclusion and recommendations: Almost 15% of all patients with epilepsy attending pediatric neurology clinic were found to have (IE). Independent predictors for Intractable Epilepsy were neonatal onset seizures and high initial seizures frequency. Patients with IE were more likely to present with generalized epilepsies and about a quarter were diagnosed with epilepsy syndromes. More than three quarters of patients with IE had structural abnormality noted on MRI Patients with neonatal onset seizures and high seizures frequency should be followed up closely, for early diagnosis of intractable epilepsy. Intervention research is recommended in this study setting to assess the utility of ketogenic diet and epilepsy surgery for those with epilepsy syndromes and structural brain lesions that can be modified by epilepsy surgery.Asilimia 14.8 ya watoto wote wenye kifafa waligundulika kua na kifafa kisichosikia dawa (kifafa sugu). Kati ya watoto 35 waliokua na tatizo la kifafa sugu,asilimia sitini walikua na degedege la pande zote za mwili na robo ya watoto hawa walikua na sindromu za degedege na iliyoongoza ni ile inayoitwa Lennox Gaustat Syndrome. Asilimia 80 ya watoto wenye kifafa sugu walipatikana kua na matatizo kwenye maumbile ya ubongo wao walipofanyiwa kipimo cha MRI ,na tatizo la kimaumbile liitwalo cystic encephalomalacia liliongoza kwa ukubwa. Karibu nusu ya wagonjwa wote wenye kifafa sugu kinachoambatana na degedege za upande mmoja walionekana kuwa na makovu kwenye ubongo ,ambayo yanaweza kutibika kwa njia za upasuaji wa kutibu degedege. Visababishi vya kifafa sugu vilivyogundulika ni pamoja na kuanza kupata degedege ndani ya kipindi cha mwezi mmoja wa kuzaliwa(OR=3.9;95% CI 1.2-10;P=0.02) na kupata degedege mara nyingi mfululizo kabla ya kuanza matibabu (OR =4.2;95% CI 1.8-9.6);P<0.001.) Muhtasari na Mapendekezo: Karibu asilimia 15% ya watoto wote wenye kifafa wanaohudhuria kliniki ya magonjwa ya neva katika hosipitali ya taifa Muhimbili walikua na kifafa sugu. Visababishi vya kifafa sugu vilivyogundulika ni pamoja na kuanza kupata degedege ndani ya mwezi mmoja wa kuzaliwa na kupata degedege mara nyingi kabla ya kuanza matibabu. Wengi wa wagonjwa waliokua na kifafa sugu walikua wakipata degedege za pande zote mbili za mwili huku robo yao wakiwa na syndromu za kifafa. Zaidi ya robo tatu ya wagonjwa waliokua na kifafa sugu pia walikua na matatizo ya kimaumbile katika ubongo wao. Tunapendekeza watoto wanaopata degedege katika kipindi cha mwezi mmoja wa kuzaliwa na wanaopata degedege mara nyingi mfululizo wafuatiliwe kwa ukaribu zaidi ili kujua kama kifafa chao ni sugu. Pia tunapendekeza ifanyike tafiti ya kuangalia ufanisi wa upasuaji pamoja na njia nyingine katika kutibu kifafa sugu