Prevalence and factors associated with epilepsy among children with hydrocephalus at Cure Children’s Hospital of Uganda

Abstract

Background: Hydrocephalus (HC) affects over 225000 in Sub Saharan Africa and about 4000 infants per year in Uganda. Developing epilepsy in HC may worsen the cognitive impairment and quality of life with added financial burden. However, there is limited data on the burden of epilepsy among children with hydrocephalus. Objective: To determine the prevalence and factors associated with epilepsy among children with hydrocephalus at Cure Children’s Hospital of Uganda. Method: A cross-sectional study involving chart reviews for patients (<18 years) with hydrocephalus that were managed at Cure Children’s hospital between January 2015 and December 2019. Demographic data, clinical presentation, treatment and outcomes were extracted and analyzed. Participants’ baseline characteristics were described using proportions for categorical variables, association between predictor and outcome variables were assessed using logistic regression. STATA version 15.0 was used for analysis. Results: Overall, 278 patients with hydrocephalus were included, 75 (27%) had documented epilepsy, 50.7% (38/75) of whom had epilepsy diagnosed before surgery. Males were 64% (48/75), 88% (66/75) were infants under one year, 82.7% (62/75) had Post infectious hydrocephalus (PIH) and 60% (45/75) had a history of neonatal infection. The odds of epilepsy among children who had more than one surgery were approximately two-fold (adjusted odds ratio [aOR]=1.82, 95%CI: 1.25-2.67, p=0.002) compared to those who had one surgery. Having convulsions in the initial febrile illness preceding onset of hydrocephalus increased the odds of epilepsy (aOR=1.88, 95%CI: 1.13-3.13, p=0.015). Conclusion: Majority of the children with hydrocephalus and epilepsy were of PIH etiology. Having convulsions in the initial febrile illness preceding onset of hydrocephalus and having more than one surgery increased the odds of epilepsy although type of surgery did not affect this risk. Key words: Hydrocephalus, epilepsy, Ventriculoperitoneal shunt, Endoscopic Third Ventriculostom