Risk factors for epilepsy among children attending the paediatric neurology clinic of mulago hospital.

Abstract

BACKGROUND: Epilepsy is the most common chronic neurological disorder in the world. The world health organisation estimates that there are about 50 million people living with epilepsy and about 80% of these live in developing countries. The higher burden in developing countries is thought to be secondary to preventable causes such as peri-natal brain injury, CNS infections and head injury. The risk factors for childhood epilepsy in Uganda have not been studied, yet knowledge of these risks can contribute to the development of preventive measures and clinical management. We hypothesized that previous acute central nervous system infections, a history of febrile seizures, peri-natal trauma or a family history of epilepsy are the most important risk factors for epilepsy in Uganda. OBJECTIVE: The objective of this study was to determine the risk factors for epilepsy among children attending the paediatric neurology clinic at mulago hospital. DESIGN: This was a case-control study conducted from January to March 2009. Cases were children with epilepsy attending the paediatric neurology clinic. Controls were age frequency matched children with no clinically diagnosed epilepsy attending the general paediatric outpatient clinic. MEASUREMENTS: Parents/ guardians of cases and controls were interviewed for the above risk factors using the same questionnaire. A physical examination and neurological exam was performed and medical records of the cases reviewed for previous evaluations including EEG recordings and imaging. EEG recordings were performed for the newly diagnosed patients. RESULTS: Most children 59/120 (49.2%) had symptomatic epilepsy, 31/120 (25.8%) had idiopathic epilepsy and 30/120 (25.0%) had cryptogenic epilepsy. Risk factors independently associated with epilepsy were a history of previous acute CNS infections OR 22 {95%CI 4.98-100.8}, P value <0.001, a history of febrile seizures OR 4.00 {95%CI 1.85-8.67}, p value= 0.001 and a history of failure to cry immediately after birth OR 5.00 {95%C1 I.73-14.3}, P value= 0.0003. Focal epilepsy was the predominant type and was associated with a history suggestive of a previous acute CNS infection with OR 2.70 {95%C1 1.0-7.5} p value 0.0239. CONCLUSIONS: Most epilepsy among children attending the paediatric neurology clinic of mulago hospital is symptomatic and partial in nature. The most important risk factors for epilepsy include previous acute CNS infection, febrile seizures and failure and failure to cry immediately after birth. RECOMMENDATIONS: Primary prevention of acute CNS infection such as pyogenic meningitis and cerebral malaria in young children should be strengthened to reduce their occurrence and in turn reduce the burden of childhood epilepsy among children attending to the paediatric neurology clinic of mulago hospital. In addition, a larger multi centre or community based study should be conducted to identify risk factors among children in Uganda as this was a highly select group of children.