Pattern of Epilepsy and associated neurological impairmrnts among patients attending the Peadiatrict Neurology Clinic at Mulago Hospital
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Introduction: Epilepsy is a leading neurological disorder globally. It is estimated that 0.5-1% of all children worldwide have epilepsy with the majority presenting during infancy or early childhood. Epilepsy is usually associated with multiple disabilities which affect not only the patient, but the family and community in which the patient lives. Objective: To describe the pattern of Epilepsy and the associated neurological impairments among children attending the Paediatric Neurology Clinic of Mulago Hospital. Study design: This was a descriptive cross sectional study. Procedures: All patients meeting the selection criteria who attended the clinic from January to March 2009 were consecutively enrolled. A clinical history and a detailed neurological examination were performed. In addition the participant's were screened for hearing using the otoaccoustic emission method, visual acuity using Snellen chart and cognition in children ≥ 6years using the Cogstate method. The participants who were unable to do the test due to severe mental retardation and those whose Z score was -2 or less in any of the cogitate assessments was considered to have severe cognitive impairment Those considered to have neurological impairment were those with motor, visual and hearing impairment as the cognitive impairment was an estimate due to lack ofnonnal controls from similar study setting. Results: The prevalence of epilepsy among the patients who attended the clinic during the study period was 145/212 (68.4%). Of the patients enrolled into the study, using an electro-clinical classification, 78/123 (63.4%) had partial epilepsy while 45/123 (37.3%) had generalized epilepsy. In contrast, using clinical criteria only, 28/123 (22.8%) had partial epilepsy while 95/123 (77.2%) had generalized epilepsy. The majority of epilepsies were symptomatic 81/123 (65.8%). Cryptogenic and idiopathic epilepsies accounted for 37/123 (30%) and 5/123 (4.1%) respectively. Specific epileptic syndromes were identified in 24/123 (19.5%) of the study participants. Fifty percent (50%) of the study participants had a neurological impairment while 10.5% had multiple impairments. The proportions of neurological impairments among the study participants were: motor 45/123 (36.6%); visual 25/123 (20.3%) and hearing 7/123 (5.7%). Among children 2: 6 years, 24/59 (40.7%) had severe cognitive impairment compared to those with generalized epilepsy OR 3.36 (CIl.54-7.30) P-value 0.002. Conclusion: The majority of patients attending the Paediatric Neurology clinic at Mulago hospital had partial epilepsy. BEG improved the diagnosis of epilepsy in these study participants. Half of the study participants had co-morbid neurological impairments in the areas of motor, visual and hearing. Almost half of the study participant's 2:6years had severe cognitive impairment. Recommendations: There is need to incorporate EEG imaging in routine work up of patients with epilepsy attending specialist centres. Secondly, multidisciplinary care and rehabilitation should be incorporated in the management of patients with epilepsy to achieve optimal functioning in view of the significant burden of co-morbid neurological impairments. Further research should be conducted to describe other neurological impairments that may co-exist in patients with epilepsy like behaviour, speech and language impairments.