Prevalence and factors associated with drug-resistant epilepsy among children attending the pediatric neurology clinic at an urban tertiary hospital in Uganda

Abstract

Epilepsy is among the most prevalent and serious neurological diseases. Anti-seizure medications are still the mainstay of management in most epilepsies. Globally, 10-40% of patients are estimated to have drug resistant epilepsy (DRE). However, there is limited data regarding DRE among children in low resource settings. Objective: This study aimed at determining the prevalence and factors associated with DRE among children with epilepsy in a large pediatric neurology clinic in Uganda. Methods: A cross-sectional study was performed between April and June 2023. Children aged 1 to 17 years with epilepsy, who had been on antiseizure medication (ASM) for at least 12 months, were recruited. Results: The prevalence of DRE was 12.2% (34/278); (95% CI: 8.6 – 16.7%). Factors associated with DRE included; multiple seizure episodes [APR=6.5, 95% CI: 3.3-17.4, P<0.0001], multiple seizure types [APR=4.4, 95% CI: 3.0-9.4, P<0.0001], diagnosis of an epilepsy syndrome [APR=3.6, 95% CI: 2.5-8.3, P=0.026], prior history of status epilepticus [APR=3.6, 95% CI: 2.7-6.1, P=0.001], focal seizure type [APR=2.3, 95% CI: 1.3-4.2, P=0.002], and symptomatic epilepsy [APR=2.1, 95% CI: 1.4-3.8, P=0.041]. Conclusion: The 12.2% prevalence of DRE estimated in this study is still high. Lower-level clinicians should be on higher alert for children with high risk factors for DRE like; multiple frequent seizures types, likely developmental and epileptic encephalopathies (DEE) and symptomatic epilepsy for timely referral to tertiary epilepsy specialized care. The study further underscores the need to make epilepsy syndromes part of routine epilepsy care.