Epidemiology of children with epilepsy at a tertiary referral centre in South Africa

Abstract

PurposeThis retrospective observational hospital-based study assessed the characteristics of children with epilepsy in a sub-Saharan African tertiary service over a 10-year period. MethodsChildren with a primary or secondary diagnosis of epilepsy seen during the study period were identified from the departmental database. Demographic and clinical data were collected from the database and available medical records. ResultsOf 4701 children managed in the neurology service, 2407 children (51%) had epilepsy. The 2017 International League Against Epilepsy Classification of the Epilepsies was used to ascribe seizure and epilepsy type, epilepsy syndrome diagnosis and aetiologic categories. Forty-three percent of children had seizure onset before age one year. Focal Epilepsy occurred in 48% of the cohort (n = 1145). Twenty-five percent had an epilepsy syndrome diagnosis. Most children (54%) had epilepsy of unknown aetiology. Among those with underlying non-genetic aetiologies (33%), sequelae of intracranial infections, perinatal insults and structural brain malformations were most prevalent. Motor disability was present in 24% of children. Seventy-four percent had at least one associated motor disability, intellectual or learning disability, developmental delay or psychiatric comorbidity. ConclusionEpilepsy is common in sub-Saharan Africa. Many affected children have avoidable aetiologies. Compared to data from similar hospital-based studies in poorly resourced and resource-equipped settings, our cohort had a higher proportion of seizure onset below the age of one year and a greater number of infectious aetiologies, which is similar to population-based studies reported in sub-Saharan Africa. The presence of comorbidities is significant and demands greater advocacy for services for these children.