Epilepsy in rural Ugandan children: seizure pattern, age of onset and associated findings.

Abstract

Much information on childhood epilepsy in sub Saharan Africa is hospital based. A survey was considered necessary before integrating epilepsy management into a Ugandan community programme. Using an 'outreach' method, children with recurrent seizures were offered assessment at 19 sites in Rukungiri District. A brief history and neurological and developmental assessment was carried out on each child. A clinical diagnosis of epilepsy, including seizure type, was given to 440 of 618 children <18 years with 178 exclusions. The age-specific prevalence of epilepsy in children < 15 years was 2.04‰ (95% CI 1.94‰ to 2.24 ‰) based on 395 cases in an <15 years population of 193,126. Percentage distribution by seizure type was:-generalised tonic-clonic (53%), complex partial seizures CPS (27%), simple partial and miscellaneous seizures (6% each), with some diagnostic overlap between seizure types. Cerebral palsy, evident or evolving, was most strongly associated with CPS. A positive perinatal or infantile history was noted in 12 and 6% respectively, and 50.2% of seizures began in infancy. The prevalence of epilepsy is similar in Gambian children. The high contribution from early-onset CPS, resembles Kenyan reports of malaria-associated CPS, suggesting a causal association with malaria.