Multiple anti-epileptic drug use in children with epilepsy in Mulago hospital, Uganda: a cross sectional study.

Rita Atugonza,Levicatus Mugenyi,Richard Idro,Elly Katabira,Mark Kaddumukasa,Angelina Kakooza-Mwesige,Samden Lhatoo,Martha Sajatovic

doi:10.1186/s12887-016-0575-0

Abstract

BackgroundSeizures in up to one third of children with epilepsy may not be controlled by the first anti-epileptic drug (AED). In this study, we describe multiple AED usage in children attending a referral clinic in Uganda, the factors associated with multiple AED use and seizure control in affected patients.MethodsOne hundred thirty nine patients attending Mulago hospital paediatric neurology clinic with epilepsy and who had been on AEDs for ≥6 months were consecutively enrolled from July to December 2013 to reach the calculated sample size. With consent, the history and physical examination were repeated and the neurophysiologic and imaging features obtained from records. Venous blood was also drawn to determine AED drug levels. We determined the proportion of children on multiple AEDs and performed regression analyses to determine factors independently associated with multiple AED use.ResultsForty five out of 139 (32.4 %) children; 46.7 % female, median age 6 (IQR = 3–9) years were on multiple AEDs. The most common combination was sodium valproate and carbamazepine. We found that 59.7 % of children had sub-therapeutic drug levels including 42.2 % of those on multi-therapy. Sub-optimal seizure control (adjusted odds ratio [ORa] 3.93, 95 % CI 1.66–9.31, p = 0.002) and presence of focal neurological deficits (ORa 3.86, 95 % CI 1.31–11.48, p = 0.014) were independently associated with multiple AED use but not age of seizure onset, duration of epilepsy symptoms, seizure type or history of status epilepticus.ConclusionOne third of children with epilepsy in Mulago receive multiple AEDs. Multiple AED use is most frequent in symptomatic focal epilepsies but doses are frequently sub-optimal. There is urgent need to improve clinical monitoring in our patients.

Highlights

Seizures in up to one third of children with epilepsy may not be controlled by the first anti-epileptic drug (AED)
Patterns of epilepsy Based on EEGs, generalized epilepsy was described in 49/125 (39.2 %) children; 57.1 % were male with a median age of 6 (IQR = 4 – 8) years
The study found that 1/3 children with epilepsy in the clinic were on multiple AEDs which was associated with poor seizure control and the presence of focal neurologic deficits

Summary

Introduction

Seizures in up to one third of children with epilepsy may not be controlled by the first anti-epileptic drug (AED). It has been suggested that the patients’ clinical characteristics such as frequent, Atugonza et al BMC Pediatrics (2016) 16:34 focal and long duration of seizures, symptomatic or syndromic epilepsy, history of status epilepticus, and the presence of neurological deficits, is the primary reason for failure of the first AED, rather than drug related factors such as efficacy and adverse effects. The answers to these questions are important, because inadequate response to initial treatment with the first AED and subsequent treatment with multiple AEDs is believed, in itself, to be a poor prognostic factor in epilepsy [12,13,14]

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