Clinical Characteristics, Treatment Outcome and Associated Factors of Epilepsy Among Children at Hospitals of North-West Ethiopia

Figures & data

Table 1 Socio-Demographic Characteristics of Patients with Epilepsy at Comprehensive Specialized Hospital of North-West Ethiopia, 2021 (n = 385)

Sociodemographic Characteristics	Value (%)
Sex
Male	237 (61.6)
Female	148 (38.4)
Age category of patients
2–6 years	76 (19.7)
7–10 years	77 (20)
11–17 years	232 (60.3)
Age of onset of seizure
<=1 year	67 (17.5)
>1 year	317 (82.5)
Area of residence
Urban	112 (29.1)
Rural	273 (70.9)
Caretaker
Father	193 (50.1)
Mother	138 (35.8)
Grandparents	54 (14.1)
Monthly income of caretaker (in Birr)
>3000	60 (15.6)
<=3000	325 (84.4)
Educational status of caretaker
Primary school	62 (16.1)
Secondary school	33 (8.6)
Diploma	20 (5.2)
Degree	54 (14)
Illiterate	216 (56)

Table 2 Clinical Characteristics of Patients with Epilepsy at Comprehensive Specialized Hospital of North-West Ethiopia, 2021 (n = 385)

Clinical Characteristics	Value (%)
Reported Aura symptoms
Dizziness
Yes	22 (5.7)
No	363 (94.3)
Blurring of vision
Yes	88 (22.9)
No	297 (77.1)
Temporary loss of vision
Yes	29 (7.5)
No	356 (92.5)
Panic attack
Yes	78 (20.30
No	307 (79.7)
Fear
Yes	123 (32)
No	262 (68)
Epigastric sensation
Yes	20 (5.2)
No	365 (94.8)
Laughing
Yes	21 (5.5)
No	364 (94.5)
Miscellaneous aura symptoms
Yes	19 (5)
No	366 (95)
No aura reported	192 (49.9)
Automatism
Yes	10 (2.6)
No	375 (97.4)
Seizure types
Generalized tonic clonic	338 (87.8)
Generalized Tonic	3 (0.8)
Generalized Clonic	7 (1.8)
Atonic	9 (2.3)
Myoclonic	4 (1)
Absence	6 (1.6)
Focal aware	12 (3)
Focal unawareness	6 (1.5)
Seizure frequency before treatment
<=3 per week	112 (29.1)
≥4 per week	273 (70.9)
Peak time for the seizure occurrence
Afternoon only	87 (22.6)
Night only	37 (9.6)
Day and night	233 (60.5)
Early morning (minutes of waking up from sleep)	13 (3.4)
Late morning	15 (3.9)
	260 (67.5)
Precipitating factors
Sleep deprivation
Yes	70 (18.2)
No	315 (81.8)
Photic stimulation
Yes	49 (12.7)
No	336 (87.3)
Fever
Yes	38 (9.9)
No	347 (90.1)
Hyperventilation
Yes	4 (1)
No	381 (99)
Anxiety
Yes	87 (22.6)
No	298 (77.4)
Alcohol intake
Yes	40 (10.4)
No	345 (89.6)
No precipitating factor reported	260 (67.5)
Postictal phase
Sleep
Yes	257 (66.8)
No	128 (33.2)
Lethargy
Yes	157 (40.8)
No	228 (59.2)
Headache
Yes	92 (23.9)
No	293 (76.1)
Dizziness
Yes	72 (18.7)
No	313 (81.3)
Blurring of vision
Yes	24 (6.2)
No	361 (93.8)
Confusion
Yes	50 (13)
No	335 (87)
Miscellaneous postictal phenomenon
Yes	26 (6.7)
No	359 (93.3)
No postictal phenomenon reported	34 (8.8)
History of Status epilepticus
Yes	28 (7.3)
No	357 (92.7)
Family history
Yes	21 (5.4)
No	364 (94.6)
Proximate cause
HIE	34 (8.8)
Head injury	28 (3.6)
Central nervous system infection	30 (2.3)
Structural brain lesions and polycythemia	16 (0.7)
Unknown	277 (84.9)
Comorbidity
Cerebral palsy with global developmental delay	23 (6)
Autism	13 (3.4)
HIV infection	13 (3.4)
Type 1 DM	21 (5.4)
Hearing loss	12 (3.12)
No	303 (78.7)
Diagnostic tests
EEG
Yes	15 (3.9)
No	370 (96.1)
MRI or CT scan of the brain
Yes	11 (2.9)
No	374 (97.1)

Abbreviations: CT, Computed Tomography; DM, Diabetes Mellitus; EEG, Electroencephalogram; HIE, Hypoxic Ischemic Encephalopathy; HIV, Human Immunodeficiency Virus; MRI, Magnetic Resonance Imaging.

Table 3 Treatment Characteristics of Patients with Epilepsy at Comprehensive Specialized Hospital of North-West Ethiopia, 2021 (n = 385)

Treatment Characteristics of Patients	Value (%)
Prayer or Traditional medicine
No	196 (50.9)
Yes	189 (49.1)
Caregiver awareness that epilepsy is treatable
No	107 (27.8)
Yes	278 (72.2)
Duration of seizure before start of treatment (in years)
<=1 year	104 (27)
>1 year	281 (73)
Number of follow up
<=5	30 (7.8)
>6	355 (92.2)
Number of anticonvulsants the patient is taking
One	331 (86)
Two	38 (10)
Three	16 (4)
Anticonvulsant started as monotherapy
PB	215 (55.8)
PHT	108 (28.1)
VPA	31 (8.1)
CBZ	28 (7.3)
CLN	3 (0.8)
Anticonvulsant/s that the patient taking currently
PB alone	217 (56.4)
PHT alone	103 (26.8)
VPA alone	4 (1)
CBZ alone	7 (1.8)
PB and PHT	14 (3.6)
PB and VPA	8 (2.1)
PB and CBZ	7 (1.8)
PHT and CBZ	5 (1.3)
CLN and PHT	3 (0.8)
PB, PHT and CBZ	8 (2.1)
PB, PHT and VPA	7 (1.8)
PB, CBZ and VPA	2 (0.5)
Phase of treatment
Escalating	47 (12.2)
Maintenance	200 (52)
Tapering	138 (35.8)
Treatment outcome
Controlled	247 (64.2)
Uncontrolled	138 (35.8)
Adverse drug reactions of anticonvulsants
Gum hypertrophy
Yes	10 (2.6)
No	375 (97.4)
Ataxia
Yes	3 (0.8)
No	382 (99.2)
Drowsiness
Yes	20 (5.2)
No	365 (94.8)
Skin rash
Yes	12 (3.1)
No	373 (96.9)
Hyperactivity
Yes	86 (22.3)
No	299 (77.7)
No adverse drug reaction reported	258 (67)
Adherence
Excellent	220 (57.1)
Good	107 (27.8)
Poor	58 (15.1)

Abbreviations: CBZ, Carbamazepine; CLN, Clonazepam; PB, Phenobarbital; PHT, Phenytoin; VPA, Valproic acid.

Table 4 Factors Associated with Treatment Outcome in Epileptic Patients at Comprehensive Specialized Hospital of North-West Ethiopia, 2021 (n = 385)

Controlled	Epilepsy Treatment Outcome		COR	AOR	P value
	Uncontrolled n (%)	Controlled n (%)
Timing of seizure
Afternoon only	24(17.4)	65(26.3)	1	1	1
Night only	14(10.1)	23(9.3)	0.61(0.27–1.37)	0.58(0.23–1.50)	0.264
Both during day and night	90(65.2)	141(57.1)	0.58(0.34–0.99)	0.46(0.25–0.86)	0.014
Early morning (up to 8:00AM)	5(3.6)	8(3.2)	0.59(0.17–1.98)	0.54(0.13–2.21)	0.394
Late morning (up to 12:00AM)	5(3.6)	10(4.0)	0.74(0.23–2.38)	0.66(0.17–2.52)	0.543
Seizure frequency
Not recurrent	31(22.5)	81(32.8)	1	1	1
Recurrent	107(77.5)	166(67.2)	0.59(0.37–0.96)	0.38(0.20–0.71)	0.002
History of status epilepticus
Yes	12(8.7)	16(6.5)	1	1	1
No	126(91.3)	231(93.5)	1.37(0.63–3)	1.43(0.57–3.56)	0.451
Aetiology
Unknown	87(63.0)	190(77.0)	1	1	1
Perinatal insult	18(13.0)	16(6.5)	0.41(0.2–0.83)	0.77(0.3–2)	0.587
Head injury	11(8.0)	17(7.0)	0.71(0.32–1.57)	0.97(0.37–2.52)	0.952
CNS infections	15(10.9)	15(6.1)	0.46(0.21–0.98)	0.39(0.16–0.90)	0.028
Cerebrovascular injury	7(5.1)	9(3.6)	0.59(0.21–1.63)	0.39(0.12–1.25)	0.114
First ASM
PB	76(55.1)	179(56.3)		1	1
VP	14(10.1)	16(6.9)	0.66(0.31–1.42)	0.75(0.04–1.86)	0.538
CBZ	7(5.1)	21(8.5)	1.64(0.67–4.03)	1.16(0.42–3.17)	0.771
PHT	39(28.3)	69(27.9)	0.97(0.6–1.57)	0.63(0.36–1.11)	0.109
CLZ	2(1.4)	1(0.4)	0.27(0.02–3.1)	0.13(0.05–3.21)	0.213
Adherence
Poor	26(18.8)	32(13.0)	1	1	1
Good	47(34.1)	60(24.3)	1.04(0.54–1.97)	1.08(1.23–5.03)	0.832
Excellent	65(47.1)	155(62.7)	1.94(1.07–3.50)	2.49(1.23–5.03)	0.011
Age of onset of seizure
During infancy	36(26.3)	31(12.5)	1	1	1
Above 1 year	101(73.7)	216(87.4)	2.48(1.45–4.42)	2.23(1.18–4.20)	0.013
Number of family member
1	13(9.4)	14(5.7)	1	1	1
Above 1	125(90.6)	233(94.3)	1.73(0.79–3.8)	1.51(0.57–4.25)	0.405
Comorbidities
No	98(71.0)	205(83.0)	1	1	1
Cerebral palsy with Global developmental delay	14(10.1)	9(3.6)	0.31(0.13–0.73)	0.28(0.94–0.84)	0.024
HIV	6(4.3)	7(2.8)	0.56(0.18–1.7)	0.49(0.14–1.68)	0.258
Type 1 DM	5(3.6)	16(6.5)	1.53(0.54–4.3)	1.19(0.14–1.68)	0.258
Autism	8(5.8)	5(2.0)	0.3(0.1–0.94)	0.26(0.07–0.98)	0.048
Hearing loss	7(5.1)	5(2.0)	0.34(0.1–1.10)	0.29(0.74–1.12)	0.073
Educational level
Illiterate	86(62.3)	130(52.6)	1	1	1
Primary	13(9.4)	49(19.8)	2.5(1.28–4.87)	3.21(1.52–6.80)	0.002
Secondary	11(8.0)	22(8.9)	1.32(0.61–2.87)	1.53(0.61–3.82)	0.366
Diploma	7(5.1)	13(5.3)	1.23(0.47–3.20)	1.34(0.38–4.77)	0.650
Degree	21(15.2)	33(13.4)	1.04(0.56–1.91)	1.00(0.45–2.24)	0.993
Side effects
No	83(60.1)	175(70.9)	1	1	1
Yes	55(39.9)	72(29.1)	0.62(0.40–0.96)	0.65(0.37–1.12)	0.121
Aura
No	77(55.8)	115(46.6)	1	1	1
Yes	61(44.2)	132(53.4)	1.32(0.87–2.01)	1.12(0.64–1.95)	0.691

Notes: Logistic model for controlled, goodness-of-fit test. Hosmer-Lemeshow chi2(8) = 6.85. Prob > chi2 = 0.5533. Evidence of the overall goodness of fit was reflected by a non-significant p-value. Here, the Hosmer–Lemeshow test p-value was 0.5533. This finding suggested a good overall fit.

Abbreviations: AOR, Adjusted Odd Ratio; ASM, Anti Seizure Medication; CBZ, Carbamazepine; CLN, Clonazepam; DM, Diabetes Mellitus; HIV, Human Immunodeficiency Virus; PB, Phenobarbital; PHT, Phenytoin; VPA, Valproic acid.

Figure 1 Comparison of good treatment response between other studies and this study.

Figure 2 Timing of seizure control after initiation of anti-epileptic drugs used of patients with epilepsy at Comprehensive Specialized Hospital of North-west Ethiopia, 2021 (n = 385).

Figure 3 Number of anti-epileptic drugs used and treatment outcome of patients with epilepsy Comprehensive Specialized Hospital of North-west Ethiopia, 2021 (n = 385).