Prediction of seizure outcome in childhood epilepsies in countries with limited resources: a prospective study.
OBJECTIVE
To identify predictors of seizure control in newly presenting children with epilepsy in countries with limited resources.


METHODS
Three hundred and ninety children (273 males, 117 females) aged 2 months to 15 years with newly diagnosed epilepsy were enrolled prospectively at first visit to the multidisciplinary clinic at the children's hospital in Dhaka, Bangladesh. Data about seizures, motor disability, psychomotor development, and electroencephalography were obtained. Regular monitoring of antiepileptic drug treatment was continued at least for one year. Associations between seizure control and potential predictors were determined by multivariate analysis.


RESULTS
Three hundred and ninety children were enrolled in 6 months, of whom over 60% were from low-income families, 60% had onset at under 1 year, 74% had more than one seizure per week, 69% a single-seizure type, and 38% a history of delayed onset of breathing at birth. Cognitive deficits (IQ<70; 58%) and/or motor (significant limitation of daily living activities; 47%) deficits were common. After 1 year of regular treatment, seizure control was good (seizure freedom) in 53%, and poor (at least one seizure in the last 3mo of follow-up) in 47%. The predictors of poor seizure control were an IQ<70, associated motor disability, multiple seizure types, and a history of cognitive regression (1.9 times more likely to have poor seizure control).


CONCLUSIONS
Seizure control can be predicted using three clinical factors (motor disability, cognitive impairment, and multiple seizure types) at the first clinic visit. Such predictors assist the development of referral plans and management guidelines for childhood epilepsies in resource-poor countries.
Neurosciences Unit, Institute of Child Health and Shishu (Children's) Sasthya (Health) Foundation Hospital, Dhaka, Bangladesh. selina_h_banu@yahoo.com
Selina H
SH
Banu
Naila Z
NZ
Khan
Mahmuda
M
Hossain
Saadia
S
Ferdousi
Stewart
S
Boyd
Rod C
RC
Scott
Brian
B
Neville
D000203:Activities of Daily Living / Q000145:classification; D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use*; D001459:Bangladesh; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000175:diagnosis / Q000188:drug therapy; D003299:Cooperative Behavior; D003906:Developing Countries; D004827:Epilepsy / Q000175:diagnosis* / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D033183:Interdisciplinary Communication; D008297:Male; D019957:Motor Skills Disorders / Q000175:diagnosis / Q000188:drug therapy; D011446:Prospective Studies; D016896:Treatment Outcome
D000927:Anticonvulsants