Cognition and behavior in a prevalent cohort of children with epilepsy in rural northern Tanzania: A three-year follow-up study.
OBJECTIVE
Eighty-five percent of the 33 million children with epilepsy (CWE) worldwide live in low- and middle-income countries (LMICs). There is limited research into epilepsy-related comorbidities in LMICs, and there are no studies of the long-term progression of behavioral and intellectual difficulties in childhood epilepsy in sub-Saharan Africa. We aimed to assess behavior and cognition at three-year follow-up in CWE in rural Tanzania.


METHODS
In 2010, a cross-sectional study identified 112 CWE 6 to 14years of age and 113 age- and sex-matched controls in the Hai district of northern Tanzania. From March to June 2013, cases and controls (now 10 to 18years of age) were followed up. At baseline, behavior was assessed using the Rutter A Questionnaire and cognition using the Goodenough-Harris Drawing Test. Details of current seizure frequency and antiepileptic drug (AED) use among CWE were collected.


RESULTS
At follow-up, cases had significantly more behavioral difficulties compared with controls (48% of 108 cases versus 14% of 103 controls (p<0.001)). Additionally, 69% of the cases and 16% of the controls had cognitive impairment (p<0.001). In CWE with decreased seizure frequency from baseline to follow-up, behavior had improved significantly. At follow-up, there was no significant difference in behavior between CWE with decreased seizure frequency and those with good seizure control throughout.


CONCLUSIONS
Behavioral difficulties and cognitive impairment are common among CWE in this population. Improved access to AED treatment and subsequent improved seizure control may reduce the frequency of behavioral difficulties seen in this population.
The Medical School, Newcastle University, Newcastle upon Tyne, UK; Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK.
Kathryn
K
Powell
Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK. Electronic address: Richard.walker@nhct.nhs.uk.
Richard W
RW
Walker
Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
Jane
J
Rogathe
Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK.
William K
WK
Gray
London School of Hygiene and Tropical Medicine, UK.
Ewan
E
Hunter
Centre for Geographical Medicine (Coast), Kilifi, Kenya; Muhimbili-Wellcome Programme, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania; Dept of Psychiatry, University of Oxford, Oxford, UK.
Charles R
CR
Newton
Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Neurosciences Unit, Institute of Child Health, University College London, London, UK.
Kathryn
K
Burton
D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D016022:Case-Control Studies; D002648:Child; D002653:Child Behavior Disorders / Q000453:epidemiology* / Q000209:etiology; D003072:Cognition Disorders / Q000453:epidemiology* / Q000209:etiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004827:Epilepsy / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data; D012640:Seizures / Q000188:drug therapy; D013636:Tanzania / Q000453:epidemiology
D000927:Anticonvulsants
Behavior; Cognition; Epilepsy; Pediatric; Sub-Saharan Africa; Tanzania