title: Multiple anti-epileptic drug use in children with epilepsy in Mulago hospital, Uganda: a cross sectional study.
abstract: BACKGROUND
  Seizures 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.
  
  
  METHODS
  One 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.
  
  
  RESULTS
  Forty 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 [OR(a)] 3.93, 95 % CI 1.66-9.31, p = 0.002) and presence of focal neurological deficits (OR(a) 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.
  
  
  CONCLUSIONS
  One 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.
authors.affiliation: Department of Pediatrics, Makerere University, College of Health Sciences, Kampala, 7072, Uganda. atugonzarita@gmail.com.
authors.forename: Rita
authors.initials: R
authors.lastname: Atugonza
authors.affiliation: Department of Pediatrics, Makerere University, College of Health Sciences, Kampala, 7072, Uganda.
authors.forename: Angelina
authors.initials: A
authors.lastname: Kakooza-Mwesige
authors.affiliation: Neurological and Behavioral Outcomes Center, University Hospital Case Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
authors.forename: Samden
authors.initials: S
authors.lastname: Lhatoo
authors.affiliation: Department of Medicine, Makerere University, College of Health Sciences, Kampala, 7072, Uganda.
authors.forename: Mark
authors.initials: M
authors.lastname: Kaddumukasa
authors.affiliation: Infectious Diseases Research Collaboration, Mulago Hospital Complex, Kampala, Uganda.|Centre for Statistics, Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Diepenbeek, Belgium.
authors.forename: Levicatus
authors.initials: L
authors.lastname: Mugenyi
authors.affiliation: Neurological and Behavioral Outcomes Center, University Hospital Case Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
authors.forename: Martha
authors.initials: M
authors.lastname: Sajatovic
authors.affiliation: Department of Medicine, Makerere University, College of Health Sciences, Kampala, 7072, Uganda.
authors.forename: Elly
authors.initials: E
authors.lastname: Katabira
authors.affiliation: Department of Pediatrics, Makerere University, College of Health Sciences, Kampala, 7072, Uganda.|Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Idro
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014454:Uganda
chemical_list: D000927:Anticonvulsants