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Profile of childhood epilepsy in Bangladesh
Selina H Banu1, Naila Z Khan, Mahmuda Hossain
1Child Development and Neurology Unit, Dhaka Shishu (Children's) Hospital, Sher-e-Bangla Nagar, Dhaka, Bangladesh. parvez@bangla.net
Insights
Childhood epilepsy in Bangladesh presents significant challenges, with many children experiencing poor seizure control and neurodevelopmental issues. Early referral and specialized services closer to home are crucial for better outcomes.
Area of Science:
- Pediatrics
- Neurology
- Global Health
Background:
- Childhood epilepsies in Bangladesh are understudied, lacking baseline diagnostic and outcome data.
- A significant proportion of affected families belong to middle and lower-income groups.
- Perinatal asphyxia and neonatal seizures are common comorbidities.
Purpose of the Study:
- To provide baseline information on the diagnosis and clinical outcomes of childhood epilepsy in Bangladesh.
- To identify factors associated with poor seizure remission in children with epilepsy.
- To highlight the need for improved access to specialized epilepsy services.
Main Methods:
- A prospective study of 151 children (2 months to 15 years) with recurrent unprovoked seizures.
- Follow-up in an epilepsy clinic for at least 1 year.
- Assessment of epilepsy types, comorbidities, cognitive development, adaptive behavior, and seizure remission.
Main Results:
- Generalized epilepsy was most common (63.6%), with 14.6% diagnosed with severe epilepsy syndromes.
- Symptomatic epilepsy was prevalent (61%), associated with poor cognitive development (72.8%) and adaptive behavior (57%).
- Half of the children (50.3%) experienced poor seizure remission, predicted by seizure type, cognition, seizure frequency, motor disability, and EEG findings.
Conclusions:
- Children with epilepsy in Bangladesh often present late to tertiary hospitals with co-occurring neurodevelopmental morbidities.
- Effective management requires early referral and comprehensive care, with services decentralized closer to patients' homes.
- Further research is needed to establish efficient early referral and management pathways for childhood epilepsy in Bangladesh.
Abstract:
Very little is known about childhood epilepsies in Bangladesh. This study was conducted within a national children's hospital in Dhaka city to provide baseline information on diagnosis and clinical outcomes of 151 children (98 males, 53 females, age range between 2 months to 15 years, median age of 3 years). Participants who presented with recurrent unprovoked seizures were followed up in an epilepsy clinic for at least 1 year. Of presenting families, 68.3% were from middle-income and lower-income groups. A history of perinatal asphyxia and neonatal seizures was present in 46.4% and 41.1% of participants respectively. Generalized, partial, and unclassifiable epilepsy were found in 63.6%, 25.2%, and 11.2% respectively. Severe outcome (malignant) epilepsy syndromes were diagnosed in 14.6%. Symptomatic epilepsy was found in 61%. Poor cognitive development was present in 72.8% and poor adaptive behaviour in 57%. Poor seizure remission occurred in 50.3%. Factors most predictive of poor seizure remission were: multiple types of seizures, poor cognition at presentation, high rates of seizures, associated motor disability, and EEG abnormalities. The study suggests that most children presenting at tertiary hospitals for seizure disorders come late and with associated neurodevelopmental morbidities. Specialized services are needed closer to their homes. The process for establishing early referral and comprehensive management of childhood epilepsies in Bangladesh requires further study.