Factors affecting epilepsy treatment outcomes in Nigeria

Epilepsy is a complex chronic illness with variable treatment outcomes determined by factors specific to each affected person. We investigated prognostic factors for epileptic seizure outcome after 2 years of anti-epileptic drug (AED) monotherapy.

Two hundred and thirty-four AED naïve epilepsy patients were started on AED monotherapy and monitored for 2 years for seizure control. Patients on AED polytherapy were excluded. Prognostic factors investigated were socio-demographics characteristics, age of onset of epilepsy, etiology and precipitants of seizures, presenting seizure types, duration of epilepsy before initiation of AED, family support for treatment, compliance to AED, and clinic attendance.

Patients were 160 (68.4%) males and 74 (31.6%) females, with mean ages of 26.2 ± 10.4 and 30.7 ± 16.0 years, respectively. Mean age of onset of epilepsy was 19.0 ± 15.0 years. None of the patients was treated with AED for first seizures, although 75% received traditional and spiritual therapy. Majority were single and of low socioeconomic background, and treatment was funded mainly by parents/guardians. About 88% presented with partial seizures, and carbamazepine was the commonest AED used followed by phenytoin sodium. At the end of 2 years of AED, 147 (63%) achieved complete seizure control, and significant prognostic factors were female sex, age older than 20 years at presentation, secondary and tertiary education attainment, being employed, family support, regular clinic attendance, AED compliance, and generalized epilepsy.

Patients with epilepsy are more likely to achieve complete seizure control when they are older, educated, and employed or supported by family members to buy their AEDs and attend clinics regularly.