Prevalence, risk factors, and neurobehavioral comorbidities of epilepsy in Kenyan children
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Published on: August 25, 2014
Charles J Kind1, Charles R J C Newton1,2,3, Symon M Kariuki2
1St. Johns College University of Oxford Oxford United Kingdom.
Insights
Epilepsy and acute symptomatic seizures are more prevalent in Kenyan children than in high-income countries. Addressing risk factors and neurobehavioral comorbidities is crucial for effective epilepsy management.
Area of Science:
- Neurology
- Pediatrics
- Epidemiology
Background:
- Epilepsy and acute symptomatic seizures pose a significant health burden in low-income regions.
- Understanding the prevalence and risk factors in specific populations is essential for targeted interventions.
Purpose of the Study:
- To determine the prevalence, risk factors, clinical features, and neurobehavioral comorbidities of epilepsy and acute symptomatic seizures in school-aged children in Kilifi, Kenya.
- To inform public health strategies for seizure disorder management in the region.
Main Methods:
- A cross-sectional study screened 11,223 school-aged children in Kilifi, Kenya.
- Children screening positive underwent clinical, electroencephalographic (EEG), and neuropsychological evaluations.
- Statistical analyses included prevalence calculations, log binomial regression, and logistic regression to identify risk factors and comorbidities.
Main Results:
- Prevalence of lifetime epilepsy was 20.9/1,000 and active epilepsy was 11.5/1,000. Acute symptomatic seizures prevalence was 68.8/1,000.
- Risk factors for epilepsy included perinatal complications, hospitalization, geophagia, and snoring. Risk factors for acute symptomatic seizures included family history, abnormal pregnancy, hospitalization, and snoring.
- Neurobehavioral comorbidities were high in children with epilepsy (54%), significantly associated with ADHD, ASD, and cognitive impairments.
Conclusions:
- The burden of seizure disorders in Kilifi is substantial and higher than in high-income countries.
- Preventing identified risk factors can reduce the burden of these conditions.
- Integrated management plans addressing neurobehavioral comorbidities are vital for comprehensive epilepsy care.
Objective:
To investigate the prevalence, risk factors, clinical features, and neurobehavioral comorbidities of epilepsy and acute symptomatic seizures in school-aged children in Kilifi, Kenya.
Methods:
Randomly selected children (N = 11,223) were screened for epilepsy and other neurodevelopmental disorders. Those who screened positive were invited for further clinical, electroencephalographic (EEG), and neuropsychological evaluations. Prevalence was measured by dividing cases by screened population, providing Agresti-Coull confidence intervals (CIs). Prevalence ratios were computed using log binomial regression, and odds ratios (ORs) were computed using logistic regression; both were implemented with generalized linear models. Attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and other neurodevelopmental impairments were assessed in cases and controls.
Results:
Prevalence of lifetime epilepsy was 20.9 per 1,000 (95% CI = 18.4-23.7), and that of active epilepsy was 11.5 per 1,000 (95% CI = 9.7-13.6). Prevalence of acute symptomatic seizures was 68.8 per 1,000 (95% CI = 64.2-73.6). Acute symptomatic seizures preceded a diagnosis of epilepsy in 8% of children. Of 98 children diagnosed with epilepsy, focal seizures were seen in 79%, abnormal EEG was seen in 39%, and 83% were not receiving antiepileptic drugs. Childhood absence epilepsy and Lennox-Gastaut epilepsy were the most easily identifiable epilepsy syndromes. Perinatal complications, previous hospitalization, geophagia, and snoring were risk factors for epilepsy. Family history of seizures, abnormal pregnancy, previous hospitalization, and snoring were risk factors for acute symptomatic seizures. Neurobehavioral comorbidities were present in 54% of subjects with lifetime epilepsy and in 3% of controls, with associations for individual comorbidities being statistically significant: ADHD (OR = 14.55, 95% CI = 7.54-28.06), ASD (OR = 36.83, 95% CI = 7.97-170.14), and cognitive impairments (OR = 14.55, 95% CI = 3.52-60.14).
Significance:
The burden of seizure disorders in this area is higher than in locations in high-income countries, and can be reduced by preventing risk factors. A comprehensive management plan for neurobehavioral comorbidities of epilepsy should be incorporated into standard epilepsy care.
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