Assessment and treatment of childhood epilepsy in Haiti
Gabriel Crevier-Sorbo1, Tristan Brunette-Clément2, Edgar Medawar1
1Faculty of Medicine McGill University Montreal QC Canada.
Insights
Pediatric epilepsy treatment in Haiti showed improved seizure control for many children. Key factors for poor outcomes included abnormal neurological exams and developmental delays, informing resource allocation in low-income countries.
Area of Science:
- Pediatric Neurology
- Global Health
- Epileptology
Background:
- Pediatric epilepsy disproportionately affects low- and middle-income countries (LMICs).
- Limited data exists on the effectiveness of epilepsy treatment programs in LMICs.
- The Clinique D'Épilepsie de Port-au-Prince (CLIDEP) is Haiti's sole pediatric epilepsy referral center.
Purpose of the Study:
- To evaluate the outcomes of children with epilepsy treated at CLIDEP in Haiti.
- To identify factors associated with seizure control and diagnosis in pediatric epilepsy patients in a LMIC setting.
Main Methods:
- A 10-year retrospective review of 812 children assessed and treated at CLIDEP.
- Primary outcome: seizure control; Secondary outcome: accurate epilepsy diagnosis.
- Principle component regression (PCR) analysis to identify outcome-associated variables.
Main Results:
- Most children (82%) had electroencephalography; few (7%) had cranial imaging.
- Despite high loss to follow-up (24%), 51% of returning children had less frequent seizures with 79% medication compliance.
- PCR identified phenotypes associated with poor seizure control (neurological abnormalities, comorbidities, developmental delay) and epilepsy diagnosis (febrile seizures, higher seizure frequency).
Conclusions:
- The study outlines the landscape of childhood epilepsy diagnosis, treatment, and outcomes in Haiti.
- Findings support the effectiveness of epilepsy management programs in LMICs.
- Results can guide resource allocation and improve referral structures for pediatric epilepsy in resource-limited settings.
Objective:
The global burden of pediatric epilepsy is disproportionately concentrated in low- and middle-income countries (LMICs). However, little is known about the effectiveness of current treatment programs in this setting. We present the outcomes of children who were assessed and treated at the Clinique D'Épilepsie de Port-au-Prince (CLIDEP), the only pediatric epilepsy referral center in Haiti.
Methods:
A 10-year retrospective review of children consecutively assessed and treated at CLIDEP was performed. The primary outcome was seizure control following treatment for epilepsy. The secondary outcome was an accurate determination of the diagnosis of epilepsy. A data-driven principle component regression (PCR) analysis was used to identify variables associated with outcomes of interest.
Results:
Of the 812 children referred for evaluation, most children (82%) underwent electroencephalography to investigate a possible epilepsy diagnosis. Very few children (7%) underwent cranial imaging. Although many patients were lost to follow-up (24%), most children who returned to clinic had less frequent seizures (51%) and compliance with medication was relatively high (79%). Using PCR, we identified a patient phenotype that was strongly associated with poor seizure control which had strong contributions from abnormal neurological examination, higher number of antiepileptic drugs, comorbid diagnoses, epileptic encephalopathy or epilepsy syndrome, and developmental delay. Head circumference also contributed to epilepsy outcomes in Haiti with smaller head sizes being associated with a poor seizure outcome. A dissociable phenotype of febrile seizures, suspected structural abnormality, epileptic encephalopathy or epilepsy syndrome, and higher seizure frequency was associated with a diagnosis of epilepsy.
Significance:
We describe the current landscape of childhood epilepsy in Haiti with an emphasis on diagnosis, treatment and outcomes. The findings provide evidence for the effectiveness of programs aimed at the diagnosis and management of epilepsy in LMICs and may inform the allocation of resources and create more effective referral structures.
Related Concept Videos
01:24Epilepsy and Seizures: Overview
Various factors can trigger epilepsy, including genetic factors, brain damage, metabolic causes, and unknown etiology. Diagnosis of epilepsy involves electroencephalography (EEG), which...
01:13Seizures: Classification
Seizures are typically classified into two main categories: focal and generalized seizures.
Focal Seizures
Focal seizures originate from specific regions of the brain. These seizures are further sub-classified into two types:
01:30Electroconvulsive Therapy