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The impact of a newly established specialized pediatric epilepsy center in Tanzania: An observational study
Miriam Aricò1, Mario Mastrangelo2, Sofia Pia Di Noia3
1Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy; UOC Neuropsichiatria Infantile, Azienda Unità Sanitaria Locale Bologna, Italy.
Insights
A new pediatric epilepsy clinic in Tanzania improved diagnosis and treatment, with 76% of patients achieving seizure freedom. Enhancing access to antiseizure medications like sodium valproate is crucial for better outcomes in resource-limited settings.
Area of Science:
- Neurology
- Global Health
- Pediatrics
Background:
- Pediatric epilepsy diagnosis and management present unique challenges in resource-limited settings.
- Establishing specialized clinics can improve diagnostic accuracy and patient care.
Purpose of the Study:
- To evaluate the impact of a newly established pediatric epilepsy clinic in Ifakara, Tanzania.
- To assess the spectrum of epilepsy and treatment outcomes in a resource-limited environment.
Main Methods:
- Recruitment of patients aged 0-18 years referred to the Pediatric Epilepsy Unit.
- Collection of demographic and clinical data using Kobo Toolbox.
- Descriptive analysis of collected data, including EEG findings and diagnoses.
Main Results:
- 143 pediatric patients evaluated; epilepsy confirmed in 87.
- Focal epilepsy (57) and generalized epilepsy (24) were common diagnoses.
- Electroencephalogram (EEG) abnormalities detected in 80.85% of recorded EEGs.
- Hypoxic-ischemic encephalopathy was the most frequent etiology (39%).
- Phenobarbital was the most used antiseizure medication (ASM); therapeutic changes proposed for 95 patients.
- 76% of patients achieved complete seizure freedom at follow-up.
Conclusions:
- The study highlights the epilepsy spectrum in pediatric patients in a resource-limited setting.
- Improving access to essential ASMs, including sodium valproate and newer generation medications, is vital for enhancing prognostic implications.
- Specialized clinics improve epilepsy care and outcomes in underserved regions.
Purpose:
This study evaluated the impact of a newly established clinic for the diagnosis of pediatric epilepsy in a resource-limited center (Ifakara, Tanzania).
Methods:
Patients aged 0-18 years referred to the Pediatric Epilepsy Unit of Saint Francis Referral Hospital were recruited. Demographic and clinical data were collected through Kobo Toolbox and analyzed through a descriptive analysis..
Results:
143 patients were evaluated, and for 48 of them an EEG was recorded (abnormalities were detected in 80.85% of the cases). The diagnosis of epilepsy was confirmed in 87 patients. Focal epilepsy was diagnosed in 57 patients, generalized epilepsy in 24 patients, and forms of unknown onset in 6 patients. Epilepsy was excluded for 9 children. Etiologies included hypoxic-ischemic encephalopathy (39%), central nervous system infections (3.4%), and genetic diseases (3.4%). A specific epilepsy syndrome was diagnosed in 16 patients. 74 patients were under treatment; the most used antiseizure medication (ASM) was phenobarbital (43.36%), followed by carbamazepine (16.08%), sodium valproate (11.19%), phenytoin (2.8%), and lamotrigine (0.7%). Therapeutic changes were proposed to 95 patients, more frequently consisting of withdrawing phenobarbital (39.16%), switching to sodium valproate (27.97%), switching to or adjusting carbamazepine dosage (27.27%), and starting prednisone (2.8%). 76% of the patients with confirmed epilepsy achieved complete seizure freedom at the fourth follow-up consultation.
Conclusions:
Our data depicted the epilepsy spectrum and highlighted the prognostic implications of improving the availability of ASMs such as sodium valproate and second- and third-generation ones in resource-limited countries.
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