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Abstract：
BACKGROUND: Epilepsy contributes to high morbidity among children and adolescents in developing countries. A quarter of all children with epilepsy will be resistant to anti-seizure medications (ASMs), with associated neurocognitive impairments and risk of higher mortality. This study aimed to estimate and characterize drug-resistant epilepsy (DRE) (defined as failure to achieve sustained remission after adequate trials of two tolerated and appropriately chosen ASMs) and its associated factors among children and adolescents with epilepsies attending the pediatric neurology clinic at Muhimbili National Hospital (MNH), Dar es Salaam Tanzania.
METHODS: This cross-sectional study was conducted from June 2020 to June 2021. Children with epilepsies and who had been treated with ASMs for at least 3 months were eligible for inclusion. Exclusion criteria included children whose caregivers denied consent and those who exhibited acute medical conditions necessitating admission on the scheduled visit day. Data on demographic characteristics, perinatal history, detailed history of the seizures semiology, drug history, magnetic resonance imaging (MRI), and electroencephalography (EEG) results were obtained from caregivers and medical records available during recruitment. Seizures and epilepsies were classified using the 2017 International League Against Epilepsy (ILAE) classification. Logistic regression was used to determine factors associated with DRE.
RESULTS: A total of 236 children and adolescents aged between 4 months and 15 years (Median age 72 months (IQR = 42-78)) were enrolled in this study. We found the proportion of DRE to be 14.8% in this cohort. Of the thirty-five patients with DRE, 60% had generalized epilepsy and almost 25% had a diagnosis of an epilepsy syndrome, the most common being Lennox-Gastaut syndrome (LGS). Structural abnormalities on brain MRI were seen in almost 80% of all patients with DRE, the most prevalent being cystic encephalomalacia, which was observed in 34% of patients. Patients using both ASMs and alternative therapies accounted for 9% of this cohort. The onset of seizures during the first month of life (aOR = 1.99; 95%CI 1.7-4.6; p = 0.031) and high initial seizure frequency (aOR = 3.6; 95%CI 1.6-8;p = 0.002) were found to be independently associated with DRE.
CONCLUSIONS: The proportion of DRE in Tanzania is high. Patients with neonatal onset seizures and high initial seizure frequency should be followed up closely to ensure early diagnosis of DRE.
METHODS: This cross-sectional study was conducted from June 2020 to June 2021. Children with epilepsies and who had been treated with ASMs for at least 3 months were eligible for inclusion. Exclusion criteria included children whose caregivers denied consent and those who exhibited acute medical conditions necessitating admission on the scheduled visit day. Data on demographic characteristics, perinatal history, detailed history of the seizures semiology, drug history, magnetic resonance imaging (MRI), and electroencephalography (EEG) results were obtained from caregivers and medical records available during recruitment. Seizures and epilepsies were classified using the 2017 International League Against Epilepsy (ILAE) classification. Logistic regression was used to determine factors associated with DRE.
RESULTS: A total of 236 children and adolescents aged between 4 months and 15 years (Median age 72 months (IQR = 42-78)) were enrolled in this study. We found the proportion of DRE to be 14.8% in this cohort. Of the thirty-five patients with DRE, 60% had generalized epilepsy and almost 25% had a diagnosis of an epilepsy syndrome, the most common being Lennox-Gastaut syndrome (LGS). Structural abnormalities on brain MRI were seen in almost 80% of all patients with DRE, the most prevalent being cystic encephalomalacia, which was observed in 34% of patients. Patients using both ASMs and alternative therapies accounted for 9% of this cohort. The onset of seizures during the first month of life (aOR = 1.99; 95%CI 1.7-4.6; p = 0.031) and high initial seizure frequency (aOR = 3.6; 95%CI 1.6-8;p = 0.002) were found to be independently associated with DRE.
CONCLUSIONS: The proportion of DRE in Tanzania is high. Patients with neonatal onset seizures and high initial seizure frequency should be followed up closely to ensure early diagnosis of DRE.
摘要：
背景：癫痫导致发展中国家儿童和青少年的高发病率。四分之一的癫痫儿童会对抗癫痫药物（ASM）产生抗药性，与相关的神经认知障碍和更高的死亡率的风险。这项研究旨在评估和表征在Muhimbili国家医院（MNH）儿科神经科门诊就诊的儿童和青少年癫痫患者中的耐药性癫痫（DRE）（定义为在两种耐受且适当选择的ASM进行充分试验后未能实现持续缓解）及其相关因素。坦桑尼亚达累斯萨拉姆。
方法：这项横断面研究于2020年6月至2021年6月进行。患有癫痫并接受ASM治疗至少3个月的儿童有资格入选。排除标准包括照顾者拒绝同意的儿童和表现出急性疾病的儿童，需要在预定的探视日入院。关于人口特征的数据，围产期病史,详细的癫痫发作历史符号学，药物史,磁共振成像（MRI），和脑电图（EEG）结果来自招募期间的护理人员和医疗记录。使用2017年国际抗癫痫联盟（ILAE）分类法对癫痫发作和癫痫进行分类。使用Logistic回归确定与DRE相关的因素。
结果：本研究共纳入236名年龄在4个月至15岁（中位年龄72个月（IQR=42-78））的儿童和青少年。我们发现DRE在该队列中的比例为14.8%。在35名DRE患者中，60%的人患有全身性癫痫，近25%的人被诊断为癫痫综合征，最常见的是Lennox-Gastaut综合征（LGS）。在所有DRE患者中，几乎80％的患者都出现了脑MRI结构异常，最普遍的是囊性脑软化症,这在34%的患者中观察到。同时使用ASM和替代疗法的患者占该组的9%。发现在生命的第一个月内癫痫发作（aOR=1.99；95CI1.7-4.6；p=0.031）和高初始发作频率（aOR=3.6；95CI1.6-8；p=0.002）与DRE独立相关。
结论：坦桑尼亚的DRE比例很高。对新生儿发作性癫痫发作和首次发作频率高的患者应密切随访，以确保早期诊断DRE。
方法：这项横断面研究于2020年6月至2021年6月进行。患有癫痫并接受ASM治疗至少3个月的儿童有资格入选。排除标准包括照顾者拒绝同意的儿童和表现出急性疾病的儿童，需要在预定的探视日入院。关于人口特征的数据，围产期病史,详细的癫痫发作历史符号学，药物史,磁共振成像（MRI），和脑电图（EEG）结果来自招募期间的护理人员和医疗记录。使用2017年国际抗癫痫联盟（ILAE）分类法对癫痫发作和癫痫进行分类。使用Logistic回归确定与DRE相关的因素。
结果：本研究共纳入236名年龄在4个月至15岁（中位年龄72个月（IQR=42-78））的儿童和青少年。我们发现DRE在该队列中的比例为14.8%。在35名DRE患者中，60%的人患有全身性癫痫，近25%的人被诊断为癫痫综合征，最常见的是Lennox-Gastaut综合征（LGS）。在所有DRE患者中，几乎80％的患者都出现了脑MRI结构异常，最普遍的是囊性脑软化症,这在34%的患者中观察到。同时使用ASM和替代疗法的患者占该组的9%。发现在生命的第一个月内癫痫发作（aOR=1.99；95CI1.7-4.6；p=0.031）和高初始发作频率（aOR=3.6；95CI1.6-8；p=0.002）与DRE独立相关。
结论：坦桑尼亚的DRE比例很高。对新生儿发作性癫痫发作和首次发作频率高的患者应密切随访，以确保早期诊断DRE。
