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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 4  |  Issue : 2  |  Page : 1-6

Pattern and characteristics of childhood seizure disorders in a Secondary Care Hospital at Abha City, Aseer Region, K.S.A


Department of Pediatrics and Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia and Abha Maternity and Children Hospital, Abha, Saudi Arabia

Date of Web Publication13-Aug-2020

Correspondence Address:
FRCPI, FRCPCH Mohamed E El Awad
Dept. of Child Health, College of Medicine, King Khalid University, Abha
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-743X.292034

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  Abstract 


Objectives: Epilepsy is one of commonest central nervous system disorders especially in children. It causes significant impact on wellbeing of affected individuals. This study aimed to assess characteristics of affected children and the pattern of their seizure disorders. Methods: The study was a retrospective one on epileptic patients attending the neurology outpatient clinics at Abha Maternity and children Hospital, Abha, Saudi Arabia for the period from Oct2015-March2016. Results: A total of 220 cases were studied (119 males & 101 females.) The following parameters were studied and analyzed: Age groups, Seizures types, Comorbidities of affected individuals and types of medications used. The commonest affected age group was (6years – 12 years) {50%} with Onset of seizures was commonly in the first year of life (>80% of cases). Commonest types of seizures were generalized tonic/clonic (over 60 % of cases) Many Comorbidities were detected in affected children. Global developmental delay and mental retardation. Conclusion: Epilepsy commonly starts in younger age groups with deleterious effects on affected children. Characteristics of affected children as well as pattern of their epilepsies were studied. Some comorbidities which are commonly overlooked by treating physicians were detected. There is real need to establish registries for childhood epilepsies.

Keywords: Childhood epilepsies; Age groups; types; Medications; Comorbidities


How to cite this article:
H. Alghamdi AA, S. Alqahtani AQ, Alqahtani SY, Al-Arim MA, Almusa HA, Al-Arim MA, El Awad ME. Pattern and characteristics of childhood seizure disorders in a Secondary Care Hospital at Abha City, Aseer Region, K.S.A. King Khalid Univ J Health Sci 2019;4:1-6

How to cite this URL:
H. Alghamdi AA, S. Alqahtani AQ, Alqahtani SY, Al-Arim MA, Almusa HA, Al-Arim MA, El Awad ME. Pattern and characteristics of childhood seizure disorders in a Secondary Care Hospital at Abha City, Aseer Region, K.S.A. King Khalid Univ J Health Sci [serial online] 2019 [cited 2021 Apr 10];4:1-6. Available from: https://www.kkujhs.org/text.asp?2019/4/2/1/292034




  Introduction Top


Epilepsy affects more than 50 million people worldwide. More than 85% of them in the developing world. Internationally epilepsy prevalence in adults and children is 4-8/1000 population. Epilepsy disorders start in childhood in over 60% of cases.[1],[2],[3],[4],[5] They are prevalent in all societies. They affect all classes. Epileptic disorders are among the most important CNS disorders that have significant impact on affected children.

Epilepsy constitutes the main bulk of pediatric cases attending neurology clinics.[6]

It is therefore important to study characteristics of affected children and to find out the pattern of these seizure disorders. Some seizure disorders don’t cause long term disabilities e.g. febrile convulsions, but some types are likely to cause significant impairment of cognitive and motor abilities of affected individual’s e.g. progressive myoclonic epilepsies.[7],[8]

Treatment of epileptic disorders is not always benign. It might not be accepted on sociocultural reasons although 70% of cases are likely to be controlled by drugs. Drug treatment can lead to many side effects: idiosyncratic or dose related.

There are many obstacles in carrying out coordinated well-structured studies to know the prevalence and impact of epilepsy in different societies. The introduction of the World Health Organization (WHO) research protocol for neurological disorders in developing countries has been a major breakthrough in the standardization of epidemiological research on epilepsy.[4]

In absence of proper national registry of epileptic patients, hospital based studies remain the only available source of information.Population based or community studies are subject to much bias as families might not give precise information regarding seizure classification …etc.

This study is an effort to find the pattern of childhood seizures (types, age distribution, co morbidities and types of medications used.)


  Methods Top


This study is retrospective one. Data were collected from patients, files attending the pediatric neurology clinics at Abha Maternity and Children Hospital for the period from October 2015 - March 2016. Different variables were studied (age groups, types of seizures, associated clinical problems (comorbities), types of drugs used etc.) The data was directly from extracted from patient case notes available in the hospital. The study covered only patients seen in pediatric neurology clinics .Patients data contained all the essential variables covered by the study. Cognitive disorders were assessed by clinical psychologists using standardized used in the hospital.

Abha maternity and children hospital is the main referring center for children with neurological disorders for the southern region of the KSA. The study was carried out from Oct 2015 to March 2016.

The study was approved by the hospital and regional Ethical and Research societies. The total No. of cases studied was 220. 119 males and 101 females (male: female ratio 1: 0.8)


  Results Top


Age groups

Distribution of cases

As shown on [Table 1] the most common age of patients is >6y – 12y with 110 cases (50%), followed by the group >3y – 6y 41 cases (18.6%). The group >1y – 3y constituted 30 cases (13.6%), ad 0 - 1y there were 26 cases (11.8%). The least group was >12y: 13 cases (5.9%).
Table 1: Age Distribution and Onset Age

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Onset of seizures

Most of cases started their first seizure in the first year of life 83 cases (37.7%), 3y -6y: 46 cases (20.9%), >1y - 3y there were 45 cases (20.5%), 14 cases (18.6%) in group >6y – 12y. 5 cases (2.3%) the age of onset was not known with certainty. Children older than 12years with first seizure are seen in adult clinics.

Classification Types of seizures

In [Figure 1], Generalized tonic/clonic accounted for 63 cases (28.6%), generalized tonic 17 cases (7.7%) and atonic 9 cases (4.1%), Infantile spasms were seen in 10 cases (4.5%). Myoclonic {benign} were encountered in 9 cases (4.1%) while progressive type accounted for 9 cases (4.1%). Absence seizures were encountered in 9 cases (4.1%). Simple partial seizures were seen in 6 cases (2.7%) and complex partial 8 cases (3.6%).
Figure 1: Percentages of Childhood Seizure Types Prevalent in Abha, K.S.A.

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Febrile convulsions were seen in 22cases (10%). 33 cases had more than one type of seizures (15%)

Associated Defects

In [Table 2], development delay (motor, cognitive or combined) was encountered in in a total of 45 cases (20.5%) while multiple defects {structural congenital or developmental} were seen in 41 cases (21.4%). Isolated mental retardation accounted for (9.5%) seen in 21 cases. Cerebral palsy was seen in 31 cases (14.1%), hydrocephalus in 9 cases (4.1%) and post traumatic epilepsy was seen in 7 cases (3.2%). Learning difficulties was detected in 15 cases (6.8%) and hyperactivity in 4 cases (1.8%). Visual defects noted were: 6 cases (2.7%) had squint and 3 cases (1.4%) had blindness. Deafness was noted in 3cases (1.4%).
Table 2: Associated Problems

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Other characteristics

Polytherapy (more than one antiepileptic drug): 62 cases (28.2%). Partial control: 79 cases (35.9%). Status epilepticus history: 20 cases (9.1%). Patients referred to specialized higher neurology centers 41 cases (18.6%) These are usually complicated cases that need care at specialized epilepsy centers.

Drugs

[Table 3] shows the frequencies of drugs usages as follows: Sodium valproate is the most commonly used in 84 cases (38.2%), followed by Levetiracetam 58 cases (26.4%), Carbamazepine 44 cases (20%) , Phenobarbitone 32 cases (14, 5%) , Topamirate 31 cases (14.1%) , Clonazepam 8 cases (3.6%) and Ethosuximide 4 cases (1.8%) . 13 cases (5.9%) received no medication at the time of the study.
Table 3: Drugs Usage Frequency

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  Discussion Top


Recognizing the importance of epilepsy on populations of the Middle East the World Health Organization (WHO), International League against Epilepsy (ILAE) and International Bureau for Epilepsy (IBE) held a meeting “Epilepsy as A Public Health Concern in the Eastern Mediterranean Region” Cairo, Egypt, on 3rd and 4th March 2003. Professionals from Health and Social Sciences sectors and representatives from universities coming from the member states of the Eastern Mediterranean Region unanimously agreed to the following Declaration: a. Epilepsy is the most common serious chronic brain disorder.[9] The impact of epilepsy is most severe in children and adolescents.

The overall prevalence of epilepsy in Saudi Arabia is 6/1000.[10],[11],[12],[13],[14] Worldwide Epilepsy is one of the most common pediatric neurological disorders with higher incidence during the school years. The average prevalence rate in 32 studies from different parts of the world has been estimated at 5.16/1000.[14] Epilepsy is twice as common in children as in adults.[15],[16],[17],[18],[19] We have noticed predominance of male cases (54%).

Onset age incidence is commoner in early age and adolescence. This seems to the trend worldwide.[20],[21],[22],[23] Our study has shown this trend too. These years represent a critical period of the child’s social, psychological, and physical development.

The school period will significantly impact the child’s quality of life and future adult roles.[3],[4]

Generalized epilepsies are the most prevalent in our study. This follows the international trend . Idiopathic generalized epilepsies (IGEs) constitute one-third of all epilepsies.[24],[25],[26],[28],[29]

Monothderapy is still the mainstay of therapy in epilepsies management as it has got better efficacy and tolerability than polytherapy.[30],[31] 62% of patients in our study are receiving monotherapy. Children with difficult forms of seizures are likely to need more than one drug with the expectant results of side effects. Sodium valproate is the most commonly used as it controls most types of seizures. Next to it Levetiracetam in 26 % of cases. It is interesting to see newer drugs like levetiracetam and topamirate being used more frequently. It is to be considered that anti-epileptic drugs in general have the potential for affecting the cognitive and behavioral domains with varying frequencies.[32],[33] Of these Phenobarbitone is traditionally known to cause significant cognitive dysfunction in older children. Its use in very young is still the common practice worldwide.[34],[35] Newer antiepileptics are not commonly used in the neonatal period because of safety issues. In our series phenobarbitone is used in 14.5% of cases.

Complicated cases who do not respond to conventional therapy available locally are referred to higher centers for advanced management in highly equipped specialized centers. 41 (18.6%) of our cases were referred to these centers. These cases were usually refractory to conventional medications available locally or children who may be referred for surgical options. 9% of our patients experienced status epilepticus. These patients are at increased risk to develop long term sequaelae both cognitive and motor.[7],[36]

In addition to recurrent epileptic seizures, children with epilepsy can have coexisting medical problems with cognitive and behavioral difficulties that will add to their suffering. They are at increased risk of educational under achievement, learning difficulties, mental health problems, social isolation and poor self-esteem.[33] In our study mental retardation, delayed development and learning difficulties are the most important observed cognitive defects. It is interesting to note that 21.4% of children have multiple defects that definitely affect their wellbeing. For the motor aspects it is interesting to note that 14.1% of children have cerebral palsy. Studies on epilepsies commonly ignore the impact on behavioral and learning difficulties of affected children. Delayed development (motor and cognitive) beside isolated mental retardation is encountered with significant frequencies. Some patients in school years experienced Learning disabilities .This is likely to be due to their primary conditions and the effects of antiepileptic drugs they are receiving. This latter effect is underestimated in clinical departments that look after epileptic children receiving anticonvulsant medications.

Epidemiological studies provide information on the prevalence, incidence, causal factors and natural history of epilepsy.[3] Several studies have been performed in industrialized as well as developing countries, however epidemiological studies in developing countries have particular methodological difficulties including case ascertainment, definition and classification.[4] Despite these difficulties future studies into childhood epilepsy should have priority in funding. National registry is greatly needed to achieve optimum care of affected children.

Our study was limited by the fact that it was hospital based. Community based studies would be a better choice but they lack the correct information as societies here are not accurate in giving precise information regarding their illness with neurological disorders. This is even worse with epilepsy as it carries an unfavorable stigma.

National registries compiled by local health and social departments would be the best source for vital information in this regard. Till these goals are achieved hospital records would remain an important source of information regarding childhood epilepsies.


  Conclusion Top


Epilepsy starts in younger age groups with significant impact on affected children. It is important to study characteristics of affected children as well the pattern of their epilepsies. This should be coupled with studies into cognitive disabilities of affected children. Generalized seizures are the most frequently encountered types. Delayed development, learning difficulties and other psychological problems which are commonly overlooked by treating Physicians were detected. Beside specific antiepileptic medications these patients need psychological and educational therapy. There is real need to establish registries for childhood epilepsies in the region and ultimately nationwide.

Conflict of interest

The authors declare no conflicts of interest.

Funding

No funding was received for this study.



 
  References Top

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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3]



 

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