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Multiple anti-epileptic drug use in children with epilepsy in Mulago hospital, Uganda: a cross sectional study
BACKGROUND: Seizures in up to one third of children with epilepsy may not be controlled by the first anti-epileptic drug (AED). In this study, we describe multiple AED usage in children attending a referral clinic in Uganda, the factors associated with multiple AED use and seizure control in affecte...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4785653/ https://www.ncbi.nlm.nih.gov/pubmed/26961364 http://dx.doi.org/10.1186/s12887-016-0575-0 |
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author | Atugonza, Rita Kakooza-Mwesige, Angelina Lhatoo, Samden Kaddumukasa, Mark Mugenyi, Levicatus Sajatovic, Martha Katabira, Elly Idro, Richard |
author_facet | Atugonza, Rita Kakooza-Mwesige, Angelina Lhatoo, Samden Kaddumukasa, Mark Mugenyi, Levicatus Sajatovic, Martha Katabira, Elly Idro, Richard |
author_sort | Atugonza, Rita |
collection | PubMed |
description | BACKGROUND: Seizures in up to one third of children with epilepsy may not be controlled by the first anti-epileptic drug (AED). In this study, we describe multiple AED usage in children attending a referral clinic in Uganda, the factors associated with multiple AED use and seizure control in affected patients. METHODS: One hundred thirty nine patients attending Mulago hospital paediatric neurology clinic with epilepsy and who had been on AEDs for ≥6 months were consecutively enrolled from July to December 2013 to reach the calculated sample size. With consent, the history and physical examination were repeated and the neurophysiologic and imaging features obtained from records. Venous blood was also drawn to determine AED drug levels. We determined the proportion of children on multiple AEDs and performed regression analyses to determine factors independently associated with multiple AED use. RESULTS: Forty five out of 139 (32.4 %) children; 46.7 % female, median age 6 (IQR = 3–9) years were on multiple AEDs. The most common combination was sodium valproate and carbamazepine. We found that 59.7 % of children had sub-therapeutic drug levels including 42.2 % of those on multi-therapy. Sub-optimal seizure control (adjusted odds ratio [OR(a)] 3.93, 95 % CI 1.66–9.31, p = 0.002) and presence of focal neurological deficits (OR(a) 3.86, 95 % CI 1.31–11.48, p = 0.014) were independently associated with multiple AED use but not age of seizure onset, duration of epilepsy symptoms, seizure type or history of status epilepticus. CONCLUSION: One third of children with epilepsy in Mulago receive multiple AEDs. Multiple AED use is most frequent in symptomatic focal epilepsies but doses are frequently sub-optimal. There is urgent need to improve clinical monitoring in our patients. |
format | Online Article Text |
id | pubmed-4785653 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-47856532016-03-11 Multiple anti-epileptic drug use in children with epilepsy in Mulago hospital, Uganda: a cross sectional study Atugonza, Rita Kakooza-Mwesige, Angelina Lhatoo, Samden Kaddumukasa, Mark Mugenyi, Levicatus Sajatovic, Martha Katabira, Elly Idro, Richard BMC Pediatr Research Article BACKGROUND: Seizures in up to one third of children with epilepsy may not be controlled by the first anti-epileptic drug (AED). In this study, we describe multiple AED usage in children attending a referral clinic in Uganda, the factors associated with multiple AED use and seizure control in affected patients. METHODS: One hundred thirty nine patients attending Mulago hospital paediatric neurology clinic with epilepsy and who had been on AEDs for ≥6 months were consecutively enrolled from July to December 2013 to reach the calculated sample size. With consent, the history and physical examination were repeated and the neurophysiologic and imaging features obtained from records. Venous blood was also drawn to determine AED drug levels. We determined the proportion of children on multiple AEDs and performed regression analyses to determine factors independently associated with multiple AED use. RESULTS: Forty five out of 139 (32.4 %) children; 46.7 % female, median age 6 (IQR = 3–9) years were on multiple AEDs. The most common combination was sodium valproate and carbamazepine. We found that 59.7 % of children had sub-therapeutic drug levels including 42.2 % of those on multi-therapy. Sub-optimal seizure control (adjusted odds ratio [OR(a)] 3.93, 95 % CI 1.66–9.31, p = 0.002) and presence of focal neurological deficits (OR(a) 3.86, 95 % CI 1.31–11.48, p = 0.014) were independently associated with multiple AED use but not age of seizure onset, duration of epilepsy symptoms, seizure type or history of status epilepticus. CONCLUSION: One third of children with epilepsy in Mulago receive multiple AEDs. Multiple AED use is most frequent in symptomatic focal epilepsies but doses are frequently sub-optimal. There is urgent need to improve clinical monitoring in our patients. BioMed Central 2016-03-09 /pmc/articles/PMC4785653/ /pubmed/26961364 http://dx.doi.org/10.1186/s12887-016-0575-0 Text en © Atugonza et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Atugonza, Rita Kakooza-Mwesige, Angelina Lhatoo, Samden Kaddumukasa, Mark Mugenyi, Levicatus Sajatovic, Martha Katabira, Elly Idro, Richard Multiple anti-epileptic drug use in children with epilepsy in Mulago hospital, Uganda: a cross sectional study |
title | Multiple anti-epileptic drug use in children with epilepsy in Mulago hospital, Uganda: a cross sectional study |
title_full | Multiple anti-epileptic drug use in children with epilepsy in Mulago hospital, Uganda: a cross sectional study |
title_fullStr | Multiple anti-epileptic drug use in children with epilepsy in Mulago hospital, Uganda: a cross sectional study |
title_full_unstemmed | Multiple anti-epileptic drug use in children with epilepsy in Mulago hospital, Uganda: a cross sectional study |
title_short | Multiple anti-epileptic drug use in children with epilepsy in Mulago hospital, Uganda: a cross sectional study |
title_sort | multiple anti-epileptic drug use in children with epilepsy in mulago hospital, uganda: a cross sectional study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4785653/ https://www.ncbi.nlm.nih.gov/pubmed/26961364 http://dx.doi.org/10.1186/s12887-016-0575-0 |
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