Cognitive dysfunction in children living with epilepsy at a public tertiary hospital in Kenya

Abstract

Objective: To determine the prevalence, pattern of cognitive dysfunction and factors associated with cognitive dysfunction in children aged 7-13 years on treatment for epilepsy at the Paediatric neurology clinic in a public tertiary referral facility in Kenya.

Study design, setting and duration: A descriptive cross-sectional study carried out a public tertiary referral facility (Kenyatta National Hospital, KNH) in Kenya at the Paediatric Neurology clinic. Consecutive sampling was carried out between October-November 2019.

Subjects: Children aged 7-13years with a clinical diagnosis of Epilepsy with an electroencephalogram (EEG) and corroborative history available. Informed consent from the parent/guardian.

Outcomes: Factors affecting the presence of cognitive dysfunction in children living with different types of epilepsy and who are managed with different classes of anti-epileptic drugs

Results: The median age of study group was 10 years (IQR 8-11). The most common type of epilepsy was generalised motor seizures (63.3%). The mean age of onset of epilepsy was 1.33 years (SD±0.47). The prevalence of cognitive dysfunction was 40.6% Factors that were significantly associated with cognitive dysfunction included: early age of onset OR=3.17(95%CI 1.5, 6.27), partial epilepsy, OR=4.7(95%CI 1.18, 18.5) absent seizures, OR=5(95%CI 1.94 12.98) use of sodium valproate and carbamazepine OR=4.21(95% CI 1.10 3.74) and high frequency of seizures OR=3.79(95%CI 1.94, 7.40).

Conclusion: There is high prevalence of cognitive dysfunction in children with epilepsy seen at Kenyatta National Hospital. Early age of onset of epilepsy, partial or absent seizures, high frequency of convulsion and use of carbamazepine or sodium valproate are significantly associated with cognitive dysfunction.