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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/21819

Title: Multiple anti-epileptic drug use in children with epilepsy in Mulago hospital, Uganda: a cross sectional study
Authors: Atugonza, Rita
Kakooza-Mwesige, Angelina
Lhatoo, Samden
Kaddumukasa, Mark
Mugenyi, Levicatus
Sajatovic, Martha
Katabira, Elly
Idro, Richard
Issue Date: 2016
Citation: BMC PEDIATRICS, 16
Abstract: 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 [ORa] 3.93, 95 % CI 1.66-9.31, p = 0.002) and presence of focal neurological deficits (ORa 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.
Notes: [Atugonza, Rita; Kakooza-Mwesige, Angelina; Idro, Richard] Makerere Univ, Dept Pediat, Coll Hlth Sci, Kampala 7072, Uganda. [Lhatoo, Samden; Sajatovic, Martha] Case Western Reserve Univ, Univ Hosp Case Med Ctr, Neurol & Behav Outcomes Ctr, 11100 Euclid Ave, Cleveland, OH 44106 USA. [Kaddumukasa, Mark; Katabira, Elly] Makerere Univ, Dept Med, Coll Hlth Sci, Kampala 7072, Uganda. [Mugenyi, Levicatus] Mulago Hosp Complex, Infect Dis Res Collaborat, Kampala, Uganda. [Mugenyi, Levicatus] Hasselt Univ, Interuniv Inst Biostat & Stat Bioinformat, Ctr Stat, Diepenbeek, Belgium. [Idro, Richard] Univ Oxford, Ctr Trop Med & Global Hlth, Nuffield Dept Med, Oxford, England.
URI: http://hdl.handle.net/1942/21819
DOI: 10.1186/s12887-016-0575-0
ISI #: 000371587200003
ISSN: 1471-2431
Category: A1
Type: Journal Contribution
Validation: ecoom, 2017
Appears in Collections: Research publications

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