The clinical classification of seizures among children with epilepsy seen at the Moi Teaching and Referral Hospital in Eldoret, Kenya

Abstract

Epilepsy continues to take its toll among children causing impaired physical, psychological and social functioning of those affected. The annual rate of new cases of epilepsy is approximately 5-7 cases per 10,000 children from birth to age 15 years, and in any given year, about 5 of every 1,000 will have epilepsy. Classification of epileptic seizures relies on clinical phenomenology as well as electroencephalography (EEG), and accurate classification is important since it impacts on choice of medication as well as prognostication. This paper sought to describe the Clinical Classification of epilepsy in children seen at Moi Teaching and Referral Hospital, Eldoret. A cross sectional study was carried out between January 2011 and July 2011 in the general peadiatric wards and the paediatric outpatient clinic at the MTRH. The study subjects were all children aged one month to 14 years. Consecutive sampling of children who had clinical features consistent with epilepsy was done for in the recruitment of study subjects. Data was collected in a structured questionnaire and EEGs were recorded in the hospital’s EEG laboratory. Descriptive data was grouped in frequencies and mean and range was used to summate data. Association between factors was analysed by linear regression and Chi-square was used to analyse differences in epilepsy classification based on clinical features or EEG independently. From the study, fifty-six children with epilepsy were enrolled into the study, 35(62.5 %) of whom were male and 21(37.5%) were female (M:F 1:0.6). The youngest age at onset of seizures recorded in the study was one month and the mean age was 4.2 years. Twenty-six patients (46.4%) had generalized tonic clonic seizures, nine (16.1%) had partial seizures, eight (14.3%) had mixed seizures, six children (10.7%) had absence seizures, six (10.7%) had tonic seizures and one (1.8%) had myoclonic seizures. The commonest seizure types in children seen at MTRH are generalized tonic-clonic and partial seizures. The generalized spike-and-wave patterns and focal spike-and- wave patterns were the commonest EEG patterns. However, EEG findings increased the proportion of children with partial (focal onset) seizures. Therefore, physicians should use both clinical phenomenology and EEG patterns in classifying patients with epilepsy so as to improve on treatment and follow-up.