Factors Associated With Poor Control Of Epilepsy At Kenyatta National Hospital Adult Neurology Clinic

Abstract

Background: Epilepsy is the most common neurological condition seen at KNH neurology clinic comprising of 16.6% of all neurologic diseases. Approximately 80% of epileptic patients achieve remission by the end of second year. It is a chronic illness with major psycho-socio-economic consequences. The mainstay of management remains chronic medication. Controlled epilepsy improves quality of life and motivates patients to seek medical care. Poorly controlled epilepsy has been associated with higher rates of mortality, unemployment, and cognitive impairment. Several factors affecting control of epilepsy include drug adherence, biological factors, psychosocial factors, cultural factors and socio/economic factors. Few studies have been done locally on epilepsy especially on factors contributing to poor control of epilepsy. Objectives: The main objective of the study was to examine the factors associated with poor control of adult epilepsy at KNH neurology clinic. The specific objectives were; 1. To determine the prevalence of poor control among epilepsy patients attending the neurology clinic at KNH. 2. To determine the type of seizure among patients with epilepsy. 3. To determine the drug taking behavior among those epilepsy patients attending the neurology clinic at KNH. 4. To document the EEG characteristics among these patients. 5. To determine the random serum level of specified AED in a random sample of some well controlled and poorly controlled epileptic patients. 6. To document the CT scan characteristics among these patients. 7. To compare the above features among controlled and poorly controlled patients. Design/Methods: The study design was a cross-sectional comparative study. Study site: The study was undertaken at Kenyatta National Hospital adult neurology clinic. Subjects: The study involved all patients with seizure disorders for more than 2 years in the KNH neurology clinic. Study period: The study was undertaken between October 2003 and February 2004. Results: Three hundred and sixty patients had seizures for more than 2 years and out of whom 180 were selected. The prevalence of poorly controlled epilepsy was found to be 40%. The mean age of the subjects was 28.73+/-11.96 years with a peak age group of21-30 years and age range of 13 to 70 years. Poorly controlled patients were younger compared to well-controlled patients (27.53 years versus 29.93 years, P=0.028), and had longer duration of epilepsy (11.12 years versus 8.63 years, P=0.015). Although not statistically significant the poorly controlled group had more focal spikes and waves EEG pattern (40 versus 30, P=0.772), had more patients using alternative therapy (25 versus 15, P=0.0729), had poor drug adherence which was statistically significant (48 versus 24, P<O.OOl), had missed drugs for longer duration in the last 3 months which was significant (12.81 versus 5.12 days, P=0.005). The number of AEDs, drug side effect profile, occupation, and education level were similar among the groups. Conclusion: Poor control of epilepsy is still a major problem with a prevalence of 40%. The poor drug adherence is a major factor, which was associated with poor control of epilepsy due to financial reasons.