Prevalence, pattern and factors associated with cognitive dysfunction in children with epilepsy attending the pediatric neurology clinic at Kenyatta national hospital.

Abstract

Background Epilepsy is the fourth most common neurological disorder in the world. A vast majority of the children afflicted reside in sub-Saharan Africa. Children living with epilepsy have a higher risk of a broad range of cognitive disturbances and are predisposed to significant intellectual disability. Early diagnosis enables referral to rehabilitation programs and appropriate school placement. Optimal cognitive function in children is crucial for normal growth and development. Primary objective To determine the prevalence and pattern of cognitive dysfunction in children aged 7-13 years on treatment for epilepsy at the paediatric neurology clinic in Kenyatta National Hospital (KNH). Methods This was a cross-sectional study. It was conducted at KNH, paediatric neurology clinic. The participants were children aged 7-13 years with a diagnosis of epilepsy. Cognitive function was assessed using a standardized tool called the modified mini mental state examination tool. A questionnaire with seizure variables was administered to the caregiver. Data analysis A total of 177 children were recruited. The median age was 10 (IQ 8, 11).Majority (62.7%) was male. The most common type of epilepsy was generalised motor seizures (63.3%).Sodium valproate and phenobarbital were the most commonly prescribed anticonvulsant with majority of the children being on combination treatment. The mean age of onset of epilepsy was 1.33years (±0.47). The prevalence of cognitive dysfunction was 40.6%. Factors that were significantly associated with cognitive dysfunction included: Early age of onset (p=0.02), partial epilepsy (p=0.028), absent seizures (p=0.001), use of sodium valproate (p=0.03) and carbamazepine (p=<0.001) and high frequency of seizures (p=<0.001). Conclusion There is a high prevalence of cognitive dysfunction among children living with epilepsy at KNH. Factors associated with cognitive dysfunction include: Early age of onset of epilepsy, partial or absent seizures, high frequency of convulsion and use of carbamazepine or sodium valproate.