Emotional and behavioral problems in children with epilepsy attending the pediatric neurology clinic at a referral hospital in Kenya

Abstract

Introduction: Epilepsy is a common neurological condition, with a lifetime prevalence of 1% in children. Research has shown a high prevalence of emotional and behavioral problems in children with epilepsy. The aim of this study was to determine the prevalence of emotional and behavioral problems in children with epilepsy attending the pediatric neurology clinic in a referral hospital in Kenya and examine associated sociodemographic and clinical variables.

Methods: This was a cross-sectional descriptive study. Children with epilepsy aged between 6 and 12 years attending the Kenyatta National Hospital pediatric neurology clinic were recruited. Inclusion criteria for the study were children diagnosed with epilepsy, age between 6 and 12 years, accompanied by a primary caregiver, and the primary caregiver being willing to participate in the study. A sociodemographic questionnaire as well as the Child Behavior Checklist school-age version (CBCL/6-18) was administered to the caregiver accompanying the child.

Results: One hundred and seventy-seven children with epilepsy were recruited (66% males) with a mean age of 8.9 (standard deviation (SD): 2) years. The mean age at onset of seizures was 4.5 years; 48% of the children had first seizure while aged less than 2 years, 76% reported generalized tonic-clonic seizures, and 58% were on antiepileptic drugs (AEDs). The overall prevalence of emotional and behavioral problems was 46%, and the four leading symptom clusters were attention problems, aggressive behavior, social problems, and withdrawal/depression. The risk of emotional and behavioral problems was increased in children using more than one AED (odds ratio (OR) = 2.21, 95% confidence interval (CI), 1.18-4.14) and those aged ten years and above (OR = 2.7, 95% CI, 1.3-5.64). The risk of emotional and behavioral problems was reduced in children with infrequent seizures (OR = 0.08, 95% CI, 0.01-0.06) and in children reporting no seizure in the past year (OR = 0.08, 95% CI, 0.01-0.65).

Conclusion: Emotional and behavioral problems are common among children with epilepsy in Kenya. This highlights the need to screen for these problems in children on treatment for epilepsy for early identification and subsequent management to improve outcome.