Pattern of diagnostic and therapeutic care of childhood epilepsy in Alexandria, Egypt.

OBJECTIVES

To evaluate the quality of care delivered to children with epilepsy and study the predictors of seizure recurrence after initial control.

DESIGN

A cross-sectional study was conducted during 4-month period (1 January to 30 April 1999).

SETTING

Children's hospitals providing out-patient and in-patient services to the majority of children in Alexandria, Egypt.

OUTCOME

Seizure recurrence after at least 6 months from anti-epileptic drug (AED) adjustment.

RESULTS

Electroencephalogram was performed in 82.1% of cases, whereas plasma assay was performed in only 7% of cases. AEDs were initiated after the first seizure rather than the first recurrence of seizure. Carbamazepine was the most frequently prescribed drug, followed by valproate, except for generalized absence type, which was mainly managed by valproate. Suboptimal quality of care consisted mainly of poor diagnostic assessment of children with epilepsy, underuse of plasma monitoring for AED levels, unjustified use of oral AEDs during breakthrough fits, and defective health education to the caregivers of children with epilepsy that was manifested by non-compliance with AEDs in 30.1% of cases. The outcome of the current healthcare was a 71.6% recurrence of seizures after initial control. Continuous seizures before treatment, a polytherapy regimen, and non-compliance with management procedures were significant predictors for seizure recurrence.

CONCLUSIONS

More specialized neurological care and health education programs for the caregivers of children with epilepsy are warranted. By exploring the details of medical practice, a foundation is provided upon which to build a quality improvement program, using the parameters in our study as an initial framework.