Kind Charles J, Newton Charles R J C, Kariuki Symon M
St. Johns College University of Oxford Oxford United Kingdom.
KEMRI-Wellcome Trust Research Programme Kilifi Kenya.
Epilepsia Open. 2017 Aug 19;2(4):388-399. doi: 10.1002/epi4.12069. eCollection 2017 Dec.
To investigate the prevalence, risk factors, clinical features, and neurobehavioral comorbidities of epilepsy and acute symptomatic seizures in school-aged children in Kilifi, Kenya.
Randomly selected children (N = 11,223) were screened for epilepsy and other neurodevelopmental disorders. Those who screened positive were invited for further clinical, electroencephalographic (EEG), and neuropsychological evaluations. Prevalence was measured by dividing cases by screened population, providing Agresti-Coull confidence intervals (CIs). Prevalence ratios were computed using log binomial regression, and odds ratios (ORs) were computed using logistic regression; both were implemented with generalized linear models. Attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and other neurodevelopmental impairments were assessed in cases and controls.
Prevalence of lifetime epilepsy was 20.9 per 1,000 (95% CI = 18.4-23.7), and that of active epilepsy was 11.5 per 1,000 (95% CI = 9.7-13.6). Prevalence of acute symptomatic seizures was 68.8 per 1,000 (95% CI = 64.2-73.6). Acute symptomatic seizures preceded a diagnosis of epilepsy in 8% of children. Of 98 children diagnosed with epilepsy, focal seizures were seen in 79%, abnormal EEG was seen in 39%, and 83% were not receiving antiepileptic drugs. Childhood absence epilepsy and Lennox-Gastaut epilepsy were the most easily identifiable epilepsy syndromes. Perinatal complications, previous hospitalization, geophagia, and snoring were risk factors for epilepsy. Family history of seizures, abnormal pregnancy, previous hospitalization, and snoring were risk factors for acute symptomatic seizures. Neurobehavioral comorbidities were present in 54% of subjects with lifetime epilepsy and in 3% of controls, with associations for individual comorbidities being statistically significant: ADHD (OR = 14.55, 95% CI = 7.54-28.06), ASD (OR = 36.83, 95% CI = 7.97-170.14), and cognitive impairments (OR = 14.55, 95% CI = 3.52-60.14).
The burden of seizure disorders in this area is higher than in locations in high-income countries, and can be reduced by preventing risk factors. A comprehensive management plan for neurobehavioral comorbidities of epilepsy should be incorporated into standard epilepsy care.
调查肯尼亚基利菲学龄儿童癫痫和急性症状性癫痫发作的患病率、危险因素、临床特征及神经行为共病情况。
随机选取儿童（N = 11223）进行癫痫和其他神经发育障碍筛查。筛查呈阳性者被邀请进行进一步的临床、脑电图（EEG）和神经心理学评估。患病率通过病例数除以筛查人群计算得出，并提供阿格雷斯蒂 - 库尔置信区间（CI）。患病率比值采用对数二项回归计算，比值比（OR）采用逻辑回归计算；两者均通过广义线性模型实现。对病例组和对照组评估注意缺陷多动障碍（ADHD）、自闭症谱系障碍（ASD）及其他神经发育障碍情况。
终生癫痫患病率为每1000人中有20.9例（95%CI = 18.4 - 23.7），活动性癫痫患病率为每1000人中有11.5例（95%CI = 9.7 - 13.6）。急性症状性癫痫发作患病率为每1000人中有68.8例（95%CI = 64.2 - 73.6）。8%的儿童在癫痫诊断前有急性症状性癫痫发作。在98例诊断为癫痫的儿童中，79%有局灶性发作，39%脑电图异常，83%未接受抗癫痫药物治疗。儿童失神癫痫和伦诺克斯 - 加斯东癫痫是最易识别的癫痫综合征。围产期并发症、既往住院史、食土癖和打鼾是癫痫的危险因素。癫痫发作家族史、异常妊娠、既往住院史和打鼾是急性症状性癫痫发作的危险因素。54%的终生癫痫患者存在神经行为共病，而对照组为3%，各共病的相关性具有统计学意义：ADHD（OR = 14.55，95%CI = 7.54 - 28.06）、ASD（OR = 36.83，95%CI = 7.97 - 170.14）和认知障碍（OR = 14.55，95%CI = 3.52 - 60.14）。
该地区癫痫发作疾病负担高于高收入国家地区，可通过预防危险因素来减轻。癫痫神经行为共病的综合管理计划应纳入标准癫痫护理中。
