Treatment of Epilepsy in Rural Ethiopia: 2 Year Follow-up

Abstract

Abstract Background: Epilepsy is the commonest cause of neurological disability in rural Ethiopia. Untreated epileptic seizures read to physical injury and psychosocial morbidity. Frequent seizures have a determining effect on education, employment and marital life. Objective: To review outcomes of a two years follow-up study. Methods: The study was conducted in December 2001 at the epilepsy clinics at five health centers in the region around Gondar in northern Ethiopia. The case records of patients who had been followed up for two or more years were reviewed. Patients who missed 3 or more consecutive clinic visits were not included and were classified as defaulters. Result: Forty nine percent of patients were still under follow-up after 1 year and this fell to 38% at 2 years. There was marked variation between HCs with 73% still under follow-up at 2 years at two HCs. Of those still under follow-up at 2 years 48% had been seizure free for 1 year or more and another 34% experienced a >90% reduction in seizure frequency. 87% were treated with phenobarbitone monotherapy (median dose: 150mg/day). Age of onset of epilepsy before age 15 years and seizure frequency of one or more seizures per week prior to treatment were associated with failure to achieve one year remission. Duration of epilepsy and seizure type did not affect seizure control. Review of the records of 318 patients who had defaulted from follow-up at one HC showed that seizure control at the time of default was similar to that achieved by the patients still attending with only 5% poorly controlled compared with 3.9%. The mean travelling time to the HC was 4.1hrs for the defaulters and 5.4hrs for those still attending. Conclusion: Good follow-up rates can be achieved even after two years and that response to treatment in those who remain under follow-up is very good falling little short of what is seen in more developed countries. [Ethiop.J.Health Dev. 2004;18(1):31-34]