Facteurs influencant la réponse au traitement antiépileptique chez les enfants à l'Hôpiatal Gynéco-obstétrique et Pédiatrique de Yaoundé

Madeleine Laurette Nguambi Onguene (ameliee.owotsogo@yahoo.fr)
Pédiatrie, Yaounde I
July, 2015


Introduction and objective:
Seizures affect close to 50 million people around the world, wherein 2/3 are children and 1/5 live in Sub-Saharan Africa . World-wide prevalence of seizures occurrs in children lies between 0.5 to 1‰. Mbonda and al. found that 1.85% of the children population consulting at the Yaoundé Central Hospital suffered from seizures . About 10 to 40% will continuously have seizures inspite of appropriate anti-epileptic drug treatment.Such intractable epilepsy has physical, psychological and intellectual repercussion on children.Our study aimed at identifying factors affecting drug-resistant epilepsy in children aged 1 to 15 at the Gynaco-Obstetric and Pediatric Hospital of Yaoundé (GOPHY).

We have carried out a cross-sectional and analytic research from February 6 to April 27, 2015 at GOPHY. We included children aged 1 to 15 placed under antiepileptic drug for close to 12 months , compliant , regularly consulting at the GOPHY and whose parents consented to participate in the study. We excluded cases for which treatment had been interrupted or modified without medical notice, and those with febrile seizures. For each patient, we collected clinical data : socio-demographic data, personal and family medical report, type and etiology of the epileptic crisis, antenatal, perinatal or post-natal epilepsy risk factors, the type of epileptic syndrome, therapeutic failure to early treatment, and the number of anti-epileptic drugs used at moment. We also collected results of tests conducted before the beginning of treatment, notably: computed tomography, cerebral magnetic resonance imaging, and electroencephalogram. The children were examined by a neuropaediatrician assisted by the main investigator. Emphasis was laid on the neurological test with measurement of head circumference, developmental quotient evaluation by use of the Denver developmental screening test, the research of posture abnormalities, muscular strength and tonus disorder. Data analysis was made with use of SPSS version 20.0, and SPAD version 5.5. A univaried, bivaried, and multidimensional study through multiple correspondence analysis, as well as logic regression modeling were carried out, and the threshold of significance was fixed at 0.05.

Within the period of our investigation, we recruited 105 children consulted at the neuropaediatrics unit of GOPHY. We observed 51 drug-resistant patients what made a prevalence of 48.57%. The mean age was 6.24 ± 4.38 years. Symptomatic etiology was most represented with 56 patients (53.3%). Partial symptomatic crises figured first of various epileptic types observed, with 37.15%. Complex partial crises made up 40% of crises observed. The West syndrome was the most specified and recurrent syndrome with 16, 19%. We identified 13 risk factors of drug-resistant epilepsy after logic regression modeling. Symptomatic etiology was ranked first with an OR of 8.63 (P = 0,008). Neonatal asphyxia was the unic predictive factor of perinatal medical history with an OR of 3.03 (P= 0, 00). The West syndrome was the sole predictive epileptic syndrome of drug-resistant epilepsy with an OR of 4.27 (P = 0,012). As for morphologic tests, predictive parameters were: abnormalities at cerebral computed tomography with an OR of 4.57 (P = 0, 001), porencephaly with an OR of 5.81 (P = 0,005) and cerebral atrophy with an OR of 3.4 (P = 0,009). Clinical factors were: abnormal neurological examination with an OR of 4.75 (P = 0,000), developmental delay with an OR of 6.87 (P = 0,001), motor deficit with an OR of 4.7 (P = 0,000), spastic quadriplegia with an OR of 2.62 (P = 0, 043) and therapeutic failure at early treatment with an OR of 6.87 (P = 0,000).

Our study found a prevalence of drug-resistant epilepsy estimated at 48.57%. The neonatal asphyxia was the primary risk factor found in our work. The strengthening of emergencies obstetric and newborn care would be reduced significantly the prevalence of children with drug resistant epilepsy in our context.

Key words: drug resistant epilepsy – children – risk factor – Yaounde.