Abstract
Abstract
Background
Antiseizure medication (ASM) monotherapy is generally preferred for childhood epilepsy, but some children require two or more ASMs because of persistent seizures, epilepsy syndrome, treatment transition or greater clinical complexity. Contemporary Ugandan data on the frequency and clinical correlates of paediatric ASM polytherapy are limited.
Objective
To determine the prevalence of current ASM polytherapy and identify clinical factors associated with polytherapy among children and adolescents attending a specialist paediatric neurology clinic in Uganda.
Methods
We conducted a cross-sectional analysis of retrospectively abstracted clinical data from 496 children and adolescents aged 1–18 years with epilepsy attending the Paediatric Neurology Clinic at St. Francis Hospital Nsambya, Kampala, Uganda. Current ASM regimen was classified as monotherapy or polytherapy. Modified Poisson regression with robust standard errors was used to estimate crude and adjusted prevalence ratios (PRs) with 95% confidence intervals (CIs).
Results
Seventy-eight of 496 participants were recorded as receiving polytherapy, giving a prevalence of 15.7% (95% CI 12.8–19.2). In the primary adjusted model, generalized epilepsy was associated with a higher prevalence of recorded polytherapy than focal epilepsy (aPR 2.62, 95% CI 1.70–4.04; p < 0.001), while any documented comorbid condition was associated with approximately twice the prevalence (aPR 2.01, 95% CI 1.25–3.23; p = 0.004). Medication-name review classified 64/496 (12.9%) as receiving at least two recognizable ASMs; agreement with the recorded regimen classification was 92.7% (Cohen's kappa 0.70). In this sensitivity analysis, the association with comorbidity remained strong (aPR 2.65; p < 0.001), whereas the generalized-epilepsy association attenuated to borderline statistical significance (aPR 1.60; p = 0.050).
Conclusion
Approximately one in six children and adolescents were recorded as receiving ASM polytherapy. Comorbidity was the most robust clinical correlate across outcome definitions. The association with generalized epilepsy was sensitive to how polytherapy was classified, highlighting the importance of standardized medication reconciliation in retrospective epilepsy research.