Management of Pediatric Epilepsy in Lebanon: Evaluation of factors affecting seizure control, treatment adherence, quality of life and depression.

Pediatric epilepsy is the most common chronic and recurrent neurologic condition in childhood, posing a great public concern. Children with epilepsy suffer increased morbidity and mortality mainly due to injury, developmental comorbidities, and an increased risk of sudden death that persists into adulthood. They also have impaired health related quality of life (HRQOL), and are at a great risk of developing psychiatric disorders, such as depression and anxiety, leading to suicidal ideation.

Management of pediatric epilepsy involves administration of antiepileptic medication (AEDs) to control seizures. Despite optimal medical therapy with antiepileptic medication, 20% to 35% of children with newly diagnosed epilepsy continue to have seizures. This has been attributed to nonmodifiable factors related to the disease severity itself; such as symptomatic etiology and abnormal neuroimaging, and to modifiable factors like adherence to treatment.

In clinical practice, it is crucial to identify early on after diagnosis the likely clinical course of pediatric epilepsy, both in terms of seizure control and possible development of intractable epilepsy. This would allow for early interventions such as intensification of therapy with modern antiepileptic drugs or neurosurgery.

In Lebanon, there are no studies evaluating the management of pediatric epilepsy. The magnitude of poorly controlled epilepsy is unknown and there is no data available addressing the factors associated with poor seizure control or poor adherence to treatment. Also, the importance of assessing HRQOL and the presence of psychiatric disorders has been ignored, since the traditional medical goal in the management of epilepsy has only focused on achieving seizure control with minimal or no adverse medication effects. This work carried out in Lebanon will extend knowledge to an area that has not been investigated so far.

The primary objective of this thesis is to evaluate different aspects in the management of pediatric epilepsy in Lebanon. The specific objectives are to: (1) Evaluate factors predictive of poor seizure control in new onset pediatric epilepsy after 12 months of treatment initiation; (2) Examine variations in the health-related quality of life (HRQOL) in newly diagnosed patients and 12 months following diagnosis, and to study the effect of seizure control/non-control on HRQOL; (3) Evaluate adherence to AEDs and identify factors predictive of non-adherence; (4) Evaluate the psychometric properties of the Neurological Disorders Depression Inventory-Epilepsy for Youth (NDDI-E-Y) for identification of depression in routine clinic visits.

This research project comprises an observational prospective study on patients with newly diagnosed epilepsy to evaluate seizure control and quality of life after 1 year of diagnosis. A cross-sectional observational study will also be done to evaluate adherence to AEDs and assess the validity of the NDDI-E-Y.

Mots clés :Epilepsy, AEDs, Risks Factors, Children, Lebanon