PATTERN OF EPILEPSY TREATMENT OUTCOME AND ITS PREDICTORS AMONG EPILEPTIC PATIENTS ON FOLLOW UP AT NEUROLOGIC CLINIC OF HIWOT FANA SPECIALIZED UNIVERSITY HOSPITAL AND DILCHORA REFERAL HOSPITAL, EASTERN ETHIOPIA: A RETROSPECTIVE COHORT STUDY

Abstract

Epilepsy is a chronic neurological disease with variable therapeutic responses. To design effective treatment strategies for epilepsy, it is important to understand treatment responses and predictive factors. However, there are many controversies and inconclusive pieces of evidence about the remission pattern of epilepsy patients in developing countries. Besides, the studies available in the Ethiopia setting are negligible, particularly that addressed children. Objective: This study aimed to determine the pattern of seizure remission and associated factors among epileptic patients on follow-up in Hiwot Fana Specialized University Hospital and Dilchora Referal Hospital, from July 2 to 31, 2021. Methods: A retrospective cohort study was conducted at Hiwot Fana Specialized University Hospital and Dilchora Referal Hospital, Eastern Ethiopia. A data collection tool was developed to record relevant information from existing medical records. Data were analyzed by using SPSS Version 21.0. The data was presented using the mean and median for continuous variables or frequency for categorical variables. A univariable and multivariable Cox proportional hazards model was performed to determine the association of each independent variable with seizure remission. A p-value of < 0.05 at a 95% Confidence interval was used to establish a statistically significant association. Result: A total of 418 patients were included in the study from two hospitals. Among them, 276 (66%) were adults and 178(42.6%) have encountered the hospitals a year after the disease onset. Among included study participants, 252 (60.3%) of them revealed to achieve seizure remission. In multivariable Cox proportional analysis, epileptic patients who were taking dual therapy were 44% less likely to achieve remission (AHR=0.56, 95% CI: 0.32-0.98), patients who had < 12 months pretreatment duration were 2.361 times more likely to achieve remission (AHR=2.36, 95% CI: 1.28-4.37) and participants who had good adherence to anti-epileptics were 2.4 times more likely to achieve remission (AHR= 2.4, 95% CI: 1.33-4.34). Conclussion: In this study, more than a third of patients have never achieved remission during the follow-up and the remitting relapsing course was the most common remission pattern. Taking more than one antiseizure medication, longer pretreatment duration and non-adherence to medication were the contributors to poor remission. Patients with those characteristics should be addressed with due attention