PMID- 32524044 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20231111 IS - 2470-9239 (Print) IS - 2470-9239 (Electronic) IS - 2470-9239 (Linking) VI - 5 IP - 2 DP - 2020 Jun TI - Assessment and treatment of childhood epilepsy in Haiti. PG - 190-197 LID - 10.1002/epi4.12384 [doi] AB - OBJECTIVE: The global burden of pediatric epilepsy is disproportionately concentrated in low- and middle-income countries (LMICs). However, little is known about the effectiveness of current treatment programs in this setting. We present the outcomes of children who were assessed and treated at the Clinique D'Epilepsie de Port-au-Prince (CLIDEP), the only pediatric epilepsy referral center in Haiti. METHODS: A 10-year retrospective review of children consecutively assessed and treated at CLIDEP was performed. The primary outcome was seizure control following treatment for epilepsy. The secondary outcome was an accurate determination of the diagnosis of epilepsy. A data-driven principle component regression (PCR) analysis was used to identify variables associated with outcomes of interest. RESULTS: Of the 812 children referred for evaluation, most children (82%) underwent electroencephalography to investigate a possible epilepsy diagnosis. Very few children (7%) underwent cranial imaging. Although many patients were lost to follow-up (24%), most children who returned to clinic had less frequent seizures (51%) and compliance with medication was relatively high (79%). Using PCR, we identified a patient phenotype that was strongly associated with poor seizure control which had strong contributions from abnormal neurological examination, higher number of antiepileptic drugs, comorbid diagnoses, epileptic encephalopathy or epilepsy syndrome, and developmental delay. Head circumference also contributed to epilepsy outcomes in Haiti with smaller head sizes being associated with a poor seizure outcome. A dissociable phenotype of febrile seizures, suspected structural abnormality, epileptic encephalopathy or epilepsy syndrome, and higher seizure frequency was associated with a diagnosis of epilepsy. SIGNIFICANCE: We describe the current landscape of childhood epilepsy in Haiti with an emphasis on diagnosis, treatment and outcomes. The findings provide evidence for the effectiveness of programs aimed at the diagnosis and management of epilepsy in LMICs and may inform the allocation of resources and create more effective referral structures. CI - (c) 2020 The Authors. Epilepsia Open published by Wiley Periodicals Inc. on behalf of International League Against Epilepsy. FAU - Crevier-Sorbo, Gabriel AU - Crevier-Sorbo G AUID- ORCID: 0000-0001-5581-937X AD - Faculty of Medicine McGill University Montreal QC Canada. FAU - Brunette-Clement, Tristan AU - Brunette-Clement T AD - Faculty of Medicine University of Montreal Montreal QC Canada. FAU - Medawar, Edgar AU - Medawar E AD - Faculty of Medicine McGill University Montreal QC Canada. FAU - Mathieu, Francois AU - Mathieu F AD - Division of Neurosurgery Department of Surgery University of Toronto Toronto ON Canada. FAU - Morgan, Benjamin R AU - Morgan BR AD - Faculty of Medicine University of Toronto Toronto ON Canada. FAU - Hachem, Laureen AU - Hachem L AD - Division of Neurosurgery Department of Surgery University of Toronto Toronto ON Canada. FAU - Fallah, Aria AU - Fallah A AD - Department of Neurosurgery UCLA Mattel Children's Hospital David Geffen School of Medicine at UCLA Los Angeles CA USA. FAU - Weil, Alexander G AU - Weil AG AD - Faculty of Medicine University of Montreal Montreal QC Canada. AD - Division of Neurosurgery Ste Justine Hospital Montreal QC Canada. FAU - Ibrahim, George M AU - Ibrahim GM AUID- ORCID: 0000-0001-9068-8184 AD - Division of Neurosurgery Department of Surgery University of Toronto Toronto ON Canada. AD - Division of Neurosurgery Hospital for Sick Children Toronto ON Canada. AD - Institute of Biomaterials and Biomedical Engineering University of Toronto Toronto ON Canada. AD - Institute of Medical Science University of Toronto Toronto ON Canada. LA - eng PT - Journal Article DEP - 20200302 PL - United States TA - Epilepsia Open JT - Epilepsia open JID - 101692036 PMC - PMC7278551 OTO - NOTNLM OT - Caribbean OT - Global health OT - Pediatric OT - low- and middle-income countries COIS- The authors have no conflicts of interest to disclose. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. EDAT- 2020/06/12 06:00 MHDA- 2020/06/12 06:01 PMCR- 2020/03/02 CRDT- 2020/06/12 06:00 PHST- 2019/09/12 00:00 [received] PHST- 2019/12/23 00:00 [revised] PHST- 2020/02/13 00:00 [accepted] PHST- 2020/06/12 06:00 [entrez] PHST- 2020/06/12 06:00 [pubmed] PHST- 2020/06/12 06:01 [medline] PHST- 2020/03/02 00:00 [pmc-release] AID - EPI412384 [pii] AID - 10.1002/epi4.12384 [doi] PST - epublish SO - Epilepsia Open. 2020 Mar 2;5(2):190-197. doi: 10.1002/epi4.12384. eCollection 2020 Jun.