Determinants of Noncompliance to Clinic Appointments and Medications among Nigerian Children with Epilepsy: Experience in a Tertiary Health Facility in Enugu, Nigeria

Is there a relationship between socioeconomic factors and prevalence, adherence and outcome in childhood epilepsy? A systematic scoping review

OBJECTIVES

Socioeconomic factors play a role in the outcome of chronic diseases in childhood. Epilepsy is the most common chronic neurological disease in childhood. The relationship between socioeconomic factors and prevalence, adherence and outcome in children with epilepsy has not been systematically reviewed and therefore the aim of our study.

METHODS

Searches were conducted in PubMed, Embase and Cochrane databases from the first documented publications until 31st May 2020. The keywords included socioeconomic status, epilepsy, anticonvulsant, children and systematic review.

RESULTS

The search generated 4687 abstracts. 26 articles were included in the final analysis after the screening process. We found one paper regarding prevalence, 12 regarding adherence and 13 regarding outcome and their relationship to socioeconomic factors. Socioeconomic factors of caregivers impacted school performance, seizure freedom, quality of life and risk of unemployment in adulthood. Lower socioeconomic status was associated with non-adherence. Epilepsy may be more prevalent in children living in lower socioeconomic neighborhoods.

CONCLUSION

Socioeconomic factors of the caregiver, especially their level of education, annual income and marital status, had a significant impact on the outcome and adherence to anticonvulsants in children with epilepsy. Children belonging to a lower socioeconomic group are at risk of having poorer outcomes regarding adherence and hence remission, quality of life and academic achievement. We need to recognize this important aspect and take it into account when making a treatment plan for children with epilepsy.

Increased non-attendance at epilepsy clinic in patients with neuropsychiatric comorbidities: A prospective study

BACKGROUND

In patients with epilepsy, regular follow-up is vital for adequate seizure control, antiseizure drugs' (ASDs) side effects, psychiatric comorbidities, and planning for epilepsy surgery. Non-attendance creates barriers to adequate patient care, inefficient allocation of resources, loss of income, and unnecessary emergency department visits due to lack of seizure control. This study aimed to determine the causes and sociodemographic characteristics of the non-attendant population at the Epilepsy Clinic.

METHODS

A prospective and observational study was carried out on patients treated at the Epilepsy Clinic of the National Institute of Neurology and Neurosurgery (NINN) in Mexico from August 2015 to June 2016. A phone interview was made with all those patients who did not attend the epilepsy consultation. This call incorporated ad hoc questions to meet the objectives of this study.

RESULTS

During the study period, 1299 patients had an appointment at the epilepsy clinic, where 233 (17.9%) patients missed their consultation, 123 (52.8%) were male, mean age was 35.9 ± 14.42 years. The most frequent cause of non-attendance was forgetfulness of the appointment in 62 patients (26.6%). Two patients died; no patient was reported to have experienced SUDEP. Non-attendant patients showed statistically significant overall prevalence of psychiatric comorbidities (41.6%), particularly depression, anxiety, and interictal psychosis.

CONCLUSION

Information on non-attendance at various specialist consultations is scarce, and to our knowledge, this is the first study to address non-attendance in patients with epilepsy in Latin America. Improving hospital protocols to reduce non-attendance can increase patient adherence to follow-up, ultimately improving the quality of care in the epilepsy clinic.

Buccal Fat Pad for Interpositional Arthroplasty in Temporomandibular Joint Ankylosis

Aim

The buccal fat pad (BPF) is a readily accessible mass of adipose tissue in the oro-maxillofacial region. It is a specialized type of fat tissue that enhances intermuscular motion. It has been used extensively for reconstruction of oral cavity defects with satisfactory outcomes. However, its use as an interpositional material in the management of temporomandibular joint ankylosis is not widespread. This report aims to present our experience with its use as an interpositional tissue in the management of temporomandibular joint ankylosis.

Materials and Methods

A total of four patients who presented with either unilateral or bilateral temporomandibular joint ankylosis were included in this study. Three patients presented with bilateral temporomandibular joint ankylosis while one patient had right unilateral bony ankylosis of the temporomandibular joint. All the patients were treated under general anaesthesia during which airway was maintained intraoperatively using tracheostomy tubes. In all cases, interpositional arthroplasty using BPF as the interpositional material was done.

Results

There were two males and two females with age range between 4 and 24 years and a median age of 12.5 years. Trauma was the aetiological factor in all cases. There were a total of seven ankylosed joints. Autogenous pedicled BPF was used in five joints, while BPF graft was utilized in two joints. Maximal interincisal opening of 35 mm or more was achieved intraoperatively before placement of the BPF in all cases. Immediate postoperative jaw exercise was commenced. Mouth opening remained satisfactory at all postoperative reviews.

Conclusion

Buccal fat pad is a reliable option for interpositional arthroplasty in the management of TMJ ankylosis, and it can be used either as a free graft or as a pedicled flap.