Prevalence of Epilepsy in School Children in El-Manyal Island

Transcription

1 Forayssa E. Talaat et al. Prevalence of Epilepsy in School Children in El-Manyal Island Forayssa E. Talaat 1, Maha El-Rabbat, Maha Atef 1, Ehab Shaker 1, Hany Taher Mohammed 1 Departments of Neurology 1, Community Medicine, Cairo University ABSTRACT This is a descriptive study, carried out on 9875 school students of 1 schools, located in El Manyal Island (Cairo) searching for students having epilepsy. During this it passed through the following stages: 1. The number of schools in El Manyal area as well as their address was collected from the Ministry of Education Information Centre.. In each school, the total number of students, their sex, and their distribution in school grades were collected from each school data records, and the medical records in the medical offices in each school.. The data about the epileptic children (number, sex, and school grades) also collected from school medical and social files as well as the Health Insurance medical centers and hospitals for children.. Data about age at onset, type of seizure, possible etiology, frequency of seizures, associated conditions and antiepileptic used were collected through individual interviews with epileptic children, school medical staff, and one of the family members whenever possible. 5. Prestructured questionnaires (designed on the WHO recommendations for the diagnosis of epilepsy), were applied to the known epileptic students and also were applied on random method on 168 students, whom age ranging from 1 to 18 years, for detection of possible non reported epileptic students. It can be concluded that: 1. The prevalence of epilepsy in school children is much similar to that in other countries. Prevalence of epilepsy is higher in boys during the school age (this may be increased exposure to accidents and trauma).. Children during school age period have relatively well controlled epilepsy (nearly 80 % of them have a monthly seizure or less).. Most children were controlled by using single antiepileptic drug, and Carbamazepine was the most commonly used, and partial seizures were the commonest type. 5. Prestructured questionnaires give results about having a paroxysmal disorder, which need to be ascertained by more investigations to confirm the diagnosis of epilepsy. (Egypt J. Neurol. Psychiat. Neurosurg., 009, 6(1): 19-) INTRODUCTION Epilepsy, which is defined as a chronic condition characterized by recurrent seizures unprovoked by any immediate identifiable cause, is a major health problem worldwide. 1 Epilepsy is one of the most common neurologic disorders of childhood affecting more than % of all children. It is well established that children with epilepsy have a higher incidence of school underachievement because of many factors, including the seizures themselves, the medications that are used to treat seizures, the psychosocial difficulties, and behavioral problems, not to mention the social stigmata and discrimination experienced by persons with epilepsy,. Being a long-term illness involving not only an organic impairment or disturbance, but frequently also gives rise to a whole array of problems in a child s or adolescent s daily Correspondence to Ehab Shaker, ehabneuro@yahoo.com. Contact number:

2 Egypt J. Neurol. Psychiat. Neurosurg. life at the personal level and in their interaction with and adaptation to their surroundings. Among these multifaceted factors, some patients find that the social attitude, the stigmata, and discrimination against epilepsy are probably more devastating than the disease itself 5. Epilepsy is a frequently occurring neurologic disease that requires early diagnosis and treatment to decrease incidence of disabilities 6. On the other hand, children with epilepsy or other handicaps may lead full lives and interact normally with their social environment. Of key importance for attainment of social integration is social support to provide healthy, appropriate social control and minimize deprivation. 7 This study has been conducted to identify the prevalence of epilepsy among pupils in schools in El-Manyal Island and to describe the demographic data of the patients, to clarify the clinical characteristics of the seizures and to find out unreported cases of epilepsy among school students. 0 SUBJECTS AND METHODS This study was carried out on 9875 students of 1 schools located in El Manyal Island (Cairo). Their list and addresses was obtained from ministry of education information center. This work was carried out from October 005 to the end of April 006. In this study epilepsy was defined as recurrent (two or more) unprovoked seizures occurring more than hours apart during life time. In this work we were concerned with: (1) Descriptive analysis of identified epileptic cases: achieved through several steps. A- Reported case finding: case finding was based on searching in (1) school social and medical records () school health offices records and student insurance hospital follow up and EEG log book records. Data was collected about the total number of students in each school, their sex, and their distribution in different school grades. Another request was made to each school system for a list of all children having seizures or identified as epileptics and also for allowing the interview with children to complete history taking and clinical examination Acceptance from relevant authorities was obtained Ministry of 009 Vol. 6 (1) - Jan education, Ministry of health and population and from the school administration. Massive efforts were made to inform and motivate the school health centers to participate in our search work. The medical and social staff members of the schools were convinced several times for believing in the objectives and goals of the study, in order to enhance feasibility and to minimize inter and intraobserver variability in the diagnosis and interview. B- Direct interviews with reported cases: i. Detailed history taking: (1) general history taking including name, age, sex, address, school grade. () History taking for possible causes, age at onset, type of seizures, and type of AEDs used (from students and additional information from school doctor, school nursing staff, school social workers and from students' relatives as much as possible). ii. General and neurologic examination: For possible motor disabilities, mental subnormalities, learning disorders, enuresis, and speech disorders. iii. Seizures were classified by seizure type based on the clinical description according to the 199 International League Against Epilepsy (ILAE) commission recommendations on classification and terminology. iv. Appling questionnaires: Prestructured questionnaires were applied by the candidate. The first questionnaire consists of yes or no questions inquiring about if the subject is known as epileptic or not, if had recurrent attacks of convulsions, or if he had ever been on antiepileptic drug treatment. The second questionnaire also consists of yes or no questions, but concerning with the type of seizure, preictal state, postictal state, and associated autonomic changes. v. The information obtained by the questionnaire was checked against

3 Forayssa E. Talaat et al. data in the medical records and data obtained through history taking. () Searching for possible unreported epileptic students: The prestructured questionnaires (previously applied on the identified cases) were applied on 168 students, whose age ranged from 1 to 18 years (1 st preparatory grade up to the rd secondary grade of regular schools). These children were chosen randomly (i.e. In all preparatory and secondary schools located in El Manyal area, one class in each grade was chosen in a random way, representing this grade) The school medical staff (nurses) and school social workers were instructed and taught how to explain the questionnaire to the students and they offered a great help in applying the questionnaires. The screening positive cases were interviewed for history taking including their symptoms, seizure type (if present), and type of drugs if any have been taken. RESULTS In our area of study there were 1 schools: 10 primary schools containing 15 students [05 (9.%) were males and 109 (50.8%) were females], 5 preparatory schools containing 155 students [1605 (7.5%) were males and 550 (5.5%) were females, as there were schools for boys, one mixed school, and only one school for girls], 5 secondary schools containing 6 students [66 (11%) were males and 896 (89%) were females, as only one mixed school and the others are for girls], and one school for mentally handicapped containing 6 children [1 (50%) were males and 1 (50%) were females). So the total 9875 students, 198 were males (.5% of total students], and 5677 were females (57.5% of total students). In those students we identified cases of epilepsy, and the prevalence rate found to be.5/1000 students, 1 (8.8%) of them were males, at a prevalence of 5/1000 male students, and (51.%) of them were females at a prevalence rate of.88/1000 female students. The following table, table (1), shows sex specific prevalence and age specific prevalence for each year age group. According to school grades: (Table and Fig. 1) In our study area there were 15 students in the primary schools (their age ranged from 6-1 years) with 17 students identified as epileptics at a prevalence rate of.1/1000, in the preparatory schools there were 155 students(their age ranged from 1-15 years) with 11 students identified as epileptics at a prevalence rate of 5.1/1000, in the secondary schools there were 6 students(their age ranged from years) with 1 students identified as epileptics at a prevalence rate of.7/1000 and in special schools for handicaps there were 6 children with children identified as epileptics at a prevalence rate of 8./1000. Age at onset: (Fig. ) Fourteen percent of the epileptic children had their first seizure before they were one year old,.1% of children had their first seizure at the age from 1-5 yeas old, 7.9% of children had their first seizure at the age from 6-9 years and 1% of children had their first seizure after the age of 9 years. Seizure type: The types of seizures found among the study children are shown in table (). Partial seizures were responsible for 8.8% of seizures, generalized seizures were responsible for 9.5% of seizures, mixed type were responsible for 7% of seizures and the unclassified seizures were responsible for about.7%. In partial seizures, 9 cases (%) were males and 1 cases (57%) were females, while in generalized seizures 8 cases (7%) were males and 9 cases (5%) were females. Possible etiology: (Table ) Of the children, children (.7%) were thought to have prenatal causes of epilepsy (e.g. CNS malformation, chromosomal abnormalities and other congenital abnormalities), children (7%) were thought to have perinatal causes (e.g. birth trauma, asphyxia, neonatal jaundice and other perinatal causes) as a precipitating factor for epilepsy, children (9.%) were thought to have a postnatal cause of epilepsy (e.g. sever head trauma, CNS infection, toxic or metabolic, CNS neoplasm and other post natal causes) and children (79%) have no apparent cause or precipitating factor for epilepsy. Frequency of seizures: (Table 5) 1

4 Egypt J. Neurol. Psychiat. Neurosurg. The recent seizure frequency (number of seizures during the last 1 months) showed that 1 children (8.8% of epileptic students) had no seizure activity during the last 1 months, 8 children (18.6%) had 1- seizures during the last year, children (7%) had 5-7 seizures, children (.65%) had monthly seizure, children (9.%) had seizures weekly and children (.65%) had daily seizures. Family history: In our study 18 children (% of total epileptic students) were found to have a first degree relative known to have epilepsy. Other associated conditions: During interviewing and examination of the epileptic children 1 children were found to have recurrent attacks of headache in a percentage of about.6% of all epileptic students, 5 children were found to have enuresis (11.6% of all epileptic students), 8 children had speech disorders (18.6% of all epileptic students), and children had some degree of mental retardation (IQ less than 70) in a percentage of 7% of all epileptic children. Also during case ascertainment only 1 children had an EEG of the cases representing 8.8% of all cases Antiepileptic drugs: (Tables 6 and 7) In our study epileptic students were found to use mainly 5 types of antiepileptic drugs (carbamazepine, clonazepam, lamotrigine, phenytoin, and valproic acid). children were found to use a single drug to control seizure activity (about 51.%of cases),16 children use two AED to control seizures (7.% of cases) and only 009 Vol. 6 (1) - Jan 5 children use more than AED to control seizures (11.6% of cases). According to the type of the drug used, the most commonly used drug was found to be carbamazepine, as 7 children use carbamazepine, 6 children use clonazepam, children use lamotrigine, 1 children use phenytoin and 0 children use valproic acid as an AED. As a monotherapy drug, 1 cases use carbamazepine as single AED (5.5% of monotherapy drug users), cases use phenytoin (9.1% of monotherapy drug users), 8 cases use valproic acid(6.% of monotherapy drug users). Results of the random study: The preformed questionnaires which were applied on the identified cases, were applied on another 168 students chosen by random sampling (from preparatory and secondary school students, this to make sure that those students are able to understand the questions and answer these questions with minimal help), the questionnaire application resulted in 6 screening positive children, they were interviewed individually for history taking and enquiring about their symptoms, seizure type if present, and any drug intake. The interview resulted in detection of only another 8 students were suffering from recurrent paroxysmal events such as repeated attacks of headache, recurrent syncopal attacks, and few of them were regularly medicated by antiepileptic drugs for these paroxysmal attacks, and they need to be ascertained by EEG and more investigated to confirm the diagnosis of epilepsy. Table 1. Sex specific prevalence of epilepsy and age specific prevalence of epilepsy for each year age group in school students in El-Manyal Island in the year Age group FEMALE MALE TOTAL Pop. 1 Prev. Num. Pop. Num Prev. Pop. Num Prev

5 Forayssa E. Talaat et al Total Pop. = Total population. - Num. = Number of cases. - Prev. = Prevalence of cases per Table. Age specific prevalence of epilepsy in school students in El-Manyal Island according to school grades in the year Type of school 1ry school Prep. School ry school Male Female Total Pop. 1 Num. Prev. Pop. Num Prev. Pop. Num. Prev Sp. School total = Pop. = Number of students. = Num. = Number of cases. = Prev. = Prevalence of cases per = Sp. School = Special school for mental subnormality children Sp. School 7% ry school 8% 1ry school 9% Prep. School 6%

6 Egypt J. Neurol. Psychiat. Neurosurg. 009 Vol. 6 (1) - Jan Fig. (1): Percent distribution of cases according to school grades in El-Manyal Island in the year > 9 years 1% < 1year 1% 6-9 years 8% 1-5 years % Fig. (): The distribution of epileptic students in El-Manyal Island according to the age at onset in the year Table. The distribution of epilepsy according to the type of seizures in epileptic students in El-Manyal Island in the year Type of seizure Male no Female no Total no % Partial seizures % Simple - 19% Complex % With ry generalization 1 5 % Generalized % Absence 1.5% Tonic, tonic-clonic, myoclonic % Atonic % Mixed 1 7%

7 Forayssa E. Talaat et al. Unclassified -.7% Total 1 100% Table. The distribution of epilepsy according to the possible etiology of seizures in epileptic students in El- Manyal Island in the year Etiology Idiopathic Prenatal Perinatal Postnatal Total Cases Percentage 79.0%.7% 7.0% 9.% 100% Table 5. The frequency of seizures per year in epileptic students in El-Manyal Island in the year Frequency None Monthly weekly Daily Unknown Number 1 8 Percentage 8.8% 18.6% 7.0%.65% 9.%.65% 7.0% Table 6. The antiepileptic drugs used and their percentage of use by epileptic students in El-Manyal Island, in the year AED PHT CBZ LTG CZP VPA Number Percent.6% 6.8% 7% 1% 6.5% Table 7. The number of antiepileptic drugs used by epileptic students and their percentages in El-Manyal Island, in the year Number of AED Number Percentage Monotherapy CBZ 1 51.% 5

8 Egypt J. Neurol. Psychiat. Neurosurg. 009 Vol. 6 (1) - Jan PHT VPA 8 Two AED 16 7.% More than AED % AED=Anti epileptic drugs, PHT= phenytoin, CBZ= carbamazepine, LTG= lamotrigine, CZP=clonazepam, VPA= valproic acid definitions and other methodological problems DISCUSSION have precluded comparisons between developed and developing countries. The prevalence rates Epilepsy is one of the commonest neurological reported in developed countries vary; i.e., Norway, disorders, so that it was studied by many, concerning.0 in 1,000 8 ; Israel,. in 1,000 9 ; China,. in its epidemiologic features, etiology, genetics, types, 1,000 6 ; United States (Rochester, MN), 6.0 in clinical pictures, outcome, treatment, and complications. 5 1, ; Italy, 6. in 1,000 0 ; Australia, 7.5 in 1,000 7; Iceland,.8 in 1, and in the rest of Epidemiologic studies investigating possible Europe the prevalence is per , while etiologic factors for epilepsy should recognize that studies in developing countries (such as Colombia, different seizure types have different etiologies as Ecuador, India, Liberia, Nigeria, Panama, United well as different prognoses. Therefore, information Republic of Tanzania and Venezuela) suggest a concerning seizure type and epilepsy syndrome is prevalence of more than 10 per 1, needed for such studies. However, large, populationbased, multiple-source ascertainment systems are This study concern was about the prevalence of epilepsy in 9875 students in 1 schools located in expensive, and data collection is a slow and meticulous process. 6 El Manyal Island area, In those students we identified reported cases of epilepsy, and the Epilepsy was defined as occurrence of at least prevalence rate found to be.5/1000 school two unprovoked seizures that did not occur within students, The crude prevalence rate of epilepsy the same -h period. Active epilepsy denotes detected in the present population was occurrence of at least one unprovoked seizure during comparatively lower than the prevalence rate the last 5 years, or treatment with antiepileptic drugs detected by a previous study carried out in Assiut (AEDs) for epilepsy in the one-year proceeding the (1996) which was 6/1000 students, and also the prevalence day. This is the same definition of prevalence in this study is lower than that epilepsy as defined by most investigators as: Hauser and Kurland, (Minnesota; 1975) prevalences reported in many other countries, as in ; Li et al. (China; 1985) 6 ; Bharucha et al. (Bombai; 1988) Sweden: 5. in 1,000 children 5, Madrid (Spain) 6, ; Koul et al. (Kashmir, India; 1988) 8 Faroes 7, Tokyo 5, UAE: 6.5 in 1,000 population, and Osuntokun et al. (Nigeria; 1987) 1 and in Ethiopia, the prevalence rate was 5. in 1,000 ; while Beran et al. (Sydney, Australia; 198) 7 population 1. However the prevalence rate detected required three or more seizures. in the present work is slightly higher than those The prevalence of active epilepsy is a detected in some developed countries; i.e. British quantitative measure that provides information that General Practice study yielding a prevalence ratio of may be used to assess resources needed to provide.0 per 1,000 inhabitants..9/1,000 in children medical care. Both the definition of active epilepsy of the ages of 0-15 years in epidemiologic study in used and the completeness of case ascertainment 8 Europe 1, and in Singapore, it was.50/1,000 influence the rate established. And because case schoolchildren 9. ascertainment is never complete, the rates we report, The limited available prevalence studies from as in other prevalence studies of epilepsy, should be considered minimum figures. 5 developing countries show variations, which may be explained in part on the basis of differences in The lifetime prevalence of epilepsy refers to investigatory methodologies (e.g. door to door the proportion of the population developing epilepsy survey, multiple random sampling, hospital over a specified period (i.e., from birth to a admission records and EEG referral records) 1. particular age) 9. Despite the plethora of prevalence According to some studies the prevalence of studies in developing countries, the lack of common 6

9 Forayssa E. Talaat et al. epilepsy in many developing countries significantly exceeds that of developed nations Higher prevalence rates of epilepsy in developing countries have traditionally been linked to a variety of conditions, including lack of prenatal, obstetric, and postpartum medical care, as well as malnutrition, infectious and parasitic disorders, and street violence 18,19. In those students identified as epileptics, 1 (8.8%) of them were males, at a prevalence of 5/1000 male students, and (51.%) of them were females at a prevalence rate of.88/1000 female students. The higher prevalence in males than females in our results is similar to results from previous study in Assiut; (1./1000 in males and 11./1000 in females) as well as other studies; Iceland (Elias Olafsson et, al; 1999) 10. Possible reasons for a sex difference include different rates of development of the immune and nervous systems between the sexes 51. As regard the age of onset of epilepsy our data differ from those obtained in Assiut study (1.% of cases had their first seizure before they were one year old and 68.5% of them had their first seizure before age of 1 years), and Lars Forsgren (Sweden, 199): found that the initial seizure occurred during the first year of life in 5.%). On the other hand our results are similar to that found by Catherine C. et, al; (Metropolitan Atlanta study, 1995) i.e. 0% of the children had a first seizure before they were years old and 55% of the children had their first seizure by the time they were years old 7. Results in our study showing partial seizures predominance which is similar to several studies in other countries; i.e. (Iceland, 1999): seizure types were partial in 8.5% of the children and generalized in 6.9%. 10, (Metropolitan, 1995): partial and secondarily generalized seizures were responsible for 58% of the types, and generalized seizures accounted for 5%, and unable to classify the seizure type in 7% of the children 7, and (Zambia, 000): fifty percent of seizures had focal onset or were complex partial 19. On the other side, our results differ from that of the study carried out in Assiut (1996), which showed that generalized seizures were responsible for 7.% of cases 1, and also several studies in developed and developing countries have reported GTCS as the most prevalent type of seizure among their populations for example, in Europe, (K. J. Eriksson et al., 1997) found that seizure type was generalized in % children, partial in %, and mixed in 9% of cases. 1 In Tanzania, (H. T. Rwiza. et, al, 199) found that generalized seizures accounted for the majority of seizures (58.0%). 0 In Guatemala, (Jorge E. et, al, 1996) found that the most common type of epileptic seizure was generalized tonic-clonic seizures (GTCS) in 50% of patients, followed by complex partial seizures (CPS) in 7.5% of patients, simple partial seizures in 6.%of patients, and generalized atonic seizures in 6.% of patients 5, and in Singapore, (Loh Ngai et, al, 1999) found that generalized seizures (65.%) were more common than partial seizures (.8%). 9 The higher percentage of partial seizures than generalized seizures in this study may be due to the population of the study (school children) which does not include severely disabled children in whom generalized epilepsies and epileptic syndromes with generalized seizures are predominant. In the present work 9 children (1%) were found to be symptomatic, children (.7%) were thought to have prenatal causes of epilepsy (e.g. CNS malformation, chromosomal abnormalities and other congenital abnormalities), children (7%) were thought to have perinatal causes (e.g. birth trauma, asphyxia, neonatal jaundice and other perinatal causes) as a precipitating factor for epilepsy, children (9.%) were thought to have a postnatal cause of epilepsy (e.g. sever head trauma, CNS infection, toxic or metabolic, CNS neoplasm and other post natal causes) and children (79%) have no apparent cause or precipitating factor for epilepsy. Although detailed history and physical examination were the only tools available in the field situation, the figures agree with findings of other studies in some developed countries; e.g. in Atlanta, USA (Shridharan et al., 1986) 8 ; and in Europe, (Eriksson et, al, 1997) found that the etiology of epilepsy could be identified in 6% of cases and was prenatal in 15% children, perinatal in 9% and postnatal in 1%.and more than half (6%) of the cases were considered idiopathic 1. Also our results are similar to that of other African and Arab countries; in Tanzania (199) no possible etiology could be determined in 7.7% of the cases 9, in United Arab Emirates (001) it was 7

10 Egypt J. Neurol. Psychiat. Neurosurg. found that, epilepsy was symptomatic in % of the cases: pre or perinatal encephalopathy %, head injury %, childhood neurological infection % and stroke 1%, and in Tunisia (199): idiopathic epilepsy represents 76.5% of the cases. 6 Recent seizure frequency was used to describe the general control of epilepsy as follows: (a) Good control: 1 or years of seizure-free time, (b) Partial control: at least 1 seizure per year but not more than 1 per month, (c) Poor control: more than one seizure per month. 1 In the present work it was found that 1 students (8.8% of epileptic students) had no seizure activity during the last 1 months, i.e. have good control of epilepsy. 1 students (0.5%) had partial control of epilepsy, 6 students (15.95%) had more frequent seizures monthly, i.e. have poor control of epilepsy and only children whose seizure frequency was not determined (5% of epileptic children). Seizure frequencies in our study is relatively near to the results of previous researches; i.e. in Europe (Eriksson et al., 1997) found that the control of epilepsy was good in 5% children, partial in 0% and poor (=intractable) in 17% cases. 1 In Sweden, (Lars Forsgren, 199) found that.1% had no seizure in the preceding year,.1% had less than one seizure/month (1-11 seizures/year): 1.6% had one to several seizures/month (1-50 / year), 11.% had weekly seizures (>50/year), and.7% had >00 seizures/year, while comparing to the results from Assiut (1996), it was found that 56.% of epileptics had one seizure per month, 18.8% had one seizure every few months, and 1.% had one seizure once per year or few years 1. During direct interview and history taking 18 children (% of total epileptic students) found to have a first degree relative known to have epilepsy. This is similar to results found in Guatemala, where.75% of patients had a history of epilepsy among first-degree family members 5. But our results differ from that of Assiut, in which family history was obtained only in % of epileptics 1. In Europe; 8.5% had relatives with epilepsy and 11.% had first-degree relatives with epilepsy. In Zambia; seventeen percent of epilepsy patients had a family history of epilepsy 19, and in Ethiopia; family history of epilepsy was ascertained in % of patients Vol. 6 (1) - Jan Mental retardation, speech disorders, movement disorders and specific learning disorders are more common in people with epilepsy than in the general population 7,9. In our study MR was only founding 7% of cases, this may be explained by our study population was school children not in general population. In the present work, migraine and other recurrent headache were also more frequent than in child population studies; this is similar to data from previous studies 50, this may explained by the coincidence of migraine and seizures, headache as a symptom of epileptic activity and the side effects of antiepileptic drugs. Also an epileptic individual may have low self-confidence caused by seizure-related sudden loss of self-control and feelings of insecurity, giving rise to more frequent tension headache. In our study epileptic students found to use mainly 5 types of antiepileptic drugs (carbamazepine, clonazepam, lamotrigine, phenytoin, and valproic acid). According to the type of the drug used, 7 children use carbamazepine as an AED (6.8% of epileptic children), 6 children use clonazepam as an AED (1% of epileptic children), children use lamotrigine (7% of epileptic children), 1 children use phenytoin as AED (.6% of epileptic children) and 0 children use valproic acid as an AED (6.5% of epileptic children).this differs from data form previous study in Iceland where the most frequently prescribed drug was carbamazepine (CBZ), (6% of all cases), Phenytoin (PHT) (% of all cases), and valproate (VPA) (% of all cases). 10 Also in our study child were found to use a single drug to control seizure activity (about 51. % of cases ), 16 children use two AED to control seizures (7.% of cases) and only 5 children use more than AED to control seizures.(11.6 % of cases). This differs from other studies which state, AED treatment in the form of monotherapy was administered to (60.9 %). Two AEDs were administered to (.%), three or more AEDs were administered to 6.% of all epileptic patients. We found that carbamazepine is the most widely used single AED, 1 cases use carbamazepine as single AED (5.5% of monotherapy drug users), cases use phenytoin as

11 Forayssa E. Talaat et al. single AED (9.1% of monotherapy drug users), 8 cases use valproic acid as single AED (6.% of monotherapy drug users). As a method for detection of unreported cases, questionnaires were applied on another 168 students (preparatory and secondary school students) chosen by random sampling resulted in detection of another 8 children raising the possibility of being unreported cases of epilepsy, but this study has several possible limitations. First, despite our best efforts, we were unable to obtain 100% participation, as the prevalence of epilepsy may be different among nonparticipants as compared with participants. A second issue concerns the sensitivity of our screening questions. The screening instrument we used contained direct questions regarding epilepsy and current drug use, in addition to questions that were adapted from the WHO protocol originally designed for neuroepidemiological studies in developing countries, so cases found by the way of questionnaires may need to be ascertained by EEG and direct interview with cases as well as their households to confirm the diagnosis. The third issue is that the group of young children (6-1 years old) and mentally subnormal children might not included in questionnaire application. The fourth is, although high sensitivities have been reported, the instrument (questionnaire) has never been validated properly 5. Therefore, we may have missed some cases of epilepsy, especially persons with partial seizures and also it was not easy to distinguish seizures from sleep apnea, transient ischemic attack, depression, psychogenic attacks, muscle headaches, narcolepsy, amaurosis fugax with migraine, nocturnal urinary incontinence, and syncope, and it may need further investigations to confirm the diagnosis of epilepsy. Summary and Conclusion It was found that: 1- cases of epilepsy were identified, and the prevalence rate found to be.5/1000 which is much similar to that in other countries - Prevalence of epilepsy in boys is 5/1000, which is slightly higher than that of girls.88/1000 during school age (this may be increased exposure to accidents and trauma). - Children during school age period have relatively well controlled epilepsy (nearly 80% of them have a monthly seizure or less). - Most children were controlled by using single antiepileptic drug, and Carbamazepine was the most commonly used, and partial seizures were the commonest type % of children have their first seizure before the age of five. 6- Most of school children epilepsy (79%) found to be idiopathic. 7- About % of total epileptic students, found to have a first degree relative known to have epilepsy. 8- Only 8 children out of 168 (who answered the questionnaire) were reported as screening positive to have epilepsy or other paroxysmal disorders. 9- Prestructured questionnaires give results about having a paroxysmal disorder, which need to be ascertained by more investigations to confirm the diagnosis of epilepsy. We recommend the following: 1- A community based study to assess the real prevalence of epilepsy in the community. - Every student with recurrent paroxysmal events should be investigated for the possibility of being epileptic. - All epileptic students should have a follow up system by Student Health Insurance program. - All schools should apply a pretested questionnaire on all students in order to detect possible unreported cases of epilepsy. REFERENCES 1. International League Against Epilepsy: Commission on Epidemiology and Prognosis, Guidelines for epidemiologic studies on epilepsy. Epilepsia, 199, : Trimble MR.: Psychiatric and psychological aspects of epilepsy, In: Porter RJ, Morselli PL, eds. The epilepsies. Boston: Butterwonhs, 1986, -5.. Pongkiat K.: Epilepsy Awareness Among School Teachers in Thailand. Epilepsia, 1999, 0(): WHO: World Health Organization. International classification of impairments, disabilities and handicaps. A manual of classification relating to the consequences of disease. Geneva,

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14 Egypt J. Neurol. Psychiat. Neurosurg. 009 الملخص العزبى Vol. 6 (1) - Jan معدل حدوث حاالت الصزع بين تالميذ المدارس بمنطقة جزيزة المنيل