Associated factors of pediatric drug resistant epilepsy in Udonthani hospital

Abstract

Background: Pediatric epilepsy is common. The average cost per person with epilepsy is estimated to be $204-11,432. One third of patients with epilepsy still suffer from drug resistant epilepsy (DRE). The associated factors that could increase the occurrence of DRE should be investigated.

Objectives:

1. To investigate associated factors of DRE.
2. To study cost of anti-epileptic drugs and investigations in epilepsy treatment both DRE and drug responsive group.

Methods: This was a retrospective study. Chart review was conducted from pediatric patients with epilepsy who had been followed up at least 2 years in Udonthani Hospital between 1 January - 31 December 2018. Univariate and multivariated analysis were analyzed by STATA (version 15).

Results: There were 30.79% DRE from total 277 pediatric epilepsy patients. Univariate analysis of associated factors of DRE included age of onset<1 year (OR 0.51, 95% CI 0.30–0.86), neurodevelopment comorbidity (OR 5.54, 95% CI 3.10–93.90), structural cause (OR 4.73, 95% CI 2.56–8.73), abnormal neuroimaging (OR 2.55, 95% CI 1.16–5.59), abnormal EEG (OR 3.69, 95% CI 1.47-9.28) and persistence of seizure after initial treatment for 2 year (OR 76.95, 95% CI 26.59–222.68) while multivariate analysis included persistence of seizure after initial treatment for 2 years (OR 95.11, 95% CI 8.42-1073.67). The average cost of anti-epileptic drug was 94.6 + 105.8 baht/day (95% CI 71.79 – 117.42) in DRE group and was 21.9 + 37.9 baht/day (95% CI 15.08 – 28.78) in drug responsive group. Total anti-epileptic drug costs were 10,672.75 baht/day and 75.3% were from DRE group. Total costs for drug level tests were 40,890 baht/day and 88.3% were from DRE group. Total EEG costs were 36,000 baht/day and 55.6% were from DRE group. Total CT brain costs were 15,000 baht/day and all from DRE group. Total MRI brain costs were 124,000 baht/day and 75% were from DRE group.

Conclusion: Associated factor for DRE was seizure persistance after initial treatment for 2 years. More than half of anti-epileptic drugs and investigation costs were from drug resistant group, which occupied 30.7% of all patients.