Sustained Seizure Freedom and Associated Factors Among Children and Adolescents Attending a Pediatric Neurology Clinic in Uganda: A Retrospective Cross-Sectional Study

Purpose: Sustained seizure freedom is a central aim of childhood epilepsy care, yet long-term outcome data from specialist pediatric services in Uganda remain limited. We estimated the prevalence of documented sustained seizure freedom and examined associated factors among children and adolescents attending a specialist pediatric neurology clinic in Uganda. Patients and Methods: We reviewed records of children and adolescents attending the Pediatric Neurology Clinic at St. Francis Hospital Nsambya. The outcome was documented freedom from all epileptic seizures for at least 24 consecutive months. Under the investigator-confirmed recording rule, blank outcome fields were classified as not achieving sustained seizure freedom. Exploratory modified Poisson models with robust standard errors examined associations among records with usable covariates. Results: Of 520 records screened, 496 were included; 385 met the documented endpoint (77.6%; 95% CI 73.7– 81.1). Structured medicine selections were available for 395 records. Levetiracetam, sodium valproate, carbamazepine, and lamotrigine were selected in both monotherapy and polytherapy records; clobazam and diazepam were additionally selected in polytherapy in these fields. The available-case adjusted analysis included 389 records, of which 379 met the endpoint. Onset at 1– 4 years versus < 1 year had an adjusted prevalence ratio (aPR) of 1.08 (95% CI 1.00– 1.17); polytherapy versus monotherapy had an aPR of 0.93 (95% CI 0.86– 1.00). Point estimates were similar across age-variable specifications, but confidence intervals were close to or crossed the null. Conclusion: More than three-quarters of reviewed records met the documented 24-month seizure-free endpoint. Estimated associations with onset age and polytherapy were small, with uncertainty close to the null across model specifications. They should be interpreted cautiously because the adjusted subset differed from the full cohort and contained few records not meeting the endpoint. Plain Language Summary: We reviewed 496 records from a specialist epilepsy clinic in Kampala, Uganda. A record met the study outcome when it documented no epileptic seizures for at least 24 months in a row. About eight in ten records met this definition. Following the confirmed recording rule, blank outcome entries were counted as not achieving sustained seizure freedom; a blank entry does not itself prove that seizures continued. We also described the medicines recorded for children receiving one or several antiseizure medicines. Comparisons accounting for other recorded factors used 389 records with usable information. The estimated differences related to onset age and the number of medicines were small. The uncertainty means that clear differences cannot be established confidently. These results do not show that using several medicines causes poorer seizure control. Epilepsy beginning before the first birthday warrants timely specialist assessment to clarify the diagnosis and treatment needs.