Landscape of childhood epilepsies – A multi-ethnic population-based study

OBJECTIVE: To describe the clinical features of childhood epilepsy in Qatar. METHODS: A retrospective cross-sectional chart review analysis was conducted at the only tertiary pediatric hospital in Qatar in 1422 patients with epilepsy followed between November 2016 and October 2019. RESULTS: 55% (781) were males and 70% were non-Qatari. Age of epilepsy onset was in the neonatal period in 9% (114/1207 patients). In the non-neonatal cohort, mean age of onset was 4 yrs 9mos ( ± 1.4mos). Focal epilepsy was the predominant epilepsy type in 45% (594/1314 patients) versus generalized epilepsy in 37% and combined focal/generalized epilepsy in 12%. Etiology was unknown in most children (782/1363, 57%) whereas structural and genetic causes represented 23% and 11% of cases respectively. No differences in epilepsy type and etiology were found between different ethnic groups. Children with genetic or structural epilepsies had an earlier epilepsy onset compared to those with unknown etiologies. At the last follow up, only 36% of patients were seizure-free and 12% (170/1422) had a history of status epilepticus. Medically refractory epilepsy was found in 37% (527/1407) of patients, with the most common etiologies being unknown (36%) and structural (37%). Neurodevelopmental co-morbidities were present in most patients (62%), with global developmental delay (47%) and learning/school difficulties (22%) being the most prevalent. 94% of patients with somatic co-morbidities had concomitant neurodevelopmental co-morbidities. Risk factors associated with an increased risk of co-morbidities and intractable epilepsy included early age of epilepsy onset (< 2 years of age); etiology; antenatal risk factors; history of previous central nervous system infection; history of status epilepticus and a family history of consanguinity and epilepsy. SIGNIFICANCE: This large multi-ethnic population-based study confirms that the prevalence, incidence and clinical features of epilepsy in Qatar is in accordance with other epidemiologic studies and highlights risk factors for the development of co-morbidities and medically-intractable epilepsy.