Children with epilepsy have onset most frequently in the first year of life. The most common seizure type is epileptic spasms, the diagnosis of which is based on the seizure type and electroencephalogram (EEG) findings. There is limited data on epilepsy in Africa in general, especially sub-Saharan Africa, and even less so for this specific seizure type. This study aimed to gather information on children with epileptic spasms at Red Cross War Memorial Children’s Hospital, the largest children’s hospital in Southern Africa, in a retrospective observational study.

187 patients were diagnosed with epileptic spasms between 2000 and 2017 . 21% of patients had a lag time that exceeded 4 months. Hypoxic ischaemic encephalopathy (HIE) was the commonest aetiology at 30% of the cohort. First-line intervention for treatment included adrenocorticotrophin (ACTH) (47%), sodium valproate (37%) and vigabatrin (15%). Outcomes at 3 months and 1 year revealed that that 77% and 55% respectively had persistent seizures, and 57% had severe-profound developmental delay after 1 year.

The prolonged lag time to treatment and the high percentage of HIE remains a compounding health care challenge in our setting. Epileptic spasms remain a significant burden of disease across sub-Saharan Africa where incidence of perinatal insults and birth hypoxia is high. This study supports this and highlights the need for effective pathways to care and the need for improved access to perinatal and postnatal care.