Introduction: Poorly controlled epilepsy is a risk factor for increased morbidity among children with cerebral palsy (CP). We aimed to define the prevalence, clinical phenotypes and barriers to optimum epilepsy control among children with CP.

Method: We used the Bangladesh CP Register (BCPR); an ongoing population-based surveillance of children with CP in Shahjadpur sub-district of Bangladesh to identify children with CP and epilepsy.   Specialist assessments were conducted led by a paediatric neurologist from Australia, with intervening phone follow-ups. Details of seizure/event type, frequency and medication compliance were collected. Antiepileptic drugs (AED) were prescribed based on seizure type, family income, comorbidity and medication availability.

Results: 23.4% (171/726) of BCPR cohort had a clinical diagnosis of epilepsy. 166 of these children were assessed between December 2016 and January 2018. 103/166 children had seizures (64/103 -generalized tonic clonic seizures, 27/103 -focal seizures), whereas 63 had non-epileptic events. AED changes consisted of dose alteration in 30.1% (31/103), medication change in 7.8% (8/103) and initiation of treatment in 37.9% (39/103). On follow-up (median 9.5 months), 30.1% (31/103) children were seizure free. Inconsistent medication due to affordability or lack of education were main reasons for poor seizure control. 8.8% (12/103) had seizures >30 mins and a robust emergency seizure management plan was unavailable.

Conclusion: Epilepsy is prevalent and poorly managed among children with CP in rural Bangladesh. Health care workers can improve epilepsy management with regular follow-up, education on common seizure types, seizure mimics, use of commonly available, affordable AED and guidelines for prolonged seizure management.