Study to improve success in paediatric epilepsy medical treatment - Seizure freedom as a primary outcome: A pre- post - quality improvement study in a tertiary teaching hospital, Bahir Dar, Ethiopia.

BACKGROUND

Poor seizure control in paediatric epilepsy treatment is a significant challenge world-wide, particularly in low-income-countries, affecting the patients' quality of life.

OBJECTIVE

Our study evaluated the effect of a multi-pronged intervention on seizure control among paediatric epilepsy patients treated at Bahir Dar University Tibebe-Ghion-Hospital.

METHODS

A pre- post- quality improvement study from January 1, 2024, to June 30, 2025, compared two groups of 129 children with epilepsy: retrospective pre-intervention group and prospective intervention group. Interventions were improving epilepsy classification, selecting appropriate anti-seizure medication (ASMs), and ASM optimization. Outcome was measured by 24-week seizure freedom. Chi-squared test and logistic regression were used for analysis.

RESULTS

Our intervention is associated with increased 24-week seizure freedom from 37% to 84%. The composite intervention bundle - Improved epilepsy classification, appropriate ASM selection, and following an ASM optimization schedule - was associated with improved seizure freedom with adjusted Odds ratio of 0.008 (0.002, 0.032). Health insurance and lack of comorbidities were associated with 24-weeks seizure freedom with adjusted Odds ratio of 2.640 (1.175, 5.931) and 2.768 (1.205, 6.359) respectively.

CONCLUSION

Reinforcing epilepsy classification, along with tailored ASM selection and optimization, allows a significant proportion of patients to achieve 24-week seizure freedom.