Abstracts

This is a Late Breaking abstract

Rationale: Worldwide, there are an estimated 50 million people with epilepsy (PWE), and nearly 80% of PWE live in low and middle-income countries such as Haiti. Haiti has a population of 11.4 million, and one specialized epilepsy center, the Epilepsy Clinic of Port-au-Prince (CLIDEP), serves the entire country. This results in a treatment gap for PWE in Haiti, a Caribbean nation where 59% of people live below the poverty threshold, and the average income is less than $2.41 per day. Two prior studies have focused on epilepsy patterns among Haitian children seen at CLIDEP.^1,2 We present the first assessment of Haiti’s epilepsy burden to include children and adults.

Methods: A retrospective chart review of all patients treated at CLIDEP from January 2019 to January 2020 was conducted. Inclusion criteria were all patients seen for epilepsy who were on at least one antiepileptic drug (AED) and had at least one electroencephalogram (EEG). Descriptive statistics included means and standard deviation, or medians and interquartile range (IQR), for continuous variables and frequencies and percentages for categorical variables. Differences between groups were tested using Student’s T-Test or Mann Whitney U Test for continuous variables and the Chi² test for categorical variables. Statistical significance was set at p ≤ .05. Excel 2016 and Stata v.17 were used for data analysis.

Results: Of 162 patients, the median age was 13, IQR (6, 28) years, the median age of seizure onset was seven years IQR (0, 21), and 51% were women. A family history of epilepsy was reported in 23/162 (14.2%) patients. Neurological examination was abnormal in 39/162 (24%), and 113/162 (70%) had an abnormal EEG. 142/162 (87.65%) patients were on one AED, 16/162 (9.88%) on two AEDs, and 4/162 (2.47%) on three or more AEDs. The most prescribed AEDs were carbamazepine 96/162 (59%), levetiracetam 48/162 (29.6%), phenobarbital 15/162 (9.3%), and phenytoin 9/162 (5.6%). Of these patients, 86/162 (53%) had at least one follow-up visit during the study period; 37/86 (43%) were seizure-free, and 31/86 (36%) had a reduced number of seizures, while 18/86 (21%) were refractory to AEDs.  Only 5/86 (6%) reported side effects from the AEDs

Conclusions: Despite the treatment gap in Haiti, this study reveals the positive impact of epilepsy treatment at a specialty clinic in a low-income country. The patients had improved seizure control and reported few side effects. In addition, the rates of refractory epilepsy were lower than described in high-income countries. Limitations of this study included a small sample size and many patients being lost to follow-up, which may reflect psychosocial and/or ecological challenges associated with access to care. Further study is needed to characterize the neuroepidemiology of epilepsy in Haiti. _x000D_  _x000D_ References: _x000D_ 1. Gabriel Crevier-Sorbo, et al. Assessment and treatment of childhood epilepsy in Haiti. Epilepsia. 2020; 2:5(2):190-197._x000D_ 2.  Gabriel Crevier-Sorbo, et al. A needs Assessment of pediatric epilepsy surgery in Haiti. J Neurosurg Pediatr 2020; 27:27(2):189-195.

Funding: Not applicable