الفهرس 
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Abstract
pilepsy care should be organized around a multi- and interdisciplinary neurological healthcare team. The goal of an epilepsy care should be to achieve a seizure free without increasing the risk of drug toxicity, adverse effects, to prevent the onset and/or the progression of complications and to help the children and adolescents with epilepsy to have a normal life by the continuing psychological and social support.
Therefore this retrospective study was designed to evaluate the quality of care of our neurology clinic through evaluation of patients with idiopathic epilepsy and regimens of epilepsy therapy, epilepsy education, adequacy of seizures control, frequency and severity of complications among all children and adolescents following up at the pediatric neurology Clinic, Ain Shams University Children’s hospital.
All 230 file of children and adolescents diagnosed as idiopathic epilepsy out of 1399 total epilepsy patients following up in the Pediatric neurology Clinic of the Children’s Hospital of Ain Shams University in the last decade were included in the study. The files went through a complete analysis of history taking and examination and a complete evaluation of the adequacy of their care and follow up.
In our study we found that number of patients diagnosed and following up in clinic in the last decade were 230 patients. Only 4.8% of them were <1 year of age and most of them >5 years (78.2%). 56% of them were males and 44% were females. Patients delivered at hospital were 72.6% but no information about mode of delivery documented in files and 27% at home.
Almost all patients had free perinatal history. Only 5.2% had maternal PROM, 0.4% maternal Hge and infection, 3% premature and 0.8% have neonatal jaundice. While all had normal developmental history.
Family history of similar condition among patients was found not exceeding 2.2% of total patients.
Age of onset of seizures in patients was between 1 to 5 years in by 53.4% while less than 1 year in 17% and more than 5 years 29.6%, leading us to preschool age is the most age affected in our study.
Most of patients’ type of seizures was generalized 82.2% specially generalized tonic-clonic type 70.9%, while the focal epilepsy type was recorded in only 17.8%.
We found that 30.5% of patient’s seizure’s frequency one or more per week while every 2 weeks was 48.2% and the monthly or more 38.2% of patients. 84.3% of patients had loss of consciousness with seizure. 99.2% of patients had post-cital sleep and enuresis while 47.8% had post-ictal headache.
No data found in files showing if any patient had attack of status epilepticus and hospitalized.
CBC had done initially in 91.3%, all did liver function tests, only 42.2% did renal function tests, 94.8% of patients had CT scan done initially and 97.4% of patient did EEG initially.
During follow up in clinic only 8.7% do CBC every 3-6 months and 5.6% more than 6 months interval. While 83.4% do liver function tests every 3-6 months and 8.3% more than 6 months interval. Only 1.7% showed elevation in liver enzymes. Only 3.5% do kidney function tests every 3-6 months interval and 8.35% more than 6 months and no abnormalities detected.
EEG during follow up done by patients either to start drug withdrawal after 2 years seizure free or intractable epilepsy during follow up. 67% of patient had EEG done and only 16.2% was documented in files.
Patients on mono-therapy were 76.5%, while 18.7% were on double-therapy and only 4.8% were on triple- therapy.
Valproate was the most famous drug used in mono-therapy by 56.3% of patients, and in 41.9% of patients added as double therapy. Carbamazepine was used as mono-therapy by 38.9% of patients and 46.9% of patients had it added to them as double therapy. Both drugs were the most famous drugs used in the clinic as the first line of treatment.
Only 4.8% of patients on triple therapy they are considered intractable epilepsy and drugs added to therapy were Phenytoin by largest percentage 45.5%, while other drugs as Topiramate by 18.2%, Lamotrigne by 18.2% and Clonazepame 18.2% of total patients on triple therapy.
Patients on anti epileptic drugs and seizure free for more than 2 years start drug withdrawal unless there are EEG changes.
Serum level of drugs was done in 2.3%of patients as recorded in files, VPA 3 and CBZ 1. While only 1 patient on double therapy did serum level to VPA, and no recorded data that patients on triple therapy did serum level at all.
Only 88.6% of Patients on mono therapy were compliant to therapy, 97.7% on double therapy patients were compliant while all patients on triple therapy were compliant.
Patients visit the clinic every 2 weeks were 9.6%, 69.1% monthly, 17% every 3 months while only 4.3% had irregular schedule.
According to questionnaire had done to 100 patient it was found that 79% of patients were compliant to visits while 21% were incompliant to visits.
Causes of incompliance to clinic either patient causes in 91% or clinic cause in 9%. Patient causes include; remote clinic from their home (13%) or time of clinic not suits theirs (29%) or both causes (49%).
Clinic causes include non satisfactory clinic service in 2.2% or non satisfactory clinic personnel behavior in 6.5%.