School drop out and fallout from idiopathic epilepsy in rural Sri Lanka.

Aims The purpose of the study was to assess the schooling status and the educational achievement of children with idiopathic epilepsy in rural Sri Lanka, and to evaluate the impact of some disease related factors on school achievement. Method Thirty six children (24 boys, 12 girls) aged 6- 16 years (mean age 10.72 years) with idiopathic epilepsy attending a clinic in rural Sri Lanka were studied. Their schooling status was recorded and the educational achievement was assessed by the standard school report and teacher assessment report for two subjects; first language and mathematics. Two sub groups of academic achievers and non-achievers were compared and the impact of some disease related factors such as gender, age at onset of seizures, duration of epilepsy, seizure type and anti-epileptic medication on academic achievement was evaluated by a statistical test. Results School failure was seen in 21 (58%) out of 36 children. Five (13.8%) failed to attend school for a continuous period exceeding six months owing to epilepsy. The main reason for non-attendance was fear of occurrence of seizures. Academic underachievement was observed in 16 (51.6%) out of 31 school-going children. School failure was seen in both subjects studied. Statistical analysis showed no impact of gender, age at onset of seizures, duration of epilepsy, seizure type and anti-epileptic medication on academic achievement. Conclusion School drop out and fallout are significantly common among children with idiopathic epilepsy. It is important for the paediatrician, teacher and parents to keep an eye on school performance so that early remedial action can be taken.

A descriptive cross sectional study on mothers self-medicating children.

Objectives To identify the reasons for selfmedicating children, social circumstances of the mothers, symptoms or disorders treated and the medicines used. Design A cross sectional descriptive study. Method Study was done by visiting homes. An interviewer-administered questionnaire was used to gather data on self-medication of children below 12 years of age in the preceding three months. Data was analysed using SPSS and Stats Direct statistical software (version 2.3.2.) Results 119 mothers satisfied the inclusion criteria for study and 85% had self-medicated their children. A physician prescribing the same drug for similar symptoms previously was the commonest reason given for self-medication. Only 89% of mothers knew that self-medication could be harmful. Most mothers involved in self-medication were unemployed. Headache was the commonest symptom and paracetamol the most commonly used drug. Conclusions This study showed the importance of educating mothers on appropriate medication of children and having safe regulatory procedures for sale of drugs in developing countries.

Challenging epilepsy with antiepileptic pharmacotherapy in a tertiary teaching hospital in Sri Lanka.

The goal of antiepileptic drug (AED) therapy is to achieve a seizure-free state and eliminate the medical and psychosocial risks of recurrent seizures. Burden of epilepsy on the economy of a country may be largely due to the expenditure on AEDs. The adverse effects may influence the compliance to AEDs and effective control of epilepsy. We determined the pattern of AED use, the degree of epileptic control achieved and the adverse effects experienced by the epileptics in a Tertiary Teaching Hospital in Sri Lanka. Carbamazepine was found to be the most frequently used AED. Monotherapy was used on 70.8% of subjects. 86.27% of the study sample had achieved effective control of epilepsy with a 50% or more reduction in seizure frequency. Of them 72.64% were on monotherapy and they were either on carbamazepine, sodium valproate, phenytoin sodium or phenobarbitone. None of the new AEDs were prescribed to these patients. 50.9% on monotherapy and 51.5% on polytherapy reported adverse effects. Somnolence followed by headache was found to be the most frequently reported adverse effects by those on monotherapy and polytherapy both. This study shows that most epileptics can be effectively managed with the conventional AEDs with clinical monitoring.

Learning difficulties in children attending a special clinic at the Lady Ridgeway Hospital.

Objectives To identify presentations of children with learning difficulties attending Child Psychiatry and Guidance Clinic (CPGC) at Lady Ridgeway Hospital (LRH) and describe their socio-demographic characteristics, health-seeking behaviour and modes of referral. Design Descriptive cross sectional study. Method Children diagnosed to have learning difficulties or attention deficit hyperactive disorder (ADHD), presenting to CPGC at LRH from 27 May to 10 June 2003, were included in study. Learning difficulties were diagnosed by a child psychiatrist using DSM IV criteria. A pre-tested, interviewer administered questionnaire (IAQ) was used to collect socio-demographic data, details on health-seeking behaviour and modes of referral from parents/ guardians. A checklist was used to identify presentations. Results 52 children with learning difficulties were identified and all participated in study. Presentations were with difficulties in reading (70%), mathematics (60%), writing (55%), communication (45%) and motor skills (50%). ADHD was found in 60% cases. 85% were males. Mean age was 9 years. 31% had deficit of schooling. 54% were urban dwellers. Caretaker was mother in 83% cases. Monthly income was greater than 3000 rupees in 92% cases. 89% children were identified by mother or teacher. Initial visits were made to a specialist unit (62%) or a primary health care service (31%).