Epidemiology and clinical characteristics of epilepsy patients in a tertiary care hospital in Egypt

Abstract Background Epilepsy is a major neurological disorder with variable etiologies, clinical presentations, and treatment outcomes. In resource-limited settings, restricted access to diagnostic facilities often hinders accurate classification and optimal management. This study aimed to describe the demographic and clinical characteristics of Egyptian patients with epilepsy attending a tertiary care hospital and to identify predictors of uncontrolled epilepsy. Results This cross-sectional study included 233 patients with epilepsy. The mean age was 32.4 ± 13.4 years, with a slight male predominance (54.9%). Migraine was the most common comorbidity (7.3%). Stress (30.9%) and missed medication doses (21.9%) were the most frequently reported seizure triggers. Uncontrolled epilepsy was observed in 67.8% of patients. Medication non-adherence (OR = 4.2; 95% CI: 2.1–8.3; p < 0.001) and financial constraints affecting medication access (OR = 2.8; 95% CI: 1.4–5.6; p = 0.003) were the strongest predictors of poor seizure control. No significant associations were found between seizure control and age, sex, education level, marital status, comorbidities, or duration of epilepsy (all p > 0.05). Idiopathic epilepsy was the predominant etiology (81.1%). Electroencephalography (EEG) abnormalities were detected in 60% of patients, while magnetic resonance imaging (MRI) revealed structural lesions in 18.4%. Sodium valproate (60.1%) and levetiracetam (52.4%) were the most commonly prescribed anti-seizure medications (ASMs), followed by carbamazepine (30.5%). The most frequently reported adverse effects included weight gain with valproate, irritability with levetiracetam, and somnolence with carbamazepine. Conclusions Epilepsy in this Egyptian cohort was most common among young adults, with idiopathic epilepsy predominating. Approximately two-thirds of patients had uncontrolled seizures. Poor seizure control was mainly associated with modifiable factors, particularly medication non-adherence and financial barriers to treatment. Improving access to diagnostic services, strengthening patient education, and ensuring affordable anti-seizure medications may help reduce the epilepsy treatment gap in Egypt.