Antipsychotic use among paediatric patients living with epilepsy in Uganda

Epilepsy is a common chronic neurological disorder in childhood, often accompanied by behavioural and psychiatric challenges such as aggression, irritability, and hyperactivity. Management of these comorbidities may involve antipsychotic medications, yet data on their use in African settings remain scarce. To examine the prevalence and patterns of antipsychotic prescribing among children and adolescents with epilepsy in Uganda. A descriptive cross-sectional study was conducted at Mulago National Referral Hospital and Butabika National Mental Referral Hospital. Children (5-9 years) and adolescents (10-17 years) with epilepsy were consecutively recruited during routine visits. Data were obtained through caregiver interviews and review of medical records. Intellectual disability was evaluated with Raven's Progressive Matrices. Antipsychotic and anti-seizure prescriptions were recorded. Data were analysed using descriptive statistics and chi-square tests. A total of 305 participants were recruited, mostly male (62.6%) and adolescents (51.8%). Overall, 6.9% (n = 21, 95% CI: 4.5-10.3) were prescribed antipsychotics, with risperidone being the most common (47.6%). The most common combinations involved carbamazepine with risperidone (38.1%) and sodium valproate with risperidone (28.6%). A statistically significant site-related difference was observed: nearly all individuals receiving antipsychotics were recruited from Mulago National Referral Hospital (9.1%), compared to only 1.2% from Butabika National Mental Referral Hospital (p = 0.014). Antipsychotic use among children and adolescents with epilepsy in Uganda is relatively low but follows international trends, with risperidone being the predominant choice. Antipsychotic prescriptions often involve combinations with carbamazepine or valproate, raising concerns about drug interactions and metabolic risks. These findings underscore the need for locally adapted prescribing guidelines, systematic monitoring of safety outcomes, and strengthened psychosocial interventions to complement pharmacological care.