Prevalence and factors associated with intellectual impairment in children with epilepsy in two national referral hospitals in Uganda

BACKGROUND: Epilepsy is a common neurological condition in children and is often associated with intellectual impairment. However, there is limited information on the intellectual impairment among children with epilepsy in Uganda. This study assessed the prevalence and associated factors of intellectual impairment among children and adolescents with epilepsy attending two national referral hospitals in Uganda. METHODS: This cross-sectional study included children and adolescents aged 5 to 17 years who had a diagnosis of epilepsy. Intellectual functioning was assessed using the Raven's Progressive Matrices. Logistic regression analysis was performed to determine demographic and clinical factors associated with intellectual impairment. RESULTS: Of 386 participants, 34.7% had intellectual impairment. Older age (adjusted odds ratio [aOR] = 6.94, P = 0.001), being in a special needs school (aOR = 14.50, P = 0.016), not being in school (aOR = 26.01, P < 0.001), delayed speech (aOR = 3.26, P = 0.030), and anti-seizure medication polypharmacy (aOR = 3.08, P = 0.020) were positively associated with intellectual impairment, while adolescent-onset epilepsy (aOR = 0.05, P = 0.030) was negatively associated. CONCLUSIONS: Intellectual impairment is common among Ugandan children and adolescents with epilepsy and is associated with older age, school non-attendance, special-needs school placement, delayed speech, and anti-seizure medication polypharmacy. These findings underscore the need for routine assessment of intellectual functioning and targeted interventions, including academic support, speech therapy, and optimization of treatment regimens.