Epilepsy is one of the most common serious chronic neurological diseases, affecting people of all ages worldwide. It is characterized by recurrent seizures. There are many causes of the disease [1].

More than 50 million people worldwide suffer from epilepsy, with over three-quarters of them living in low- and middle-income countries. It is estimated that there are 2.4 million new cases each year. Approximately 600,000 people are affected in France [1].

The prevalence of epilepsy in sub-Saharan Africa varies between 7 and 14.8‰ [1]-[3]. In Senegal, the prevalence of epilepsy was estimated at 14.2‰ in the suburbs of Dakar in 2001, with a frequency of 62.4% compared to other neurological disorders [4][5].

In the Democratic Republic of Congo, the true extent of epilepsy is not well known, although several actions have been carried out by the WHO worldwide through the UN World Health Organization’s Global Intersectoral Action Plan [6][7].

In Haut-Uélé province, the arrival of a pediatric neurologist has made it possible to set up a pediatric neurology unit at the WATSA General Reference Hospital, launch fixed, mobile, and outpatient consultation campaigns, and acquire an electroencephalogram (EEG) machine. In our region, as elsewhere in the world, people with epilepsy often face stigma and discrimination due to misconceptions and negative attitudes associated with the disease. Among other misconceptions are “possession by evil spirits”, the belief that “epilepsy is contagious”, and the assumption that it is a form of “madness”. Stigma leads to human rights violations and social exclusion. In some communities, children with epilepsy may not be allowed to attend school, and adults may be unable to find suitable employment or marry.

Treatment for epilepsy requires a number of precautions, both in terms of contraception and during pregnancy, due to the teratogenicity associated with common anti-epileptic drugs. To prevent these risks, we decided to conduct a study of our adolescent patients taking antiepileptic drugs in combination with SAYANA PRESS®, an injectable contraceptive [8], in whom we observed a complete cessation of seizures after two years of treatment. This allowed us to study the beneficial effects of combining SAYANA PRESS® as a contraceptive with either carbamazepine or phenobarbital in adolescents aged 16 to 20 in the province of Haut-Uélé.

Table 1. Study population characteristics (2014-2023).

This Table 1 presents the main characteristics of the pediatric neurology population studied during the period considered. Out of a total of 305 patients, more than half (51.8%) were followed for epilepsy, underscoring the significant burden of this condition within the cohort. Among them, 32 patients were adolescents aged 15 to 20 years, representing 20% of the sample, with a mean age of 16 years. The majority of patients originated from rural areas (84%, 27 cases), reflecting a geographical context characterized by limited access to specialized care. In addition, a high proportion (78%, 25 cases) belonged to disadvantaged families, highlighting the socio-economic vulnerability of this population.

Table 2. Clinical characteristics of epilepsy patients (n = 32).

The majority of patients experienced generalized seizures (68.7%, 20 cases), while a smaller proportion presented with focal seizures (32.3%, 12 cases) (Table 2), indicating that generalized forms were predominant in this cohort. Most patients were classified as having idiopathic epilepsy (90.6%, 29 cases), suggesting that structural or symptomatic causes were rarely identified. Importantly,all patients (100%) received treatment combining antiepileptic drugs (AEDs), carbamazepine or phenobarbital, with Sayana® contraceptive,reflecting a uniform therapeutic approach within this population. No difference was observed among patients treated with carbamazepine and those treated with phenobarbital. The clinical outcomes resulting from the combination of these two antiepileptic drugs with Sayana Press were similar in both groups.

Table 3. Seizure outcomes under treatment (n = 32).

The data presented in Table 3 demonstrate highly favorable long-term seizure outcomes among the study population. A substantial majority of patients (26/32; 81.25%) (Table 3) achieved complete seizure freedom for a period of five years, indicating sustained therapeutic efficacy and excellent long-term control. This proportion reflects not only the effectiveness of the treatment regimen but also the potential role of consistent adherence and possibly synergistic effects between antiepileptic drugs and adjunctive interventions. In addition, a smaller subset of patients (5/32; 15.62%) remained seizure-free for two years, suggesting that while seizure control was achieved, long-term stability may require extended follow-up or optimization of therapy. Importantly, only one patient (3.12%) continued to experience persistent seizures despite treatment, underscoring both the rarity of pharmacoresistance in this cohort and the overall robustness of the therapeutic approach. Taken together, these results highlight the predominance of favorable outcomes, with more than 96% of patients achieving at least two years of seizure freedom.

The vast majority of patients (81.25%) remained seizure-free for five years, while 15.62% achieved seizure freedom for two years, and only one patient (3.12%) continued to experience seizures despite treatment (Table 4). When examining predictors, all patients were within the 15 - 20 years age group, which explains the neutral odds ratio (OR = 1.00). Rural origin was common (84%), and a disadvantaged family background was also frequent (78%). The odds ratios for rural origin (OR = 0.95, 95% CI: 0.10 - 8.50) and disadvantaged families (OR = 0.97, 95% CI: 0.11 - 9.00) were close to unity, with very wide confidence intervals. This indicates no statistically significant association between these characteristics and seizure outcomes.

Table 4. Epidemioclinical characteristics.

Figure 1. Logistic regression: Seizure-free outcomes and predictive significance associated with predicted probability of seizure-free outcome.

The logistic regression results illustrated in Figure 1 show that age (15 - 20 years), rural origin, and disadvantaged family background did not exert a significant influence on the likelihood of remaining seizure-free for five years, as their odds ratios (0.95 and 0.97) were close to 1 and the wide confidence intervals encompassed the reference value. The probability curves confirm that the majority of patients (over 80%) maintained long-term seizure freedom regardless of these socio-demographic factors. These findings suggest that, within this small cohort, social or geographic characteristics did not alter treatment effectiveness, and the stability of outcomes primarily reflects the therapeutic strength of the antiepileptic regimen.

In our study, we recorded a frequency of 51.8% of epilepsy in the pediatric neurology consultation at the WATSA General Reference Hospital. This result is similar to that of other researchers, who found that more than 60% of epilepsy cases occur before the age of 20 [5][9].

In our study, 84% of patients (27 cases) were from rural areas, and 78% (25 cases) were from disadvantaged families. These results are significantly higher than those found in 2001 by the Senegalese League Against Epilepsy and Lamine THIAM et al. [5] (70.9% and 60%).

In fact, in our study, the average time between the onset of seizures and consultation at our facility was 12 months [2 days - 96 months]. Thirty-six point five percent (36.5%) of patients had initially sought traditional treatment.

Epileptic seizures were generalized in 68.7% (20 cases) and focal in 32.3% (12 cases). Our results are comparable to those of several other African authors [5][10][11]. This could be explained by the relative scarcity of EEG equipment in our settings and the spectacular nature of generalized seizures. We relied more on videos taken by parents to establish the classification of seizures.

In terms of the syndromes, 90.6% (29 cases) were noted in our series of idiopathic epilepsies. MRI, the examination of choice for morphological exploration of the brain in epileptic children, is not yet available throughout the province, nor is CT scanning.

Girls of childbearing age are affected by this disease at a rate of 20%. The combination of antiepileptic drugs and SAYANA PRESS®, a contraceptive, has a beneficial effect on the permanent cessation of seizures for 5 years in 81.25% of cases (26 cases). No studies have been conducted on SAYANA’s use in combination with antiepileptic drugs. The finding that no clinical difference was observed between patients treated with carbamazepine and phenobarbital when combined with Sayana Press suggests that progestin-based contraceptives may enhance the effectiveness of antiepileptic drugs. Progestins, through their neuroactive metabolites, are known to potentiate GABAergic inhibition and reduce neuronal excitability, thereby complementing the pharmacological action of antiepileptics in stabilizing seizure thresholds. This synergistic interaction is particularly relevant in women with epilepsy, where hormonal fluctuations can exacerbate seizure frequency, and consistent progestin exposure from long-acting formulations such as Sayana Press may help maintain therapeutic stability. These results are consistent with previous studies showing that progestins can positively interact with antiepileptic therapy, reinforcing the rationale for integrating contraceptive strategies into epilepsy management, especially in resource-limited and conflict-affected settings [12][13].

Our observations during contraception in women with epilepsy who were repeatedly raped and returned with unwanted pregnancies, abortions, or miscarriages, and congenital malformations linked to the effects of antiepileptic drugs, led us to decide to put them on contraception with the support of The United Nations Population Fund (UNFPA). Among adolescents who had started menstruating, a very positive finding was that after two years of administration of Sayana® [8] and antiepileptic drugs, we observed a definitive cessation of seizures a few years after these adolescents stopped taking antiepileptic drugs. We therefore wanted to share this observation with other researchers.

LAH: Conceptualization, study design, data collection, manuscript drafting, NM: Data analysis, interpretation of results, critical revision of the manuscript, LAH and AB: Patient recruitment, clinical data acquisition, contribution to methodology, MG, MJ and KNY: Statistical support, preparation of tables and figures, literature review, drafting of background and discussion sections, clinical supervision, validation of neurological diagnoses, contribution to patient follow-up and treatment documentation, EV, BJ and MK: Assistance in data management and quality control, support in manuscript editing and formatting for submission, contribution to interpretation of clinical outcomes, WS: Senior supervision, final approval of the manuscript.