Seizure Patterns and Neurologic Complications in Children with Neurocutaneous Disorders in a Nigerian Tertiary Hospital

Objective: Neurocutaneous disorders (NCDs) cause significant chronic morbidity in children, yet data on their clinical trajectories in Sub-Saharan Africa remain limited. This study characterised the specific seizure patterns and systemic neurological complications among children with NCDs at a tertiary health facility in Nigeria.
Materials and Methods: This descriptive cross-sectional study was conducted over a six-year period from January 2020 to December 2025 at the Paediatric Neurology Clinic of Nnamdi Azikiwe University, Nigeria. Out of 3,755 clinic attendances, 54 children with a confirmed clinical diagnosis of Neurofibromatosis Type 1 (NF1), Neurofibromatosis Type 2 (NF2), or Tuberous Sclerosis Complex (TSC) were recruited. Data regarding seizure semiology, neuroimaging (CT and MRI), and histopathological findings were compiled during the patients' clinical evaluation and analysed descriptively.
Results: The cohort comprised predominantly NF1 (66.7%) and TSC (31.5%) cases. Seizures were the primary clinical presentation driving hospital evaluation. Generalised tonic-clonic seizures were the most frequent (24.1%), followed by infantile spasms (5.6%) and focal to bilateral focal seizures (5.6%). Among the seizure subgroup, 29.2% suffered from high-frequency episodes (>10 episodes). Neuroradiological tracking revealed subependymal nodules amongst the TSC cohort in 19% of patients and cortical/subcortical tubers in 11.9%. Other structural anomalies included neuromas (9.5%), white matter abnormalities (7.1%), and hydrocephalus secondary to aqueductal stenosis (4.8%). Tissue pathology confirmed a dense burden of plexiform neurofibromas (18.5%), cutaneous neurofibromas (18.5%), and peripheral nerve sheath tumours (11.1%).  Beyond paroxysmal events, motor milestone delays affected 18.5% of the children. 
Conclusion: Pediatric NCDs carry a heavy neurological and structural burden in Nigeria, with convulsions serving as the primary driver of tertiary hospital attendance. The high prevalence of structural central nervous system anomalies directly mirrors the severity of the observed seizure phenotypes and focal deficits. These findings highlight the urgent need for subsidised, programmatic diagnostic frameworks and multi-disciplinary management strategies to overcome economic barriers and improve long-term outcomes for affected children.