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Lessa VCC, Martins MBM, Vidal ASC, Araujo LA, D'Andrea Meira I. The reality of epilepsy in primary care in Rio de Janeiro: the importance of educational projects for better patient care. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-5. [PMID: 39038804 DOI: 10.1055/s-0044-1787796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
BACKGROUND The Basic Health Unit (Unidade Básica de Saúde - UBS, in Portuguese) is the first point of contact in the public healthcare system for people with epilepsy. Primary care professionals need to appropriately diagnose, treat, and refer, if necessary, to tertiary services. OBJECTIVE To evaluate the knowledge of UBS professionals on the management of patients with epilepsy in Rio de Janeiro. METHODS Online questionnaires were performed on the topic of epilepsy before and after exposure to classes taught by epileptologists. RESULTS A total of 66 doctors participated, 54.5% of whom were residents or trained in family medicine. The majority had from 1 to 3 years of practice. Insecurity prevailed in the management of pregnant women and the elderly. Around 59.1% of the participants referred patients with seizures without examinations. A total of 78% of the participants did not correctly classify seizure types, and 2/3 did not define drug-resistant epilepsy. Induction and broad-spectrum drugs were common. The therapeutic decision depended on availability in the basic health unit (UBS) (81.8%), dosage (60.6%), side effects (34.8%), and age (36.4%). Comorbidities and sex influenced 1/4 of the sample. For 23% of the participants, the type of crisis did not affect the choice. Regarding typical non-pharmacological options, 75% of the participants were aware of cannabidiol, 40.9% of surgery, 22.7% of ketogenic diet, and 22.8% of deep brain stimulation/vagus nerve stimulation (DBS/VNS). A total of 90.2% indicated the need for training. CONCLUSION There are deficits in the knowledge of UBS professionals in the management of epilepsy. Specialized training is imperative to optimize the care offered within SUS.
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Affiliation(s)
- Vanessa Cristina Colares Lessa
- Instituto Estadual do Cérebro Paulo Niemeyer, Departamento de Epilepsia, Rio de Janeiro RJ, Brazil
- Santa Casa da Misericórdia de São Paulo, Departamento de Epilepsia, São Paulo SP, Brazil
| | - Marília Bezerra Magalhães Martins
- Instituto Estadual do Cérebro Paulo Niemeyer, Departamento de Epilepsia, Rio de Janeiro RJ, Brazil
- Hospital Universitário Gaffrée e Guinle, Departamento de Pediatria, Rio de Janeiro RJ, Brazil
| | | | - Leonardo Alves Araujo
- Instituto Estadual do Cérebro Paulo Niemeyer, Departamento de Epilepsia, Rio de Janeiro RJ, Brazil
| | - Isabella D'Andrea Meira
- Instituto Estadual do Cérebro Paulo Niemeyer, Departamento de Epilepsia, Rio de Janeiro RJ, Brazil
- Universidade Federal Fluminense, Faculdade de Medicina, Programa de Pós-Graduação em Neurologia/Neurociências, Niterói RJ, Brazil
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Moscovicz F, Taborda C, Fernández F, Borda N, Auzmendi J, Lazarowski A. Ironing out the Links: Ferroptosis in epilepsy and SUDEP. Epilepsy Behav 2024; 157:109890. [PMID: 38905915 DOI: 10.1016/j.yebeh.2024.109890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/30/2024] [Accepted: 06/08/2024] [Indexed: 06/23/2024]
Abstract
Iron is a crucial element for almost all organisms because it plays a vital role in oxygen transport, enzymatic processes, and energy generation due to its electron transfer capabilities. However, its dysregulation can lead to a form of programmed cell death known as ferroptosis, which is characterized by cellular iron accumulation, reactive oxygen species (ROS) production, and unrestricted lipid peroxidation. Both iron and ferroptosis have been identified as key players in the pathogenesis of various neurodegenerative diseases. While in epilepsy this phenomenon remains relatively understudied, seizures can be considered hypoxic-ischemic episodes resulting in increased ROS production, lipid peroxidation, membrane disorganization, and cell death. All of this is accompanied by elevated intracellular free Fe2+ concentration and hemosiderin precipitation, as existing reports suggest a significant accumulation of iron in the brain and heart associated with epilepsy. Generalized tonic-clonic seizures (GTCS), a primary risk factor for Sudden Unexpected Death in Epilepsy (SUDEP), not only have an impact on the brain but also lead to cardiogenic dysfunctions associated with "Iron Overload and Cardiomyopathy" (IOC) and "Epileptic heart" characterized by electrical and mechanical dysfunction and a high risk of malignant bradycardia. In line with this phenomenon, studies conducted by our research group have demonstrated that recurrent seizures induce hypoxia in cardiomyocytes, resulting in P-glycoprotein (P-gp) overexpression, prolonged Q-T interval, severe bradycardia, and hemosiderin precipitation, correlating with an elevated spontaneous death ratio. In this article, we explore the intricate connections among ferroptosis, epilepsy, and SUDEP. By synthesizing current knowledge and drawing insights from recent publications, this study provides a comprehensive understanding of the molecular underpinnings. Furthermore, this review offers insights into potential therapeutic avenues and outlines future research directions.
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Affiliation(s)
- F Moscovicz
- University of Buenos Aires, Faculty of Pharmacy and Biochemistry, Institute of Phisiopatology and Clinical Biochemistry (INFIBIOC), Applied Neurobiology Lab, Buenos Aires, Argentina; National Council of Scientific and Technical Research (CONICET), Argentina.
| | - C Taborda
- University of Buenos Aires, Faculty of Pharmacy and Biochemistry, Institute of Phisiopatology and Clinical Biochemistry (INFIBIOC), Applied Neurobiology Lab, Buenos Aires, Argentina; National Council of Scientific and Technical Research (CONICET), Argentina
| | - F Fernández
- University of Buenos Aires, Faculty of Pharmacy and Biochemistry, Institute of Phisiopatology and Clinical Biochemistry (INFIBIOC), Applied Neurobiology Lab, Buenos Aires, Argentina
| | - N Borda
- University of Buenos Aires, Faculty of Pharmacy and Biochemistry, Institute of Phisiopatology and Clinical Biochemistry (INFIBIOC), Applied Neurobiology Lab, Buenos Aires, Argentina
| | - J Auzmendi
- University of Buenos Aires, Faculty of Pharmacy and Biochemistry, Institute of Phisiopatology and Clinical Biochemistry (INFIBIOC), Applied Neurobiology Lab, Buenos Aires, Argentina; National Council of Scientific and Technical Research (CONICET), Argentina.
| | - A Lazarowski
- University of Buenos Aires, Faculty of Pharmacy and Biochemistry, Institute of Phisiopatology and Clinical Biochemistry (INFIBIOC), Applied Neurobiology Lab, Buenos Aires, Argentina.
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de Albuquerque LCP, Torres CM, Batista CEA, Cunha DRMDF, Bizzi JWJ, Bianchin MM. Measuring quality and safety of epilepsy monitoring units in Brazil: Adoption of quality indicators. Seizure 2024; 115:68-74. [PMID: 38218112 DOI: 10.1016/j.seizure.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 12/29/2023] [Accepted: 12/31/2023] [Indexed: 01/15/2024] Open
Abstract
PURPOSE Drug-resistant epilepsy affects a substantial proportion (30-40 %) of patients with epilepsy, often necessitating video-electroencephalography (video-EEG) monitoring. In 2016, Sauro et al. introduced a set of measures aimed at improving the quality and safety indicators reported in video-EEG evaluations. This study aims to report our experience with the implementation of these measures. METHODS We analyzed video-EEG data regarding quality and safty from a period spanning January 2016 to January 2018, involving a total of 101 patients monitored in our video-EEG unit. RESULTS Among the patients included in the study, a definitive diagnosis was attainable for 92.1 %, with 36.6 % experiencing a change in diagnosis and 65.3 % undergoing a change in treatment as a result of the video-EEG evaluation. Additionally, the referral question was fully addressed in 60.4 % of admissions, and video-EEG was considered to be very useful or extremely useful in 66.4 % of cases. Adverse events were observed in 26.7 % of patients, with the most common being the progression of focal seizures to bilateral tonic-clonic seizures (11.9 %) and the occurrence of seizure clusters (5.9 %). CONCLUSION Our findings support the implementation of Sauro et al.'s set of measures, as they provide valuable criteria for improving the reporting of video-EEG quality and safety indicators. However, challenges may arise due to variations in terminology across studies and the lack of standardized criteria for defining essential questions in video-EEG evaluations. Further research utilizing these measures is necessary to enhance their effectiveness and encourage consistent reporting of results from epilepsy monitoring units.
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Affiliation(s)
- Leonardo Cordenonzi Pedroso de Albuquerque
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, Porto Alegre, Brazil; Centro de Tratamento de Epilepsia Refratária (CETER), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Division of Neurology, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos n. 2.350, Porto Alegre, Brazil
| | - Carolina Machado Torres
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, Porto Alegre, Brazil; Centro de Tratamento de Epilepsia Refratária (CETER), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Division of Neurology, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos n. 2.350, Porto Alegre, Brazil
| | | | | | | | - Marino Muxfeldt Bianchin
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, Porto Alegre, Brazil; Centro de Tratamento de Epilepsia Refratária (CETER), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Division of Neurology, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos n. 2.350, Porto Alegre, Brazil; Basic Research and Advanced Investigations in Neurosciences, Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
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4
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Muthiah N, Rothenberger S, Abel TJ. Socioeconomic status and healthcare utilization disparities among children with epilepsy in the United States: Results from a nationally representative sample. Sci Rep 2023; 13:21776. [PMID: 38066038 PMCID: PMC10709331 DOI: 10.1038/s41598-023-48668-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
Epilepsy affects 1% of the US population. Healthcare disparities are well-studied among adults with epilepsy but less so among children. We examined whether children with epilepsy (1) have lower income than or (2) utilize the emergency department (ED) differently from children without epilepsy, and (3) if income moderates ED utilization. Data from the 2016-2019 National Survey of Children's Health were used to identify children with active "epilepsy or seizure disorder". Children with versus without epilepsy were compared. Income and ED visits were modeled with logistic and Poisson regressions. This analysis included 131,326 children; 835 were diagnosed with epilepsy. Estimated population prevalence of epilepsy was 0.6%. Children from higher-income-households were less likely to have epilepsy (aOR: 0.7). Children with epilepsy were more likely to visit EDs (aOR = 10.2), see healthcare professionals (aOR: 2.7), and receive care from specialists (aOR: 10.3). Income moderated the relationship between having epilepsy and ED visits. 7.7% of children with epilepsy did not receive needed healthcare. Some barriers were acquiring appointments (aOR: 3.9) and transportation (aOR: 4.7). In conclusion, children with epilepsy were more likely than children without epilepsy to live in lower-income-households, visit EDs, see healthcare professionals, and not receive needed healthcare. Barrier-specific policy interventions may improve medical access for children with epilepsy.
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Affiliation(s)
- Nallammai Muthiah
- Department of Neurological Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, USA
| | - Scott Rothenberger
- Department of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Taylor J Abel
- Department of Neurological Surgery, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA, 15224, USA.
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Passos GAR, Silvado CES, Borba LAB. Drug resistant epilepsy of the insular lobe: A review and update article. Surg Neurol Int 2022; 13:197. [PMID: 35673654 PMCID: PMC9168288 DOI: 10.25259/sni_58_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/24/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Epilepsy is a chronic disease that affects millions of people around the world generating great expenses and psychosocial problems burdening the public health in different ways. A considerable number of patients are refractory to the drug treatment requiring a more detailed and specialized investigation to establish the most appropriate therapeutic option. Insular epilepsy is a rare form of focal epilepsy commonly drug resistant and has much of its investigation and treatment involved with the surgical management at some point. The insula or the insular lobe is a portion of the cerebral cortex located in the depth of the lateral sulcus of the brain; its triangular in shape and connects with the other adjacent lobes. The insular lobe is a very interesting and complex portion of the brain related with different functions. Insula in Latin means Island and was initially described in the 18th century but its relation with epilepsy was first reported in the 1940–1950s. Insular lobe epilepsy is generally difficult to identify and confirm due to its depth and interconnections. Initial non-invasive studies generally demonstrate frustrating or incoherent information about the origin of the ictal event. Technological evolution made this pathology to be progressively better recognized and understood enabling professionals to perform the correct diagnosis and choose the ideal treatment for the affected population. Methods: A literature review was performed using MEDLINE/PubMed, Scopus, and Web of Science databases. The terms epilepsy/epileptic seizure of the insula and surgical treatment was used in various combinations. We included studies that were published in English, French, or Portuguese; performed in humans with insular epilepsy who underwent some surgical treatment (microsurgery, laser ablation, or radiofrequency thermocoagulation). Results: Initial search results in 1267 articles. After removing the duplicates 710 remaining articles were analyzed for titles and abstracts applying the inclusion and exclusion criteria. 70 studies met all inclusion criteria and were selected. Conclusion: At present, the main interests and efforts are in the attempt to achieve and standardize the adequate management of the patient with refractory epilepsy of the insular lobe and for that purpose several forms of investigation and treatment were developed. In this paper, we will discuss the characteristics and information regarding the pathology and gather data to identify and choose the best therapeutic option for each case.
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Affiliation(s)
- Gustavo A. R. Passos
- UFPR Post Graduate Program in Internal Medicine, Department of Neurosurgery, Mackenzie University Hospital,
| | - Carlos E. S. Silvado
- UFPR Post Graduate Program in Internal Medicine, Department of Neurology, Hospital de Clínicas da Universidade Federal do Paraná,
| | - Luis Alencar B. Borba
- Department of Neurosurgery, Hospital de Clínicas da Universidade Federal do Paraná/Mackenzie University Hospital, Curitiba, Brazil
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Buainain RP, Oliveira CTP, Marson FAL, Ortega MM. Epidemiologic Profile of Patients With Epilepsy in a Region of Southeast Brazil: Data From a Referral Center. Front Neurol 2022; 13:822537. [PMID: 35620790 PMCID: PMC9128524 DOI: 10.3389/fneur.2022.822537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Epilepsy affects about 50 million people worldwide, 80% of whom live in low- and middle-income countries. In Brazil, epidemiological studies are outdated and restricted to specific regions, mostly due to the continental size of country. Objective We aimed to present the first evidence-based study on the epidemiological aspects of individuals with epilepsy, mapping the characteristics of this disease in a referral center in a region of Southeast Brazil. Methods A retrospective study was carried out from January 2010 to March 2021. Patients were selected according to the International League Against Epilepsy Criteria. Results From a total of 618 selected patients, 317 (51.3%) were men and 301 (48.7%) were women with an average age of 34.03 ± 20.66 years. The average age at the first seizure was 15.16 ± 17.61 years. The prevalence ratio was 1.30 cases/1,000 habitants. Childhood febrile seizure was present in 44 patients (7.9%) and family history of epilepsy in 231 (37.4%) patients. The predominant type of seizure was focal in 401 (64.9%) patients. The most frequent etiologies were structural in 254 (41.1%) patients and unknown in 238 (38.5%) patients. Most of the patients' treatments were based on anti-seizure drugs in monotherapy [389 (62.9%)] with 398 (64.4%) drug-responsive patients. Conclusions Our epilepsy prevalence rate was lower than other studies in the Southeast Region of Brazil. In addition, the structural epilepsy type was predominant in our study compared with unknown causes, which is more frequent in other Brazilian regions and worldwide studies. The differences may be attributed to our region, which presents a high prevalence of neuroinfection, specially neurocysticercosis, and a referral center for traumatic brain injury. Moreover, the contrasting results reinforce the need for an adequate epidemiological assessment of epilepsy incidence in a region of Southeast Brazil.
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Affiliation(s)
- Renata Parissi Buainain
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, São Paulo, Brazil
- Laboratory of Human and Medical Genetics, São Francisco University, São Paulo, Brazil
| | | | - Fernando Augusto Lima Marson
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, São Paulo, Brazil
- Laboratory of Human and Medical Genetics, São Francisco University, São Paulo, Brazil
| | - Manoela Marques Ortega
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, São Paulo, Brazil
- Laboratory of Human and Medical Genetics, São Francisco University, São Paulo, Brazil
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Kwon CS, Wagner RG, Carpio A, Jetté N, Newton CR, Thurman DJ. The worldwide epilepsy treatment gap: A systematic review and recommendations for revised definitions - A report from the ILAE Epidemiology Commission. Epilepsia 2022; 63:551-564. [PMID: 35001365 DOI: 10.1111/epi.17112] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE In order to more appropriately apply and understand the "epilepsy treatment gap" (ETG) concept in current health systems, revised conceptual and operational definitions of ETG are timely and necessary. This article therefore systematically reviews worldwide studies of the ETG, distinguishing high-, middle-, and low-income regions, and provides recommendations for an updated International League Against Epilepsy (ILAE) definition of ETG. METHODS A systematic review of the ETG was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. The search was conducted from January 1990 to July 2019, in the online databases of Ovid MEDLINE and Embase. Identified abstracts were reviewed in duplicate and data independently extracted using a standard proforma. Data describing treatment gap information including both diagnostic and therapeutic aspects of access to epilepsy treatment were recorded. Descriptive statistics are presented. RESULTS The treatment gap reported in the 45 distinctive populations represented 33 countries. Treatment gap definitions varied widely. The reported ETGs ranged broadly from 5.6% in Norway to 100% in parts of Tibet, Togo, and Uganda. The wide range of reported ETGs was multifactorial in origin including true differences in the availability and utilization of health care among study populations, variations in operational definitions of the epilepsy treatment gap, and methodological differences in sampling and identifying representative epilepsy cases in populations. Significance and recommendations For the ETG to be a useful metric to compare levels of unmet epilepsy care across different countries and regions, a standardized definition must be adapted, recognizing some of the limitations of the current definitions. Our proposed definition takes into account the lack of effective health care insurance, the diagnostic gap, the therapeutic gap, quality-of-care, and other unmet health care needs."
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Affiliation(s)
- Churl-Su Kwon
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Neurology, Icahn school of Medicine at Mount Sinai, New York, New York, USA.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ryan G Wagner
- MRC/Wits Agincourt Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Arturo Carpio
- Research Institute, University of Cuenca School of Medicine, Cuenca, Ecuador
| | - Nathalie Jetté
- Department of Neurology, Icahn school of Medicine at Mount Sinai, New York, New York, USA
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Mohammadzadeh P, Nazarbaghi S. The prevalence of drug-resistant-epilepsy and its associated factors in patients with epilepsy. Clin Neurol Neurosurg 2021; 213:107086. [DOI: 10.1016/j.clineuro.2021.107086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/30/2021] [Accepted: 12/04/2021] [Indexed: 11/30/2022]
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Alva-Díaz C, Navarro-Flores A, Rivera-Torrejon O, Huerta-Rosario A, Molina RA, Velásquez-Rimachi V, Morán-Mariños C, Farroñay C, Pacheco-Mendoza J, Metcalf T, Burneo JG, Pacheco-Barrios K. Prevalence and incidence of epilepsy in Latin America and the Caribbean: A systematic review and meta-analysis of population-based studies. Epilepsia 2021; 62:984-996. [PMID: 33651439 DOI: 10.1111/epi.16850] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/28/2021] [Accepted: 01/30/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study was undertaken to perform an updated systematic review and meta-analysis to estimate the pooled prevalence and incidence of epilepsy in Latin America and the Caribbean (LAC), describing trends over time, and exploring potential clinical and epidemiological factors explaining the heterogeneity in the region. METHODS Observational studies assessing the incidence or prevalence of epilepsy in LAC countries up to March 2020 were systematically reviewed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Meta-analyses and cumulative analyses were performed using random-effects models. We assessed between-study heterogeneity with sensitivity, subgroup, and meta-regression analyses. Moreover, the quality of the included studies and the certainty of evidence were evaluated using the GRADE (grading of recommendation, assessment, development, and evaluation) approach. RESULTS Overall, 40 studies (from 42 records) were included, 37 for prevalence analyses and six for incidence (312 387 inhabitants; 410 178 person-years). The lifetime prevalence was 14.09 per 1000 inhabitants (95% confidence interval [CI] = 11.72-16.67), for active epilepsy prevalence was 9.06 per 1000 individuals (95% CI = 6.94-11.44), and the incidence rate was 1.11 per 1000 person-years (95% CI = .65-1.70). These high estimates have been constant in the region since 1990. However, substantial statistical heterogeneity between studies and publication bias were found. The overall certainty of evidence was low. Methodological aspects (sample size) and countries' epidemiological characteristics such as access to sanitation services and child and adult mortality rates explained the high heterogeneity. Finally, the prevalence of epilepsy associated with neurocysticercosis (NCC) in the general population was high, and the proportion of NCC diagnosis among people living with epilepsy was 17.37%. SIGNIFICANCE The epilepsy prevalence and incidence in LAC are higher than worldwide estimates, being constant since 1990 and strongly influenced by NCC. We identified high between-study heterogeneity and significant methodological limitations (e.g., heterogeneous definitions, lack of longitudinal studies). The region needs upgraded research using standardized definitions and diagnostic methods, and urgent action against preventable causes.
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Affiliation(s)
- Carlos Alva-Díaz
- Neurosciences, Clinical Effectiveness and Public Health Research Group, Universidad Cientifica del Sur, Lima, Peru
| | - Alba Navarro-Flores
- Clinical and Health Efficacy Network, REDECS, Lima, Peru.,School of Medicine, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Oscar Rivera-Torrejon
- Neurosciences, Clinical Effectiveness and Public Health Research Group, Universidad Cientifica del Sur, Lima, Peru.,Clinical and Health Efficacy Network, REDECS, Lima, Peru
| | - Andrely Huerta-Rosario
- Neurosciences, Clinical Effectiveness and Public Health Research Group, Universidad Cientifica del Sur, Lima, Peru.,Clinical and Health Efficacy Network, REDECS, Lima, Peru.,School of Medicine, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Roberto A Molina
- Neurosciences, Clinical Effectiveness and Public Health Research Group, Universidad Cientifica del Sur, Lima, Peru.,Clinical and Health Efficacy Network, REDECS, Lima, Peru.,School of Medicine, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Victor Velásquez-Rimachi
- Neurosciences, Clinical Effectiveness and Public Health Research Group, Universidad Cientifica del Sur, Lima, Peru.,Clinical and Health Efficacy Network, REDECS, Lima, Peru
| | - Cristian Morán-Mariños
- Clinical and Health Efficacy Network, REDECS, Lima, Peru.,San Ignacio de Loyola University, Lima, Peru
| | | | | | - Tatiana Metcalf
- Neurology Department, Department of Medicine and Office for Teaching Support and Research, Daniel Alcides Carrion Hospital, Callao, Peru
| | - Jorge G Burneo
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine, Western University, London, Canada
| | - Kevin Pacheco-Barrios
- Research Unit for the Generation and Synthesis of Evidence in Health, San Ignacio de Loyola University, Lima, Peru.,SYNAPSIS Mental Health and Neurology, Lima, Peru.,Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, USA
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10
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Beydoun A, DuPont S, Zhou D, Matta M, Nagire V, Lagae L. Current role of carbamazepine and oxcarbazepine in the management of epilepsy. Seizure 2020; 83:251-263. [PMID: 33334546 DOI: 10.1016/j.seizure.2020.10.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/30/2020] [Accepted: 10/22/2020] [Indexed: 02/08/2023] Open
Abstract
Epilepsy is one of the most common neurological disorders, affecting approximately 50 million people worldwide. Despite a dramatic increase in treatment options over the past 30 years, it still ranks fourth in the world's disease burden. There are now close to 30 antiepileptic drugs (AEDs), with more than two thirds introduced to the market after carbamazepine (CBZ) and one third after its derivative, oxcarbazepine (OXC). Following the introduction of these newer AEDs, the role of CBZ and OXC in the therapeutic armamentarium for seizure control and effective epilepsy management needs to be reviewed. The main guidelines list both CBZ and OXC as first-line options or second-line alternatives for the treatment of focal-onset epilepsy and primary generalized tonic-clonic seizures. While evidence suggests that overall AEDs have similar efficacy, some newer AEDs may be better tolerated than CBZ. In line with this, there have been changes in treatment patterns, with many variations across different countries. However, CBZ remains among the two or three most prescribed drugs for focal epilepsy in many countries, and is widely used across Europe, Africa, South America, and Asia, where it represents a good compromise between cost, availability, and effectiveness. OXC is among the first-choice options for the initial treatment of focal-onset seizures in several countries, including the US and China, where the oral suspension is commonly prescribed. This review provides guidance on the optimal use of these two drugs in clinical practice, including in children, the elderly, and in pregnancy.
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Affiliation(s)
- Ahmad Beydoun
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sophie DuPont
- Epilepsy Unit and Rehabilitation Unit, Hôpital de la Pitié-Salpêtrière, AP-HP, Centre de recherche de l'Institut du cerveau et de la moelle épinière (ICM), UMPC-UMR 7225 CNRS-UMRS 975 Inserm, Paris, France; Université Paris Sorbonne, Paris, France
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Maha Matta
- Novartis Pharma Services, Dubaï, United Arab Emirates
| | | | - Lieven Lagae
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium.
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How predictable is cognitive performance in Brazilian patients with pharmacoresistant mesial temporal lobe epilepsy? Epilepsy Behav 2020; 112:107453. [PMID: 33181899 DOI: 10.1016/j.yebeh.2020.107453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of the study was to investigate the independent association between clinical, demographic, psychiatric, radiologic, electrophysiological, and pharmacologic variables and cognitive performance of Brazilian patients with pharmacoresistant mesial temporal lobe epilepsy (MTLE). METHODS Ninety-three patients with pharmacoresistant MTLE related to hippocampal sclerosis (HS) were included in the study. Multiple linear regressions were done to identify predictor variables for 24 cognitive tests. Independent variables analyzed were sex, hand dominance, age, years of education, marital status, work activity, history for an initial precipitant injury (IPI), family history of epilepsy, lesion side, antiseizure medication (ASM) treatment type, ASM serum levels, benzodiazepine (BDZ) treatment, age at epilepsy onset, disease duration, monthly frequency of seizures, and Hospital Anxiety and Depression Scale (HADS) scores. RESULTS Years of education was an independent and positive predictor in 22 of the 24 cognitive tests evaluated. Male sex was also a positive predictor of one cognitive test. Variables negatively associated with cognitive performance were left side lesion (10 tests), disease duration (5 tests), polytherapy (3 tests), ASM serum levels (3 tests), and BDZ treatment or not working (1 test each). The regression model explained between 6% and 44% of the cognitive test scores variation. SIGNIFICANCE In Brazilian patients with pharmacoresistant MTLE-HS, up to 44% of cognitive test scores variation is predictable by clinical, demographic, psychiatric, radiologic, electrophysiology, and pharmacological variables. The identification of predictors of cognitive performance may be helpful for better planning of patient care.
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Oliveira Young C, Etchbehere ECSC, Souza EM, Brunetto SQ, Santos ADO, Lima MCL, Ortiz-De la Rosa S, Alvim M, Yasuda CL, Ramos CD, Cendes F, Amorim BJ. Clinical Usefulness of SISCOM-SPM Compared to Visual Analysis to Locate the Epileptogenic Zone. Front Neurol 2020; 11:467. [PMID: 32547479 PMCID: PMC7273921 DOI: 10.3389/fneur.2020.00467] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/29/2020] [Indexed: 01/28/2023] Open
Abstract
Introduction: Subtraction of ictal-interictal SPECT co-registered to MRI (SISCOM) is a quantification tool that can improve the sensitivity and specificity of the epileptogenic zone (EZ) localization. Commercially available image analysis software packages for SISCOM are costly, and Statistical Parametric Mapping (SPM) could be an alternative free software for the definition of the EZ. There are only a few studies that compare SISCOM using SPM (SISCOM-SPM) with visual analysis. Aim: To compare SISCOM-SPM vs. visual analysis for localization of the EZ in patients with pharmacoresistant focal epilepsies. Materials and methods: We evaluated all our patients with focal epilepsies that underwent ictal and interictal SPECT. We defined the reference standard to locate the EZ by pathology and follow-up (in patients submitted to surgery), or seizure semiology, serial EEG, long-term video-EEG, 18F-FDG PET/CT, and MRI (in patients who were not operated). We compared the location of the EZ by visual analysis of SPECT images and by SISCOM-SPM to the reference standard and classified as concordant, discordant, or partially concordant. Results: We included 23 patients. Visual analysis was concordant with the EZ reference standard in only 13 patients (56.5%), while SISCOM-SPM was concordant in 18 cases (78.3%), providing a 21.8% increase in the location of EZ. However, this difference was not significant due to the small sample size (p = 0.0856). Conclusion: Our preliminary results demonstrate that, in clinical practice, SISCOM-SPM has the potential to add information that might help localize the EZ compared to visual analysis. SISCOM-SPM has a lower cost than other commercially available SISCOM software packages, which is an advantage for developing countries. Studies with more patients are necessary to confirm our findings.
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Affiliation(s)
- Carla Oliveira Young
- Division of Nuclear Medicine, Department of Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Elba C S C Etchbehere
- Division of Nuclear Medicine, Department of Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Edna Marina Souza
- Center of Biomedical Engineering, University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Allan de Oliveira Santos
- Division of Nuclear Medicine, Department of Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Mariana C L Lima
- Division of Nuclear Medicine, Department of Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Marina Alvim
- Division of Epilepsy, Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Clarissa Lin Yasuda
- Division of Epilepsy, Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Celso Darío Ramos
- Division of Nuclear Medicine, Department of Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Fernando Cendes
- Division of Epilepsy, Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Barbara Juarez Amorim
- Division of Nuclear Medicine, Department of Radiology, University of Campinas (UNICAMP), Campinas, Brazil
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Mogal Z, Aziz H. Epilepsy treatment gap and stigma reduction in Pakistan: A tested public awareness model. Epilepsy Behav 2020; 102:106637. [PMID: 31805506 DOI: 10.1016/j.yebeh.2019.106637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/28/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Abstract
High epilepsy treatment gap (ETG) and stigma remain a major issue globally. Addressing the basic problems is necessary, for advances in management to be effective. According to the 1987 population-based study, prevalence of active epilepsy in Pakistan is 0.98% with 98.1% ETG in rural and 72.5% in urban population and the presence of stigma. These dismal figures were a stimulus for our reported activities. Recognizing the problems faced by 2.2 million people with epilepsy (PWE) in the country, a group of volunteers mostly from the medical community has attempted to address these issues with an ongoing sustained awareness program over the last 18 years, working within the constraints of prevailing healthcare system, with gratifying results. In 2001, under a nongovernmental organization (NGO), the Comprehensive Epilepsy Control Programme of Pakistan (CECP) was launched to address the various paucities in knowledge, attitude, and practice about epilepsy; especially ETG and stigma. The CECP has two primary components: Epilepsy Support Pakistan (CECP-ESP) for awareness and mass education and National Epilepsy Centre (CECP-NEC) for holistic management of PWE, professional education, and research. Both work in tandem, and there is an overlap of their activities. This article only evaluates the outcome of sustained awareness activities of the CECP-ESP, through direct and indirect measures after 5 years of its initiation. A significant reduction in ETG and stigma exclusively through public awareness has been possible. This model can be easily replicated by any country, with involvement of the local population.
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Affiliation(s)
- Zarine Mogal
- National Epilepsy Centre, Jinnah Postgraduate Medical Centre, Rafiqui Shaheed Road, Karachi 75510, Pakistan.
| | - Hasan Aziz
- National Epilepsy Centre, Jinnah Postgraduate Medical Centre, Rafiqui Shaheed Road, Karachi 75510, Pakistan
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Ferreira Neto Segundo A, Silva MDME, Mercer PBS, Reinert C, Borges EF, Siqueira JM, Bomediano MP, Witt MCZ. The patient with epilepsy and medicolegal aspects: a view for the neurologist. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:741-745. [PMID: 31664350 DOI: 10.1590/0004-282x20190133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/04/2019] [Indexed: 11/22/2022]
Abstract
Patients with epilepsy face innumerable obstacles in daily life, related to work, permission to drive and interpersonal relationships, which require medical guidance. This paper reports a literature review based on scientific articles and civil and traffic system, as a way to resolve doubts about medical obligations in the patient's permission to drive and work. An employment agreement requires the contractor to guarantee safety conditions as well as requiring the patient, at the pre-employment medical examination, to let the physician know previous medical conditions, including epilepsy. More than 90% of patients with epilepsy omit this information during the application assessment, thus being subject to imputation of ideological falsehood crime as disposied on article 299 of Brazilian Penal Code. Medical confidentiality breaches may only occur in specific situations. In Brazil, the authorization and driver's license renewal is governed by the Brazilian Traffic Code (Federal Law n° 9503/1997). For patient evaluations, two groups are considered: those on antiepileptic medication and those on medication withdrawal. A favorable report from the attending physician is also required, in both categories. Seizures that occur exclusively during sleep, and focal aware events or prolonged aura are not differentiated from other seizure types disposed in the traffic law. It is the responsibility of the attending physician to analyze each patient individually to resolve conflicts between public safety and the individual patient's independence. A frank and honest doctor-patient relationship is essential for the patient to understand the public and individual consequences of epileptic seizures and to feel comfortable seeking medical help.
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Affiliation(s)
| | - Maren de Moraes E Silva
- Hospital da Cruz Vermelha Brasileira Filial do Paraná, Departamento de Neurologia, Curitiba PR, Brasil
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Zafar A, Shahid R, Nazish S, Aljaafari D, Alkhamis FA, Alsalman S, Msmar AH, Abbasi B, Alsulaiman AA, Alabdali M. Nonadherence to Antiepileptic Medications: Still a Major Issue to be Addressed in the Management of Epilepsy. J Neurosci Rural Pract 2019; 10:106-112. [PMID: 30765980 PMCID: PMC6337980 DOI: 10.4103/jnrp.jnrp_136_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Context: Medication nonadherence is a significant barrier in achieving seizure freedom in patients with epilepsy. There is a deficiency of data about the reasons for nonadherence in Saudi population. Aims: The aim of this study is to prove the existence of nonadherence to antiepileptic drugs (AEDs) in patients with epilepsy and identify the responsible factors. Setting and Design: This is a prospective, cross-sectional study carried in the Department of Neurology at King Fahd Hospital of the University affiliated with Imam Abdulrahman Bin Faisal University. Subjects and Methods: Patients of all ages diagnosed to have epilepsy as mentioned in their medical record and taking antiepileptic medications were interviewed using a questionnaire. Statistical Analysis Used: Statistical analysis was performed using IBM Statistical Package for the Social Sciences version 21 (IBM Corp., Armonk, NY, USA). Statistical significance was defined as two-tailed with a P ≤ 0.05. Results: Among 152 participants, 52.6% were male and 47.4% were female. Mean age of the patients was 28 ± 14.3 (mean ± standard deviation) years. Of 152 patients, 48.7% were found to be nonadherent to their AED therapy. The most commonly identified factor was forgetfulness. Nonadherence was significantly associated with poor seizure control (P = 0.002). Conclusion: Nonadherence to the AED is common among patients with epilepsy and affects seizure control adversely.
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Affiliation(s)
- Azra Zafar
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Kingdom of Saudi Arabia
| | - Rizwana Shahid
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Kingdom of Saudi Arabia
| | - Saima Nazish
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Kingdom of Saudi Arabia
| | - Danah Aljaafari
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Kingdom of Saudi Arabia
| | - Fahd Ali Alkhamis
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Kingdom of Saudi Arabia
| | - Sadiq Alsalman
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Kingdom of Saudi Arabia
| | - Amir H Msmar
- Department of Research Statistical Support, Deanship of Scientific Research, Imam Abdulrahman Bin Faisal University, Dammam 34212, Kingdom of Saudi Arabia
| | - Badaruddin Abbasi
- Department of Research Ethics, Deanship of Scientific Research, Imam Abdulrahman Bin Faisal University, Dammam 34212, Kingdom of Saudi Arabia
| | - Abdulla A Alsulaiman
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Kingdom of Saudi Arabia
| | - Majed Alabdali
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Kingdom of Saudi Arabia
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Senay B, Gashu KD, Jemere AT, Mekonnen ZA. Epileptic patients' willingness to receive cell-phone based medication reminder in Northwest Ethiopia. BMC Med Inform Decis Mak 2019; 19:109. [PMID: 31230591 PMCID: PMC6589869 DOI: 10.1186/s12911-019-0830-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/30/2019] [Indexed: 11/13/2022] Open
Abstract
Background Poor adherence compromises medication treatment effectiveness which results in suboptimal illness control. This can lead to increased use of healthcare services, reduction in patients’ quality of life and increased healthcare costs. Reminding patients of their medication intake increases their adherence. Therefore, this study aimed to assess the willingness of epileptic patients to receive cell-phone based medication reminders and its associated factors in Northwest Ethiopia. Methods Institution based cross sectional study was conducted in the study period scheduled from March 1 to April 30, 2018 to interview 422 study participants at University of Gondar Comprehensive and Specialized Hospital, Northwest Ethiopia. Systematic random sampling was used to select 422 epileptic patients. A structured interviewer administered questionnaire was used to collect data and analyzed by using SPSS version 21. Binary and multivariate logistic regression analysis was performed to identify the determinant factors for willingness to receive cell-phone based medication reminders. P < 0.05 at 95% confidence interval was considered statistically significant. Results A total of 394 (93% response rate) respondents were interviewed. The majority of respondents 262 (66.5%) owned a cellphone. Among the participants 271 (68.8%) were willing to receive reminder messages. In the multivariate regression analysis; living in urban areas (AOR = 5.63, 95% CI; 3.18–9.96), experience of forgetting things (AOR = 2.63, 95% CI; 1.44–4.80), forgetting to take Long-term Antiepileptic Drugs (AEDs) (AOR = 2.17, 95% CI; 1.06–4.43) and average monthly income ≥2000 birr (AOR = 2.43, 95% CI; 1.03–5.75) were significantly associated with willingness to receive cell-phone medication reminders. Pertaining to marital status; being married (AOR = 5.75, 95% CI; 1.11–29.70) or divorced (AOR = 5.15, 95% CI; 1.29–20.49) participants were also more willing to receive cell-phone medication reminders as compared to singles. Conclusion Most respondents have a cellphone and were willing to use it as a medication reminder. Marital status, place of residence, average monthly income, experience of forgetting things since they started AED, forget to take AED are the most notable factors that are associated with the willingness of patients to receive cell phone drug reminder messages.
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Affiliation(s)
- Bereket Senay
- University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Kassahun Dessie Gashu
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adamu Takele Jemere
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Zeleke Abebaw Mekonnen
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Vaughan KA, Lopez Ramos C, Buch VP, Mekary RA, Amundson JR, Shah M, Rattani A, Dewan MC, Park KB. An estimation of global volume of surgically treatable epilepsy based on a systematic review and meta-analysis of epilepsy. J Neurosurg 2019; 130:1127-1141. [PMID: 30215556 DOI: 10.3171/2018.3.jns171722] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 03/12/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Epilepsy is one of the most common neurological disorders, yet its global surgical burden has yet to be characterized. The authors sought to compile the most current epidemiological data to quantify global prevalence and incidence, and estimate global surgically treatable epilepsy. Understanding regional and global epilepsy trends and potential surgical volume is crucial for future policy efforts and resource allocation. METHODS The authors performed a systematic literature review and meta-analysis to determine the global incidence, lifetime prevalence, and active prevalence of epilepsy; to estimate surgically treatable epilepsy volume; and to evaluate regional trends by WHO regions and World Bank income levels. Data were extracted from all population-based studies with prespecified methodological quality across all countries and demographics, performed between 1990 and 2016 and indexed on PubMed, EMBASE, and Cochrane. The current and annual new case volumes for surgically treatable epilepsy were derived from global epilepsy prevalence and incidence. RESULTS This systematic review yielded 167 articles, across all WHO regions and income levels. Meta-analysis showed a raw global prevalence of lifetime epilepsy of 1099 per 100,000 people, whereas active epilepsy prevalence is slightly lower at 690 per 100,000 people. Global incidence was found to be 62 cases per 100,000 person-years. The meta-analysis predicted 4.6 million new cases of epilepsy annually worldwide, a prevalence of 51.7 million active epilepsy cases, and 82.3 million people with any lifetime epilepsy diagnosis. Differences across WHO regions and country incomes were significant. The authors estimate that currently 10.1 million patients with epilepsy may be surgical treatment candidates, and 1.4 million new surgically treatable epilepsy cases arise annually. The highest prevalences are found in Africa and Latin America, although the highest incidences are reported in the Middle East and Latin America. These regions are primarily low- and middle-income countries; as expected, the highest disease burden falls disproportionately on regions with the fewest healthcare resources. CONCLUSIONS Understanding of the global epilepsy burden has evolved as more regions have been studied. This up-to-date worldwide analysis provides the first estimate of surgical epilepsy volume and an updated comprehensive overview of current epidemiological trends. The disproportionate burden of epilepsy on low- and middle-income countries will require targeted diagnostic and treatment efforts to reduce the global disparities in care and cost. Quantifying global epilepsy provides the first step toward restructuring the allocation of healthcare resources as part of global healthcare system strengthening.
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Affiliation(s)
- Kerry A Vaughan
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Christian Lopez Ramos
- 2University of California San Diego School of Medicine, La Jolla, California
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Vivek P Buch
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rania A Mekary
- 3Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS University, Boston
- 4Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School
| | - Julia R Amundson
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- 6Miller School of Medicine, University of Miami, Florida
| | - Meghal Shah
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- 7Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Abbas Rattani
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- 8Meharry Medical College, School of Medicine, Nashville; and
| | - Michael C Dewan
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- 9Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kee B Park
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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Global, regional, and national burden of epilepsy, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2019; 18:357-375. [PMID: 30773428 PMCID: PMC6416168 DOI: 10.1016/s1474-4422(18)30454-x] [Citation(s) in RCA: 485] [Impact Index Per Article: 97.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/23/2018] [Accepted: 11/14/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Seizures and their consequences contribute to the burden of epilepsy because they can cause health loss (premature mortality and residual disability). Data on the burden of epilepsy are needed for health-care planning and resource allocation. The aim of this study was to quantify health loss due to epilepsy by age, sex, year, and location using data from the Global Burden of Diseases, Injuries, and Risk Factors Study. METHODS We assessed the burden of epilepsy in 195 countries and territories from 1990 to 2016. Burden was measured as deaths, prevalence, and disability-adjusted life-years (DALYs; a summary measure of health loss defined by the sum of years of life lost [YLLs] for premature mortality and years lived with disability), by age, sex, year, location, and Socio-demographic Index (SDI; a compound measure of income per capita, education, and fertility). Vital registrations and verbal autopsies provided information about deaths, and data on the prevalence and severity of epilepsy largely came from population representative surveys. All estimates were calculated with 95% uncertainty intervals (UIs). FINDINGS In 2016, there were 45·9 million (95% UI 39·9-54·6) patients with all-active epilepsy (both idiopathic and secondary epilepsy globally; age-standardised prevalence 621·5 per 100 000 population; 540·1-737·0). Of these patients, 24·0 million (20·4-27·7) had active idiopathic epilepsy (prevalence 326·7 per 100 000 population; 278·4-378·1). Prevalence of active epilepsy increased with age, with peaks at 5-9 years (374·8 [280·1-490·0]) and at older than 80 years of age (545·1 [444·2-652·0]). Age-standardised prevalence of active idiopathic epilepsy was 329·3 per 100 000 population (280·3-381·2) in men and 318·9 per 100 000 population (271·1-369·4) in women, and was similar among SDI quintiles. Global age-standardised mortality rates of idiopathic epilepsy were 1·74 per 100 000 population (1·64-1·87; 1·40 per 100 000 population [1·23-1·54] for women and 2·09 per 100 000 population [1·96-2·25] for men). Age-standardised DALYs were 182·6 per 100 000 population (149·0-223·5; 163·6 per 100 000 population [130·6-204·3] for women and 201·2 per 100 000 population [166·9-241·4] for men). The higher DALY rates in men were due to higher YLL rates compared with women. Between 1990 and 2016, there was a non-significant 6·0% (-4·0 to 16·7) change in the age-standardised prevalence of idiopathic epilepsy, but a significant decrease in age-standardised mortality rates (24·5% [10·8 to 31·8]) and age-standardised DALY rates (19·4% [9·0 to 27·6]). A third of the difference in age-standardised DALY rates between low and high SDI quintile countries was due to the greater severity of epilepsy in low-income settings, and two-thirds were due to a higher YLL rate in low SDI countries. INTERPRETATION Despite the decrease in the disease burden from 1990 to 2016, epilepsy is still an important cause of disability and mortality. Standardised collection of data on epilepsy in population representative surveys will strengthen the estimates, particularly in countries for which we currently have no or sparse data and if additional data is collected on severity, causes, and treatment. Sizeable gains in reducing the burden of epilepsy might be expected from improved access to existing treatments in low-income countries and from the development of new effective drugs worldwide. FUNDING Bill & Melinda Gates Foundation.
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Ullah S, Ali N, Khan A, Ali S, Nazish HR. The Epidemiological Characteristics of Epilepsy in the Province of Khyber Pakhtunkhwa, Pakistan. Front Neurol 2018; 9:845. [PMID: 30459698 PMCID: PMC6232227 DOI: 10.3389/fneur.2018.00845] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 09/20/2018] [Indexed: 02/05/2023] Open
Abstract
Previous studies have shown that Khyber Pakhtunkhwa, Pakistan has a high incidence of epilepsy and a high proportion of low socioeconomic background and high treatment gap. Considering the changes over the past 20 years little is known about the current epidemiological characteristics of epilepsy in Khyber Pakhtunkhwa, Pakistan. The current study was focused to find the impact of various contributing factors on the clinical response to anti-epileptic drugs in the KP population, Pakistan. A total of 315 participants aged 19.1 ± 8.6 years were examined. Mean age of the patients was 18 ± 8.1 year. Epilepsy was high in male patients (64.39%) and urban areas (60.1%). Mostly, 88.6% of patients were belonging to low socioeconomic status background. 42.4% patients have positive family history for epilepsy and 42.8% patients had consanguineous marriages. Middle SES class patients (OR, 2.22 [CI, 0.54-9.1]) were slightly associated with controlled response to CBZ and VPA therapy. Absence seizure (OR, 1.16 [CI, 0.59-2.3]), and Complex partial seizure (OR, 1.29 [CI, 0.58-6.3]) showed good response to CBZ therapy while, Myoclonic seizure (OR, 2.23 [CI, 0.05-8.8]) was responsive to VPA therapy. However, non-compliance (R 2 0.82, P < 0.0001) and nature of seizures (R 2 0.83, P < 0.0001) were associated with the high risk for poor response to both CBZ and VPA therapy. Epilepsy was high in male patients and in urban areas. Most patients were belonging to low socioeconomic status. Non-compliance, low socioeconomic and nature of seizures strongly predict poor clinical response of anti-epileptic drugs therapy.
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Affiliation(s)
- Shakir Ullah
- Pharmacology/Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
- Center for Neuroscience, Shantou University Medical College, Shantou, China
| | - Niaz Ali
- Pharmacology/Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Adnan Khan
- Neurology Departments, Lady Reading Hospital Peshawar, Peshawar, Pakistan
| | - Saad Ali
- Neurology Departments, Lady Reading Hospital Peshawar, Peshawar, Pakistan
| | - Haleema Rehana Nazish
- Pharmacology/Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
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Durkin MS, Yeargin-Allsopp M. Socioeconomic Status and Pediatric Neurologic Disorders: Current Evidence. Semin Pediatr Neurol 2018; 27:16-25. [PMID: 30293586 PMCID: PMC8340602 DOI: 10.1016/j.spen.2018.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Socioeconomic status (SES) is an important risk factor for many neurological disorders and a determinant of health outcomes and quality of life, especially for individuals with neurologic disorders and developmental disabilities. This article focuses on the relationship between SES and pediatric epilepsy, cerebral palsy, autism spectrum disorder, and intellectual disability. Disparities in the prevalence and long-term impact of SES on functioning in persons with disabilities are observed worldwide. Clinicians can use the information presented in the article to target early identification and interventions for improving outcomes in populations most at risk for these disorders and for poor health, social, and economic outcomes.
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Affiliation(s)
- Maureen S Durkin
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, Wisconsin
| | - Marshalyn Yeargin-Allsopp
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
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Yu Z, Dong K, Chang H, Huang X, Ren Y, Fan C, Ma Q, Song H, Zhang Q, Zhang J, Huang L. The epidemiological and clinical characteristics study on epilepsy in 8 ethnic groups of China. Epilepsy Res 2017; 138:110-115. [PMID: 29126018 DOI: 10.1016/j.eplepsyres.2017.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/20/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
Abstract
To survey the epidemiological characteristics and clinical features on epilepsy in eight ethnic groups in Yunnan province of China. METHODES The investigation was based on the WHO questionnaire and ICBERG screening questionnaire. This study was performed through random cluster sampling and door-to-door survey. RESULTS A total of 76,302 individuals from eight ethnic groups were surveyed. The crude prevalence of epilepsy ranged from 1.2/1000 to 6.5/1000 in the eight ethnic groups, and the age-adjusted prevalence of epilepsy was from 2.1/1000 to 7.3/1000. The prevalence of active epilepsy varied from 1.0/1000 to 5.2/1000 in the eight ethnic groups, and the age-adjusted prevalence of active epilepsy was from 1.8/1000 to 6.7/1000. The age peak for seizures was below twenty, the patients of 61.1%-95.0% suffered from generalized seizures and 5%-21.2% had partial seizures. More than 60% of the cases in five ethnic groups, and the frequency of seizures were more than 10 events per year. More than 50% in other three ethnic groups, and the seizures had occurred less than 10 events per year. The treatment gap for active epilepsy ranged from 43.7% to 100.0% among the eight ethnic groups, while the natural remission rate varied from 5.6% to 21.0%. CONCLUSION There were both disparity and similarity in the epidemiological and clinical features of epilepsy in different ethnic group communities.
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Affiliation(s)
- ZhiPeng Yu
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100191, PR China.
| | - Kai Dong
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100191, PR China.
| | - Hong Chang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100191, PR China.
| | - XiaoQin Huang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100191, PR China.
| | - Yi Ren
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100191, PR China.
| | - ChunQiu Fan
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100191, PR China.
| | - QingFeng Ma
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100191, PR China.
| | - HaiQing Song
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100191, PR China.
| | - Qian Zhang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100191, PR China.
| | - Jing Zhang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100191, PR China.
| | - LiYuan Huang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100191, PR China.
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Radović NI, Božić K, Đurić AP, Vodopić S, Radulović L, Vujisić S. Health-related quality of life in adolescents with epilepsy in Montenegro. Epilepsy Behav 2017; 76:105-109. [PMID: 28919387 DOI: 10.1016/j.yebeh.2017.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/05/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of this study was to establish potential risk factors for poor health-related quality of life among adolescents with epilepsy in Montenegro. MATERIAL AND METHODS A sample of 104 adolescents with epilepsy (age: 11-19years) at a tertiary referral center in Podgorica, Montenegro, completed the validated Serbian version of the QOLIE-AD-48 questionnaire. They were divided into two groups: a group with active epilepsy (60 adolescents) and a group with inactive epilepsy (44 adolescents). Demographic and clinical data were collected. RESULTS Adolescents with active epilepsy had low quality of life and felt the negative impact of the disease. They also had more cognitive impairments, felt more stigmatized, and had considerably more distorted perception of their health than adolescents with inactive epilepsy (p<0.05). Females reported better social support than males (p<0.05). Older males had lower grades at school (p<0.05) than the younger ones. As expected, adolescents with the highest number of seizures in the past two years had the lowest quality of life (p<0.05). CONCLUSION In our study, the quality of life in adolescents with epilepsy was determined by severity of the disease, age, and gender.
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Affiliation(s)
- Nelica Ivanović Radović
- Institute of Child Health, Clinical Center of Montenegro, Podgorica, Montenegro; Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Ksenija Božić
- Neurology Clinic, Clinical Center of Vojvodina, Novi Sad, Serbia; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | | | - Sanja Vodopić
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro; Neurology Clinic, Clinical Center of Montenegro, Podgorica, Montenegro
| | - Ljiljana Radulović
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro; Neurology Clinic, Clinical Center of Montenegro, Podgorica, Montenegro
| | - Slavica Vujisić
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro; Neurology Clinic, Clinical Center of Montenegro, Podgorica, Montenegro.
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Economic evaluation of childhood epilepsy in a resource-challenged setting: A preliminary survey. Epilepsy Behav 2017; 76:84-88. [PMID: 28917500 DOI: 10.1016/j.yebeh.2017.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/14/2017] [Accepted: 08/14/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Considerable disease variability exists between patients with epilepsy, and the societal costs for epilepsy care are overall high, because of high frequency in the general population especially in children from developing countries. MATERIALS AND METHODS A cross-sectional study where children with established diagnosis of epilepsy were interviewed using a semi-structured questionnaire. Prevalence-based costs were stratified by patients' sociodemographic characteristics and socioeconomic scores (SES). The 'bottom-up' and 'human capital' approaches were used to generate estimates on the direct and indirect (productivity losses) costs of epilepsy, respectively. All estimates of the financial burden of epilepsy were analyzed from the 'societal perspective' using IBM SPSS statistics software, version 20.0. RESULTS The study had 103 enrollees with most in the age group of 0-5years (45.6%). Majority (61.3%) belong to the low socioeconomic class (Ogunlesi SES class IV and V) and reside (80.6%) in an urban setting. The total direct and indirect costs per month were ₦2,149,965.00 ($8497.88) and ₦363,187.80 ($1435.52), respectively. The cost of care per patient per annum was ₦292,794.50 ($1157.29), and the total cost for all the patients per year was ₦30,157,833.60 ($119,200.92). Investigative procedures are the principal cost drivers (₦15,861.17 or $18.15) comprising approximately 58.7% of the total direct costs per patient. CONCLUSIONS Cost of investigations contributed immensely to the total direct cost of care in our study. With the present economic situation in the country, out-of-pocket payments may contribute significantly to catastrophic expenditures and worsening of secondary treatment gap in children with epilepsy.
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Abstract
Epilepsy is a highly prevalent chronic neurologic disorder and leads to social, behavioural, health and economic consequences. ‘Treatment gap’ varies from 10 per cent in developed countries to 75 per cent in low-income countries. Stigma and discrimination related to epilepsy are prevalent worldwide. Electroencephalography (EEG) is considered the most important tool for evaluating the patient with epilepsy. Video-EEG monitoring is an important tool for confirming the seizure type and estimating the epileptogenic zone in the brain. Neuroimaging evaluation is important to determine the aetiology of the epilepsies. Genetic testing has increased the probability of identifying the causes of some types of epilepsies. Epilepsy can be treated in an affordable way with low-cost medications. Refractory epilepsies occur in approximately one-third of recently diagnosed patients with epilepsy. For this group of patients, there are options of surgical treatment, diets and neurostimulation to improve seizure control and quality of life. In poorly organized societies, there is a lack of prioritization of epilepsy in national health policies, limited resources for trained personnel and a shortage of basic antiepileptic medications. There is evidence of improvement in the understanding of epilepsy and a clear progress in the management of epileptic seizures in recent times.
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Addressing the social determinants of health in people with epilepsy. Epilepsy Behav 2017; 66:132. [PMID: 27756585 DOI: 10.1016/j.yebeh.2016.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 08/15/2016] [Indexed: 11/21/2022]
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Shorvon S. Neurology Worldwide. Neurology 2016. [DOI: 10.1002/9781118486160.ch1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Jennum P, Pickering L, Christensen J, Ibsen R, Kjellberg J. Welfare cost of childhood- and adolescent-onset epilepsy: A controlled national study. Epilepsy Behav 2016; 61:72-77. [PMID: 27317897 DOI: 10.1016/j.yebeh.2016.04.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 04/28/2016] [Accepted: 04/29/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Epilepsy is associated with a significant burden to patients and society. We calculated the factual excess in direct and indirect costs associated with childhood- and adolescent-onset epilepsy. METHODS Using records from the Danish National Patient Registry (1998-2002), we identified 3123 and 5018 patients with epilepsy aged 0-5years and 6-20years at the time of diagnosis, respectively. The two age groups of patients with epilepsy were matched to 6246 and 10,036 control persons without epilepsy, respectively, by gender, age, and geography. The controls were randomly chosen from the Danish Civil Registration System. Welfare costs included outpatient services, inpatient admissions, and emergency room visits based on the Danish National Patient Registry and information from the primary health-care sector based on data from the Danish Ministry of Health. This allowed the total health-care cost of epilepsy to be estimated. The use and costs of drugs were based on data from the Danish Medicines Agency. The frequencies of visits to outpatient clinics and hospitalizations and costs from primary sectors were based on data obtained from the National Patient Registry. RESULTS Children with epilepsy had higher welfare costs than controls. The highest cost was found one year after diagnosis, with higher costs up to 10years after diagnosis compared with controls. Children aged 0-5years incurred greater health-care costs than those aged 6-20years. CONCLUSION Epilepsy has major socioeconomic consequences for the individual person with epilepsy and for society.
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Affiliation(s)
- Poul Jennum
- Danish Center for Sleep Medicine, Neurophysiology Clinic, Faculty of Health Sciences, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
| | - Line Pickering
- Danish Center for Sleep Medicine, Neurophysiology Clinic, Faculty of Health Sciences, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
| | - Jakob Christensen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
| | - Rikke Ibsen
- itracks, Klosterport 4E, 4, Aarhus, Denmark.
| | - Jakob Kjellberg
- Danish National Institute for Local and Regional Government Research, Copenhagen, Denmark.
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Noble AJ, Marson AG. Should we stop saying "epileptic"? A comparison of the effect of the terms "epileptic" and "person with epilepsy". Epilepsy Behav 2016; 59:21-7. [PMID: 27084979 DOI: 10.1016/j.yebeh.2016.03.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/08/2016] [Accepted: 03/10/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The advantages and disadvantages of using "epileptic" as a noun to describe someone with epilepsy have long been debated. Recent high-profile recommendations have stated that the term should not be used, including in English, as it perpetuates stigma. This decision was largely informed by a Brazilian Global Campaign Against Epilepsy study that reported experimental evidence indicating that, with students, the label evokes more negative attitudes than "person with epilepsy". The generalizability of this effect to different countries/cultures, and thus the justification for the recommendations, has never been tested. METHODS We replicated the Brazilian study in the UK, in English, while also addressing methodological limitations. It was powered to detect the effects reported by the Brazilian study, with 234 students completing a survey regarding epilepsy attitudes. Half were randomized to Group 1 and half to Group 2. In Group 1, patients were referred to as "people/person with epilepsy" within the attitudinal measures, while in Group 2 they were referred to as "epileptic/s". Measures included translations of the questions used in the Brazilian study and the Attitudes and Beliefs about Living with Epilepsy scale. Participants' epilepsy familiarity and knowledge were also assessed. RESULTS The two groups were comparable in characteristics. A comparison of their responses to the attitude measures revealed no statistically significant or meaningful differences. CONCLUSIONS In this English replication, the word "epileptic" did not provoke more negative attitudes. This suggests that the effect reported by the Brazilian study might be culturally dependent. Methodological limitations to that study might also be relevant. Our results have implications for the global debate about how negative attitudes towards epilepsy might be addressed. Simply not saying "epileptic" may not promote the positive attitudes towards epilepsy that had been expected. To know how to best refer to those with epilepsy, evidence on the preferences of those actually living with epilepsy is needed.
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Affiliation(s)
- Adam J Noble
- Department of Psychological Sciences, University of Liverpool, UK.
| | - Anthony G Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, UK
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Beghi E. Addressing the burden of epilepsy: Many unmet needs. Pharmacol Res 2016; 107:79-84. [PMID: 26952026 DOI: 10.1016/j.phrs.2016.03.003] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/02/2016] [Accepted: 03/02/2016] [Indexed: 11/19/2022]
Abstract
Epilepsy is a heterogeneous clinical condition characterized by recurrent unprovoked seizures, their causes and complications. The incidence, prevalence and mortality of epilepsy vary with age, place and time contributing to a variable extent to the burden of the disease. Diagnostic misclassification may have strong impact on personal and societal reflections of the disease in light of its clinical manifestations and the need for chronic treatment. Epilepsy accounts for a significant proportion of the world's disease burden ranking fourth after tension-type headache, migraine and Alzheimer disease. Among neurological diseases, it accounts for the highest disability-adjusted life year rates both in men and in women. Although epilepsy is self-remitting in up to 50% of cases, variable long-term prognostic patterns can be identified based on the response to the available treatments. Epilepsy carries an overall increased risk of premature mortality with variable estimates across countries. Premature mortality predominates in patients aged less than 50 years, with epilepsies due to structural/metabolic conditions, with generalized tonic-clonic seizures, and seizures not remitting under treatment. Among deaths directly attributable to epilepsy or seizures, included are sudden unexpected death in epilepsy (SUDEP), status epilepticus, accidents, drowning, unintentional injuries, and suicide. Somatic and psychiatric disorders prevail in patients with epilepsy than in people without epilepsy. Asthma, migraine and cerebral tumors tend to occur more frequently in younger adults while cardiovascular disorders, stroke, dementia and meningioma predominate in the elderly. As being a fairly common clinical condition affecting all ages and requiring long-term (sometimes lifelong) treatment, epilepsy carries high health care costs for the society. Direct costs peak in the first year after diagnosis and then vary according to the severity of the disease, the response to treatment, and the presence of comorbidity. Although in several countries the costs of epilepsy are met by the national health systems, out-of-pocket costs may be a relevant fraction of the overall costs, especially in countries where the public management of health care is suboptimal or non-existent. Epilepsy strongly affects patients' independence, psychological health and emotional adjustment. Epilepsy impairs all aspects of health-related quality of life. Awareness and attitudes of the public about epilepsy may significantly affect the burden of the disease. All these factors add to the burden of the disease. However, many of the factors implicated in the onset of epilepsy, its course and treatment can be favorably addressed with appropriate strategic plans. More research is needed to investigate and manage the medical and psychosocial implications of epilepsy.
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Affiliation(s)
- Ettore Beghi
- Laboratory of Neurological Disorders, IRCCSIstituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156 Milan, Italy.
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El-Tallawy HN, Farghaly WM, Rageh TA, Shehata GA, Metwally NA, Badry R, Sayed MA, Abdelwarith AM, Kandil MR, Hamed MA, Mohamed KO, Tohamy AM. Spectrum of epilepsy - prevalence, impact, and treatment gap: an epidemiological study from Al-Quseir, Egypt. Neuropsychiatr Dis Treat 2016; 12:1111-8. [PMID: 27257380 PMCID: PMC4874633 DOI: 10.2147/ndt.s87765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Epidemiology continues to be an important research tool in the study of epilepsy and related disorders, providing a better understanding of the frequency, causes, and natural history of the disorder. OBJECTIVE To estimate the prevalence of epilepsy in Al-Quseir, Red Sea Governorate, Egypt, and its magnitude of treatment gap. METHODS The study was part of a door-to-door study, including every door, to screen all inhabitants in Al-Quseir (33,818 inhabitants) by three specialists of neurology and 15 female social workers (for demographic data collection) using a standardized screening questionnaire. All suspected cases were subjected to detailed history, clinical examination, and electroencephalogram. Neuroimaging studies and estimation of serum drug level were done in select cases if needed. RESULTS The study revealed that the lifetime prevalence rate of epilepsy in Al-Quseir is 5.5/1,000, with the highest peak during early childhood, while that of active epilepsy is 3.3/1,000 population. The annual incidence rate is 48/100,000, and the age-specific incidence rate has a U-shaped pattern with two peaks of incidence in early infancy and elderly life. Localization-related epilepsy is the most frequently encountered type (58.8%). The treatment gap of epilepsy in Al-Quseir is 83.8%. CONCLUSION The lifetime prevalence of epilepsy in Al-Quseir city, Red Sea Governorate, was 5.5/1000.
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Affiliation(s)
| | | | - Tarek A Rageh
- Department of Neurology, Assiut University, Assiut, Egypt
| | | | - Nabil A Metwally
- Department of Neurology, Faculty of Medicine, Al-Azhar University - Assiut Branch, Assiut, Egypt
| | - Reda Badry
- Department of Neurology, Assiut University, Assiut, Egypt
| | | | - Ahmed M Abdelwarith
- Department of Neurology, Faculty of Medicine, Al-Azhar University - Assiut Branch, Assiut, Egypt
| | | | | | | | - Amal M Tohamy
- Department of Neurology, Assiut University, Assiut, Egypt
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Aghaei I, Rostampour M, Shabani M, Naderi N, Motamedi F, Babaei P, Khakpour-Taleghani B. Palmitoylethanolamide attenuates PTZ-induced seizures through CB1 and CB2 receptors. Epilepsy Res 2015; 117:23-8. [PMID: 26370914 DOI: 10.1016/j.eplepsyres.2015.08.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 08/09/2015] [Accepted: 08/11/2015] [Indexed: 11/18/2022]
Abstract
Epilepsy is one of the most common neurologic disorders. Though there are effective medications available to reduce the symptoms of the disease, their side effects have limited their usage. Palmitoylethanolamide (PEA) has been shown to attenuate seizure in different animal models. The objective of the current study was to evaluate the role of CB1 and CB2 receptors in this attenuation. Male wistar rats were used for the current experiment. PTZ was injected to induce chemical kindling in animals. After verification of kindling in animals, treatment was performed with PEA, AM251 and AM630 in different groups. Latency to induce seizure, seizure stages and latency and duration of fifth stage of seizure was recorded for each animal. Injection of PTZ led to seizure in the animals. Pretreatment with PEA increased the latency to initiate seizures and reduced the duration of seizure. Pretreatment with different dosages of AM251 had contrary effects so that at lower doses they increased the seizure in animals but at higher doses led to the attenuation of seizure. AM630 increased seizures in a dose dependent manner. Combination of the antagonists increased the seizure parameters and attenuated the effect of PEA on seizure. PEA attenuated the PTZ-induced seizures and pretreatment with CB1 and CB2 antagonists diminished this effect of PEA, but still PEA was effective, which might be attributed to the contribution of other receptors in PEA anti-epileptic properties. Findings of the current study implied that endocannabinoid signaling pathway might have an important role in the effects of PEA.
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Affiliation(s)
- Iraj Aghaei
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Physiology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Rostampour
- Cellular and Molecular Research Center, Guilan University of Medical Sciences, Rasht, Iran; Department of Physiology, Guilan University of Medical Sciences, Rasht, Iran.
| | - Mohammad Shabani
- Neuroscience Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran.
| | - Nima Naderi
- Toxicology, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fereshteh Motamedi
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Physiology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Babaei
- Cellular and Molecular Research Center, Guilan University of Medical Sciences, Rasht, Iran; Department of Physiology, Guilan University of Medical Sciences, Rasht, Iran
| | - Behrooz Khakpour-Taleghani
- Cellular and Molecular Research Center, Guilan University of Medical Sciences, Rasht, Iran; Department of Physiology, Guilan University of Medical Sciences, Rasht, Iran
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Tang DH, Malone DC, Warholak TL, Chong J, Armstrong EP, Slack MK, Hsu CH, Labiner DM. Prevalence and Incidence of Epilepsy in an Elderly and Low-Income Population in the United States. J Clin Neurol 2015; 11:252-61. [PMID: 26022458 PMCID: PMC4507380 DOI: 10.3988/jcn.2015.11.3.252] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 02/10/2015] [Accepted: 02/12/2015] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose The purpose of this study was to estimate the incidence and prevalence of epilepsy among an elderly and poor population in the United States. Methods Arizona Medicaid claims data from January 1, 2008 to December 31, 2010 were used for this analysis. Subjects who were aged ≥65 years and were continuously enrolled in any Arizona Medicaid health plans (eligible to patients with low income) for ≥12 months between January 1, 2008 and December 31, 2009 were considered eligible for inclusion in the study cohort. In addition to meeting the aforementioned criteria, incident and prevalent cases must have had epilepsy-related healthcare claims. Furthermore, incident cases were required to have a 1-year "clean" period immediately preceding the index date. Negative binomial and logistic regression models were used to assess the factors associated with epilepsy incidence and prevalence. Results The estimated epilepsy incidence and prevalence for this population in 2009 were 7.9 and 19.3 per 1,000 person-years, respectively. The incidence and prevalence rates were significantly higher for patients with comorbid conditions that were potential risk factors for epilepsy and were of younger age than for their non-comorbid and older counterparts (p<0.05). The prevalence rates were significantly higher for non-Hispanic Blacks and male beneficiaries than for non-Hispanic Whites and female beneficiaries, respectively (p<0.05). Conclusions This patient population had higher epilepsy incidence and prevalence compared with the general US population. These differences may be at least in part attributable to their low socioeconomic status.
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Affiliation(s)
- Derek H Tang
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA.
| | - Daniel C Malone
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Terri L Warholak
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Jenny Chong
- Department of Neurology, The University of Arizona College of Medicine, Tucson, AZ, USA
| | - Edward P Armstrong
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Marion K Slack
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Chiu Hsieh Hsu
- Department of Epidemiology and Biostatistics, The University of Arizona College of Public Health, Tucson, AZ, USA
| | - David M Labiner
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA.; Department of Neurology, The University of Arizona College of Medicine, Tucson, AZ, USA
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Consanguinity and epilepsy in Oran, Algeria: A case-control study. Epilepsy Res 2015; 111:10-7. [PMID: 25769368 DOI: 10.1016/j.eplepsyres.2014.12.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/27/2014] [Accepted: 12/30/2014] [Indexed: 01/23/2023]
Abstract
PURPOSE The goal of this case-control study was to identify the significance of consanguinity and other risk factors for epilepsy in Oran, Algeria. METHODS Unrelated epileptic patients upwards of 16 years, who attended the Neurology Department between October 2013 and March 2014 were included in the study. Controls, matched for age and sex, were selected among non-epileptic patients attending the same department during the same period. The risk factors evaluated were: consanguinity, family history of epilepsy, perinatal complications, infection of the central nervous system, mental retardation, neurological impairment, history of febrile seizures, severe head trauma, cerebrovascular diseases, and addiction. RESULTS 101 cases and 202 controls participated in the study. Multivariate logistic regression identified five factors significantly associated with epilepsy: first-degree of consanguinity (odds ratio (OR)=2.15), history of epilepsy in first-degree relatives (OR=4.03), antecedent of febrile seizures (OR=5.38), severe head injury (OR=2.94) and mental retardation (OR=9.32). CONCLUSION Consanguinity, family history of epilepsy, history of febrile seizures, severe head trauma and mental retardation are risk factors for epilepsy. The implementation of a strategy for prevention and awareness of the impact of consanguineous marriages as well as genetic counseling for couples with a family history of epilepsy are needed.
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Elliott JO, Richardson VE. The biopsychosocial model and quality of life in persons with active epilepsy. Epilepsy Behav 2014; 41:55-65. [PMID: 25305434 DOI: 10.1016/j.yebeh.2014.09.035] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/10/2014] [Accepted: 09/11/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Despite a long recognized need in the field of the importance of the psychological and social factors in persons with epilepsy (PWE), the medical community has continued to focus primarily on seizures and their treatment (the biological-biomedical model). From the biopsychosocial perspective, a person's lived experience needs to be incorporated into the understanding of quality of life. While the biopsychosocial model has gained prominence over the years, it has not been studied much in epilepsy. METHODS The study sample included 1720 PWE from the 2003 and the 2005 Canadian Community Health Survey (CCHS). Data were analyzed using set correlation, as it allows for the examination of the relative contribution of sets of independent variables (biological, psychological, and social domains) and a set of dependent variables (quality of life) of interest, defined as self-rated health status, self-rated mental health status, and life satisfaction. RESULTS Results provide strong evidence that the full biopsychosocial model explained a significantly larger amount of variance in quality of life (R(2) = 55.0%) compared with the biological-biomedical model alone (R(2) = 24.8%). When the individual domains of the biopsychosocial model were controlled for, the psychological (R(2) = 24.6%) and social (R(2) = 18.5%) domains still explained a greater amount of the variance in quality of life compared with the biological-biomedical model (R(2) = 14.3%). CONCLUSIONS While seizure freedom will continue to be an important treatment goal in epilepsy, the psychological and social domains are an important consideration for both interventional programs and clinical research designed to improve quality of life in PWE. Better integration of social workers and psychologists into routine care may help address these disparities.
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Affiliation(s)
- John O Elliott
- OhioHealth Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA; The Ohio State University, College of Social Work, Stillman Hall, 1947 College Road, Columbus, OH 43210, USA.
| | - Virginia E Richardson
- The Ohio State University, College of Social Work, Stillman Hall, 1947 College Road, Columbus, OH 43210, USA.
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Abstract
Decompensation of epilepsy in burned patients may be caused by several factors. Burn is a classic etiology of systemic inflammatory response syndrome, and evolves into two physiological phases. The first 48h after injury corresponds to the first phase involving severe hypovolemic shock. The second phase corresponds to the hypermetabolic response to burns. Altered pharmacokinetics of anticonvulsant drugs is observed. Albumin and other plasma proteins are reduced, leading to increased free fraction of phenytoin, resulting in greater clearance and a lower total drug concentration. Associated with metabolic changes of burned patient, this fact predisposes to seizures in epileptic burned patients. The authors present the case of an epileptic 36-year-old-woman who developed recurrent seizures after a thermal injury, despite using the same medications and doses of anticonvulsant drugs of last 12 years, with controlled epilepsy.
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Beghi E, Hesdorffer D. Prevalence of epilepsy--an unknown quantity. Epilepsia 2014; 55:963-7. [PMID: 24966095 DOI: 10.1111/epi.12579] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2014] [Indexed: 11/27/2022]
Abstract
The incidence, prevalence, and mortality of epilepsy vary across countries with different economies. Differences can be explained by methodological problems, premature mortality, seizure remission, socioeconomic factors, and stigma. Diagnostic misclassification-one possible explanation-may result from inclusion of patients with acute symptomatic or isolated unprovoked seizures. Other sources of bias include age and ethnic origin of the target population, definitions of epilepsy, retrospective versus prospective ascertainment, sources of cases, and experienced and perceived stigma. Premature mortality is an issue in low-income countries (LICs), where treatment gap, brain infections, and traumatic brain injuries are more common than in high-income countries (HICs). Death rates may reflect untreated continued seizures or inclusion of acute symptomatic seizures. Lack of compliance with antiepileptic drugs has been associated with increased risk for death, increased hospital admissions, motor vehicle accidents, and fractures in poor communities. Epilepsy is a self-remitting clinical condition in up to 50% of cases. Studies in untreated individuals from LICs have shown that the proportion of remissions overlaps that of countries where patients receive treatment. When the identification of patients is based on spontaneous reports (e.g., door-to-door surveys), patients in remission may be less likely to disclose the disease for fear of stigmatization with no concurrent benefits. This might lead to underascertainment of cases when assessing the lifetime prevalence of epilepsy. In LICs, the proportion of people living in poverty is greater than in HICs. Poverty is associated with risk factors for epilepsy, risk for developing epilepsy, and increased mortality. The high incidence and prevalence of epilepsy found in LICs is also observed in low income individuals from HICs. Epileptogenic conditions are associated with an increased mortality. This may partly explain the difference between incidence and lifetime prevalence of epilepsy in LICs. Poverty within LICs and HICs could be a preventable cause of mortality in epilepsy.
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Affiliation(s)
- Ettore Beghi
- Department of Neurosciences, IRCCS Mario Negri Institute for Pharmacological Research, Milano, Italy
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Bell GS, Neligan A, Sander JW. An unknown quantity-The worldwide prevalence of epilepsy. Epilepsia 2014; 55:958-62. [DOI: 10.1111/epi.12605] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Gail S. Bell
- Department of Clinical and Experimental Epilepsy; NIHR University College London Hospitals Biomedical Research Centre; UCL Institute of Neurology; London United Kingdom
- Epilepsy Society; Chalfont St Peter United Kingdom
| | - Aidan Neligan
- Department of Clinical and Experimental Epilepsy; NIHR University College London Hospitals Biomedical Research Centre; UCL Institute of Neurology; London United Kingdom
| | - Josemir W. Sander
- Department of Clinical and Experimental Epilepsy; NIHR University College London Hospitals Biomedical Research Centre; UCL Institute of Neurology; London United Kingdom
- Epilepsy Society; Chalfont St Peter United Kingdom
- Stichting Epilepsie Instellingen Nederland (SEIN); Heemstede The Netherlands
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Bautista RED, Shapovalov D, Saada F, Pizzi MA. The societal integration of individuals with epilepsy: perspectives for the 21st century. Epilepsy Behav 2014; 35:42-9. [PMID: 24798409 DOI: 10.1016/j.yebeh.2014.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/06/2014] [Accepted: 04/07/2014] [Indexed: 11/16/2022]
Abstract
Epilepsy is a common neurologic disorder seen throughout the world. Advances in therapy have made it possible for persons with epilepsy (PWEs) to have improved seizure control and a better quality of life. However, it is not entirely clear whether this has resulted in their successful integration into society. This review examines the societal integration of PWEs, identifying both the progress made and the challenges that continue to hamper further advances. In general, PWEs are more integrated in western-oriented cultures. However, there continue to be ongoing difficulties due to poor education and intellectual functioning, poor social and family support, the undertreatment of coexisting psychiatric conditions, transportation and mobility limitations, and problems obtaining employment. This review also discusses the effects of low socioeconomic status on integration and the persisting prejudices that affect certain racial groups. Most importantly, this review underscores the fact that societal stigma towards PWEs is still very much alive. At the beginning of the 21st century, PWEs still encounter difficulties in their quest for full societal integration. Along with medical advances being made to improve seizure control, much still has to be done to bring about the reforms necessary to help PWEs live more meaningful and productive lives.
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Affiliation(s)
- Ramon Edmundo D Bautista
- Comprehensive Epilepsy Program, University of Florida Health Sciences Center/Jacksonville, Jacksonville, FL, USA.
| | - Denys Shapovalov
- Comprehensive Epilepsy Program, University of Florida Health Sciences Center/Jacksonville, Jacksonville, FL, USA
| | - Fahed Saada
- Comprehensive Epilepsy Program, University of Florida Health Sciences Center/Jacksonville, Jacksonville, FL, USA
| | - Michael A Pizzi
- Comprehensive Epilepsy Program, University of Florida Health Sciences Center/Jacksonville, Jacksonville, FL, USA
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Freitas-Lima PD, Baldoni ADO, Alexandre V, Pereira LRL, Sakamoto AC. Drug utilization profile in adult patients with refractory epilepsy at a tertiary referral center. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:856-61. [DOI: 10.1590/0004-282x20130169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 06/12/2013] [Indexed: 11/22/2022]
Abstract
Objective To evaluate the utilization profile of antiepileptic drugs in a population of adult patients with refractory epilepsy attending a tertiary center. Method Descriptive analyses of data were obtained from the medical records of 112 patients. Other clinical and demographic characteristics were also registered. Results Polytherapies with ≥3 antiepileptic drugs were prescribed to 60.7% of patients. Of the old agents, carbamazepine and clobazam were the most commonly prescribed (72.3% and 58.9% of the patients, respectively). Among the new agents, lamotrigine was the most commonly prescribed (36.6% of the patients). At least one old agent was identified in 103 out of the 104 polytherapies, while at least one new agent was prescribed to 70.5% of the population. The most prevalent combination was carbamazepine + clobazam + lamotrigine. The mean AED load found was 3.3 (range 0.4–7.7). Conclusion The pattern of use of individual drugs, although consistent with current treatment guidelines, is strongly influenced by the public health system.
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Affiliation(s)
| | | | - Veriano Alexandre
- Ribeirão Preto School of Medicine, University of São Paulo, São PauloSP, Brazil
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Bruno E, Bartoloni A, Zammarchi L, Strohmeyer M, Bartalesi F, Bustos JA, Santivañez S, García HH, Nicoletti A. Epilepsy and neurocysticercosis in Latin America: a systematic review and meta-analysis. PLoS Negl Trop Dis 2013; 7:e2480. [PMID: 24205415 PMCID: PMC3814340 DOI: 10.1371/journal.pntd.0002480] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 08/21/2013] [Indexed: 11/22/2022] Open
Abstract
Background The difference in epilepsy burden existing among populations in tropical regions has been attributed to many factors, including the distribution of infectious diseases with neurologic sequels. To define the burden of epilepsy in Latin American Countries (LAC) and to investigate the strength of association with neurocysticercosis (NCC), considered one of the leading causes of epilepsy, we performed a systematic review and meta-analysis of the literature. Methodology Studies published until 2012 were selected applying predefined inclusion criteria. Lifetime epilepsy (LTE) prevalence, active epilepsy (AE) prevalence, incidence, mortality, treatment gap (TG) and NCC proportion among people with epilepsy (PWE) were extracted. Median values were obtained for each estimate using random effects meta-analysis. The impact of NCC prevalence on epilepsy estimates was determined using meta-regression models. To assess the association between NCC and epilepsy, a further meta-analysis was performed on case-control studies. Principal findings The median LTE prevalence was 15.8/1,000 (95% CI 13.5–18.3), the median AE prevalence was 10.7/1,000 (95% CI 8.4–13.2), the median incidence was 138.2/100,000 (95% CI 83.6–206.4), the overall standardized mortality ratio was 1.4 (95% CI 0.01–6.1) and the overall estimated TG was 60.6% (95% CI 45.3–74.9). The median NCC proportion among PWE was 32.3% (95% CI 26.0–39.0). Higher TG and NCC estimates were associated with higher epilepsy prevalence. The association between NCC and epilepsy was significant (p<0.001) with a common odds ratio of 2.8 (95% CI 1.9–4.0). Significance A high burden of epilepsy and of NCC in LAC and a consistent association between these two diseases were pointed out. Furthermore, NCC prevalence and TG were identified as important factors influencing epilepsy prevalence to be considered in prevention and intervention strategies. Epilepsy affects approximately 70 million people worldwide and at least five million people in Latin America. Many researchers have pointed out a different distribution of epilepsy in Latin American countries, with some regions presenting higher frequencies and others presenting lower frequencies. This difference in epilepsy distribution has been attributed to many factors, mainly related to the allocation of health resources and to the presence of environmental and infectious risk factors. Among the latter stands neurocysticercosis, a parasitic disease that has been recognized as the leading cause of acquired epilepsy in the developing world, with a particularly elevated distribution in rural settings. In this study, we performed a statistical analysis to investigate whether neurocysticercosis distribution affects epilepsy distribution among Latin American countries and the relationship between these two conditions. The combined results of the studies included indicated that neurocysticercosis influences epilepsy frequency in Latin America, as countries with higher epilepsy distribution presented also higher neurocysticercosis frequency. Moreover, another analysis pointed out an association between the two diseases. These results appear very important considering that parasitic infections are modifiable factors and that their reduction may contribute to decrease epilepsy burden worldwide.
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Affiliation(s)
- Elisa Bruno
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Alessandro Bartoloni
- Department of Critical Care Medicine and Surgery, Infectious Diseases Unit, University of Florence, Florence, Italy
| | - Lorenzo Zammarchi
- Department of Critical Care Medicine and Surgery, Infectious Diseases Unit, University of Florence, Florence, Italy
| | - Marianne Strohmeyer
- Department of Critical Care Medicine and Surgery, Infectious Diseases Unit, University of Florence, Florence, Italy
| | - Filippo Bartalesi
- Department of Critical Care Medicine and Surgery, Infectious Diseases Unit, University of Florence, Florence, Italy
| | - Javier A. Bustos
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, and Center for Global Health - Tumbes and Department of Microbiology, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Saul Santivañez
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, and Center for Global Health - Tumbes and Department of Microbiology, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Héctor H. García
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, and Center for Global Health - Tumbes and Department of Microbiology, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Alessandra Nicoletti
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
- * E-mail:
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Enaminones 11. An examination of some ethyl ester enaminone derivatives as anticonvulsant agents. Bioorg Med Chem 2013; 21:3272-9. [PMID: 23602623 DOI: 10.1016/j.bmc.2013.03.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 03/01/2013] [Accepted: 03/09/2013] [Indexed: 11/21/2022]
Abstract
In this paper, we investigated the previously synthesized anticonvulsant enaminone ethyl ester analogs using the computational gaussian 03 programs. The significant chemical features of the enaminone compounds that lead to positive anticonvulsant activity were identified. From our analyses, we believe that the neutrality of the phenyl ring may be important for binding in the hydrophobic pocket of the active site and that the binding of the phenyl substituent is the main reason why some analogs are active and others are inactive.
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A community based epidemiological study of epilepsy in Assiut Governorate/Egypt. Epilepsy Res 2013; 103:294-302. [DOI: 10.1016/j.eplepsyres.2012.08.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 08/06/2012] [Accepted: 08/10/2012] [Indexed: 11/19/2022]
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Validation of a short useful questionnaire in Spanish for the epidemiological screening of epilepsy in Spain: EPIBERIA Questionnaire. NEUROLOGÍA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.nrleng.2012.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Serrano-Castro P, García-Morales I, Hernández-Ramos F, Matías-Guiu J, Mauri-Llerda J, Sánchez-Alvarez J, Sancho-Rieger J. Validación en castellano de un cuestionario breve útil para cribado epidemiológico de epilepsia en España: Cuestionario EPIBERIA. Neurologia 2013; 28:24-32. [PMID: 22608538 DOI: 10.1016/j.nrl.2012.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 02/18/2012] [Indexed: 02/08/2023] Open
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Ngugi AK, Bottomley C, Chengo E, Kombe MZ, Kazungu M, Bauni E, Mbuba CK, Kleinschmidt I, Newton CR. The validation of a three-stage screening methodology for detecting active convulsive epilepsy in population-based studies in health and demographic surveillance systems. Emerg Themes Epidemiol 2012; 9:8. [PMID: 23171721 PMCID: PMC3549939 DOI: 10.1186/1742-7622-9-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 09/20/2012] [Indexed: 11/10/2022] Open
Abstract
Background There are few studies on the epidemiology of epilepsy in large populations in Low and Middle Income Countries (LMIC). Most studies in these regions use two-stage population-based screening surveys, which are time-consuming and costly to implement in large populations required to generate accurate estimates. We examined the sensitivity and specificity of a three-stage cross-sectional screening methodology in detecting active convulsive epilepsy (ACE), which can be embedded within on-going census of demographic surveillance systems. We validated a three-stage cross-sectional screening methodology on a randomly selected sample of participants of a three-stage prevalence survey of epilepsy. Diagnosis of ACE by an experienced clinician was used as ‘gold standard’. We further compared the expenditure of this method with the standard two-stage methodology. Results We screened 4442 subjects in the validation and identified 35 cases of ACE. Of these, 18 were identified as false negatives, most of whom (15/18) were missed in the first stage and a few (3/18) in the second stage of the three-stage screening. Overall, this methodology had a sensitivity of 48.6% and a specificity of 100%. It was 37% cheaper than a two-stage survey. Conclusion This was the first study to evaluate the performance of a multi-stage screening methodology used to detect epilepsy in demographic surveillance sites. This method had poor sensitivity attributed mainly to stigma-related non-response in the first stage. This method needs to take into consideration the poor sensitivity and the savings in expenditure and time as well as validation in target populations. Our findings suggest the need for continued efforts to develop and improve case-ascertainment methods in population-based epidemiological studies of epilepsy in LMIC.
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Affiliation(s)
- Anthony K Ngugi
- The Centre for Geographic Medicine Research - Coast, KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.
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Meyer ACL, Dua T, Boscardin WJ, Escarce JJ, Saxena S, Birbeck GL. Critical determinants of the epilepsy treatment gap: a cross-national analysis in resource-limited settings. Epilepsia 2012; 53:2178-85. [PMID: 23106784 DOI: 10.1111/epi.12002] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Epilepsy is one of the most common serious neurologic disorders worldwide. Our objective was to determine which economic, health care, neurology, and epilepsy-specific resources were associated with untreated epilepsy in resource-constrained settings. METHODS A systematic review of the literature identified community-based studies in resource-constrained settings that calculated the epilepsy treatment gap, the proportion with untreated epilepsy, from prevalent active epilepsy cases. Economic, health care, neurology, and epilepsy-specific resources were taken from existing datasets. Poisson regression models with jackknifed standard errors were used to create bivariate and multivariate models comparing the association between treatment status and economic and health resource indicators. Relative risks were reported. KEY FINDINGS Forty-seven studies of 8,285 individuals from 24 countries met inclusion criteria. Bivariate analysis demonstrated that individuals residing in rural locations had significantly higher risks of untreated epilepsy (relative risk [RR] 1.63; 95% confidence interval [CI] 1.26-2.11). Significantly lower risks of untreated epilepsy were observed for higher physician density (RR 0.65, 95% CI 0.55-0.78), presence of a lay (RR 0.74, 95% CI 0.60-0.91) or professional association for epilepsy (RR 0.73, 95% CI 0.59-0.91), or postgraduate neurology training program (RR 0.67, 95% CI 0.55-0.82). In multivariate models, higher physician density maintained significant effects (RR 0.67; 95% CI 0.52-0.88). SIGNIFICANCE Even among resource-limited regions, people with epilepsy in countries with fewer economic, health care, neurology, and epilepsy-specific resources are more likely to have untreated epilepsy. Community-based epilepsy care programs have improved access to treatment, but in order to decrease the epilepsy-treatment gap, poverty and inequalities of health care, neurology, and epilepsy resources must be dealt with at the local, national, and global levels.
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Affiliation(s)
- Ana-Claire L Meyer
- Department of Neurology, University of California, San Francisco, California, USA.
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LaFrance WC, de Marinis AJ, Webb AF, Machan JT, Rusch MD, Kanner AM. Comparing standard medical care for nonepileptic seizures in Chile and the United States. Epilepsy Behav 2012; 25:224-9. [PMID: 23032137 DOI: 10.1016/j.yebeh.2012.07.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 07/26/2012] [Accepted: 07/28/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE We sought to compare the diagnostic and treatment practices for psychogenic nonepileptic seizures (PNES) in the United States (US) to Chile. METHODS A survey on the diagnostic and treatment practices for PNES was administered to practicing clinicians in Chile. Results from 96 Chilean respondents were compared to results from 307 US clinicians. Type I error (alpha) was set to 0.005 for multiple comparisons. DIAGNOSIS The diagnosis of PNES is made by inpatient video-EEG/LTM in 89% of the US respondents compared to 25% of the Chilean respondents (p<0.0001). The diagnosis of PNES is made by history and exam alone at twice the rate in Chile (38%) than in the US (16%; p<0.0001). TREATMENT A higher proportion of the Chilean respondents (65%) endorsed psychopharmacotherapy as potentially beneficial compared to the US respondents (31%; p<0.0001). DISCUSSION This cross-cultural multi-site survey reveals some differences in PNES evaluation and management between neurologists and other clinicians in the US and in Chile. Access to video EEG may improve PNES diagnosis and treatment.
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Affiliation(s)
- W Curt LaFrance
- Division of Neuropsychiatry and Behavioral Neurology, Rhode Island Hospital, Providence, RI, USA.
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Acevedo C, Acevedo K. Epilepsy treatment in developing countries: drug treatment. HANDBOOK OF CLINICAL NEUROLOGY 2012; 108:925-941. [PMID: 22939076 DOI: 10.1016/b978-0-444-52899-5.00038-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Carlos Acevedo
- University of Los Andes, Clínica Alemana, Alemana, Santiago, Chile.
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