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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 In Brazil, epidemiological studies are outdated and restricted to specific regions, mostly due to the continental size of country.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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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: 30] [Impact Index Per Article: 10.0] [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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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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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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Subki AH, Mukhtar AM, Al-Harbi RS, Alotaibi AK, Mosaad FG, Alsallum MS, Jan MMS. The Impact of Pediatric Epilepsy on Children and Families: A Multicenter Cross-Sectional Study. Clin Pract Epidemiol Ment Health 2018; 14:323-333. [PMID: 30972132 PMCID: PMC6407654 DOI: 10.2174/1745017901814010323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/02/2018] [Accepted: 11/19/2018] [Indexed: 11/22/2022]
Abstract
Background and Objectives: Epilepsy is considered one of the most prevalent causes of morbidity in children. The aim of this study is to determine how epilepsy impacts the lives of children with epilepsy and their families. Methods: A translated version of the “Impact of Pediatric Epilepsy Scale” (IPES) questionnaire was completed by the 80 mothers of children with epilepsy, recruited at three hospitals in Jeddah, Saudi Arabia This is a validated self-administered questionnaire used to assess the impact of epilepsy on the lives of the child and family, as well as the quality of life (QoL) of the child. Results: The mean age of children epilepsy was 6.32 years (SD = 3.22). The mean IPES score was 6.28 (SD = 8.42) and the mean child’s QoL was 2.85 (SD= 0.83). 87.5% of the mothers rated their child’s QoL as low. IPES score was significantly associated with cause of seizure (β=0.259; 95%-CI= 0.263 - 10.334; p = 0.039). Child’s QoL was significantly associated with frequency of seizure (β=0.251; 95%-CI= 0.016 - 0.568; p= 0.039) and child’s nationality (β=-0.270; 95%-CI -0.252, -0.013; p= 0.031). Conclusions: Pediatric epilepsy may have a greater impact on the lives of the child and the family when it is not comorbid with cerebral palsy. Quality of life tends to be lower for non-Saudi children, and children with more frequent seizures. Therefore, these groups may need more support in managing the impact that epilepsy has on their daily functioning and quality of life.
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Affiliation(s)
- Ahmed Hussein Subki
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdel Moniem Mukhtar
- Department of Family and Community Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rakan Salah Al-Harbi
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Faisal Ghazi Mosaad
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Saad Alsallum
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed M S Jan
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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7
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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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8
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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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9
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Prevalence of epilepsy in the People's Republic of China: a systematic review. Epilepsy Res 2013; 105:195-205. [PMID: 23507331 DOI: 10.1016/j.eplepsyres.2013.02.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 12/13/2012] [Accepted: 02/11/2013] [Indexed: 11/22/2022]
Abstract
To date there has not been a nationwide systematic analysis of the prevalence of epilepsy in China. The aim of this study was to estimate the prevalence of epilepsy in mainland China from the published studies and analyze the prevalence of epilepsy by survey method, gender, location, age, seizure type and prevalence of date. We searched the PubMed, Embase, Chinese Biological Medical Literature (CBM), Chinese National Knowledge Infrastructure (CNKI), Chinese Wanfang and Chongqing VIP databases for epidemiological studies on the prevalence of epilepsy. Thirty-eight studies were included that comprised a total sample size of 7,695,961, among whom 13,224 had epilepsy. The overall prevalence of epilepsy was 2.89‰. The prevalence of males and females were 3.83‰ and 3.45‰, respectively. The location-specific prevalence in urban and rural areas was 2.34‰ and 3.17‰, respectively. Prevalence by age groups, 0-9, 10-19, 20-29, 30-39, 40-49, 50-59, 60-69 and ≥70 were 2.21‰, 3.23‰, 3.14‰, 2.83‰, 2.96‰, 2.61‰, 2.76‰ and 2.22‰, respectively. In the subgroup analysis by prevalence date, prevalence rate of epilepsy ranged from 1.19‰ to 6.70‰. As for the seizure types, the overall prevalence of generalized seizures, partial seizures and unclassifiable seizures were 3.12‰, 0.57‰ and 0.23‰, respectively. Overall, the prevalence rate of epilepsy is different for each area in mainland China. A higher prevalence of epilepsy is found in the subgroup analysis by male, rural, age group of 10-19 and generalized seizures. However, more epidemiological studies are needed from other provinces to estimate the overall prevalence of epilepsy in mainland China.
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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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Kochen S, Salera C, Seni J. Pregnant women with epilepsy in a developing country. Open Neurol J 2011; 5:63-7. [PMID: 22046203 PMCID: PMC3204418 DOI: 10.2174/1874205x01105010063] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Revised: 08/02/2011] [Accepted: 08/05/2011] [Indexed: 11/22/2022] Open
Abstract
This is the first prospective study carried out in Argentina and Latin America to provide the impact of epilepsy throughout the childbearing years life of women, and pregnancy outcome in a population of pregnant women with diagnosis of epilepsy and antiepileptics drugs (AEDs). Ninety-four women were studied prospectively at the Epilepsy Center, the largest in Argentina. Of the 94 women examined in this study only 10% planned their pregnancy and received folic acid before conception.More than half of women in our study were on monotherapy, with the most frequently prescribed drugs being carbamazepine and valproic acid. In all, 90.4% of the women had a normal pregnancy and delivery. There were 8.5% spontaneous abortions. Major congenital malformations (MCM) was detected in 10.6% of newborns at birth; in the general population it varies between 1.6-3.2%. The results from this study are helpful in the highlighting correct gaps in knowledge in this population group.
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Affiliation(s)
- Silvia Kochen
- Epilepsy Center Ramos Mejía Hospital, Buenos Aires Argentina
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Yemadje LP, Houinato D, Quet F, Druet-Cabanac M, Preux PM. Understanding the differences in prevalence of epilepsy in tropical regions. Epilepsia 2011; 52:1376-81. [PMID: 21627649 DOI: 10.1111/j.1528-1167.2011.03099.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Epilepsy is a frequent chronic neurologic disorder that affects nearly 70 million people worldwide. The majority of people with epilepsy live in developing countries, where epilepsy remains a major public health problem. Wide prevalence differences exist among various populations across sub-Saharan Africa, Latin America, and Asia. In particular, prevalence is lower in Southeast Asia than in sub-Saharan Africa and Latin America. Methodologic problems alone do not seem to explain these differences shown in recent review papers. The distribution of numerous risk or etiologic factors such as infectious diseases with neurologic sequel, head injuries, or genetic factors could explain these differences. Stigmatization of people with epilepsy could lead to underestimating the prevalence of epilepsy, even in well-conducted studies. It is important to standardize the process of epidemiologic monitoring of epilepsy in order to improve the reliability in data comparison. Understanding the reasons for these differences is a crucial issue for eventually raising new hypotheses or prevention strategies.
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Affiliation(s)
- Luce-Perrine Yemadje
- University of Limoges, IFR 145 GEIST, Institute of Tropical Neurology, EA 3174 Comparative and Tropical Neuroepidemiology, Limoges, France
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Donadío M, D'Giano C, Moussalli M, Barrios L, Ugarnes G, Segalovich M, Pociecha J, Vázquez C, Petre C, Pomata H. Epilepsy surgery in Argentina: long-term results in a comprehensive epilepsy centre. Seizure 2011; 20:442-5. [PMID: 21478034 DOI: 10.1016/j.seizure.2011.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 01/19/2011] [Accepted: 02/07/2011] [Indexed: 10/18/2022] Open
Abstract
RATIONALE Epilepsy surgery procedures started in Argentina more than 50 years ago. This is the first comprehensive and systematic survey of epilepsy surgery long-term outcome from our country. METHODS A descriptive cohort study was conducted between 1998 and 2008 for drug-resistant epilepsy surgery with a minimum of 12 months follow-up (n=110). In 84 cases (76.36%) resective surgery was performed, and outcome periodically assessed using the Engel score. Patients were stratified into groups: 12, 13-36, 37-60 and over than 60 months of follow-up. Video-EEG with and without intracranial electrode implants, intraoperative electrocorticograms, Wada tests, pathology reports, use of antiepileptic drugs (AEDs), and surgical complication rates were evaluated. RESULTS Surgical techniques included: 69 lobectomies (62.7%), 15 lesionectomies (13.6%), 6 callosotomies (5.4%), 6 multiple subpial transection (5.4%), 11 vagus nerve stimulations (10%), 3 hemispherectomies (2.7%). Male: female ratio: 1/1.44. Mean age at time of surgery: 26.2 years. Mean duration of epilepsy: 14 years. Age at seizure onset: 11.5 years. Mean follow-up: 46 months. Pathology findings: mesial temporal sclerosis 32 (35.1%); dual pathology 17 (18.7%); cortical dysplasia 15 (16.4%); non-specific inflammatory changes 11 (12.1%); tumors 7 (7.7%); other 6 (6.8%). Engel scores at 12 months follow-up: 72.6% (61) class I, 16.6% (14) class II and 15.5% (13) class III-IV; 13-36 months after surgery: 68.1% of cases were class I, 15.9% class II and 15.5% class III-IV. After 37-60 months, 74% class I, 14% class II, 14% class III-IV. Over 60 months (n=45) 78% class I, 13.5% class II and 8.1% class III-IV. CONCLUSION Conducting a successful epilepsy surgery program in a developing country is challenging. These results should encourage specialists in these countries. Long-term outcome results comparable to centres in developed countries can be achieved.
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Affiliation(s)
- Martín Donadío
- Comprehensive Epilepsy Programme. Institute for Neurological Research, FLENI, Montañeses 2325, Buenos Aires, Argentina, Zip C1428AQK, Buenos Aires, Argentina
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Stalldecker G, Mallea-Gil MS, Guitelman M, Alfieri A, Ballarino MC, Boero L, Chervin A, Danilowicz K, Diez S, Fainstein-Day P, García-Basavilbaso N, Glerean M, Gollan V, Katz D, Loto MG, Manavela M, Rogozinski AS, Servidio M, Vitale NM. Effects of cabergoline on pregnancy and embryo-fetal development: retrospective study on 103 pregnancies and a review of the literature. Pituitary 2010; 13:345-50. [PMID: 20676778 DOI: 10.1007/s11102-010-0243-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The aim of the study is to assess the rate of any potential adverse effects on women who became pregnant under cabergoline (CAB) treatment and to evaluate any effects on the embryo-fetal development and on children who were born from mothers exposed to CAB in early weeks of gestation. Observational, retrospective and multicenter study on 103 pregnancies in 90 women with hyperprolactinemia. All patients were under CAB at conception. Serum prolactin at baseline was between 30 and 1921 ng/ml. Duration of therapy before pregnancy ranged from 1 to 120 months and doses ranged from 0.125 to 5 mg/week. Fetal exposure ranged from 3 to 25 weeks, 96.9% of patients received CAB during the first trimester of pregnancy and the rest until the second one. No significant complications during pregnancy were found. Seven women (7.2%) had spontaneous abortions. Preterm deliveries were recorded in eight (8.8%), only one with low weight for gestational age. Neonatal abnormalities were observed in 3 (3.6%): 1 major (Down syndrome) and 2 minor malformations (umbilical and inguinal hernia). We were able to asses the children's development in 61. Two had epilepsy and two had Pervasive Developmental Disorder (PDD). No significantly higher frequency of complications was found in pregnancies and/or offspring exposed to CAB than in the normal population. We registered 2 abnormalities in the development of the children: epilepsy and PDD. Larger series of patients are needed to assess the safety of this drug during pregnancy.
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Affiliation(s)
- Graciela Stalldecker
- Departamento de Neuroendocrinología, Sociedad Argentina de Endocrinología y Metabolismo, Diaz Velez 3889, 1200 Buenos Aires, Argentina,
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Sampaio LPB, Caboclo LOSF, Kuramoto K, Reche A, Yacubian EMT, Manreza MLG. Prevalence of epilepsy in children from a Brazilian area of high deprivation. Pediatr Neurol 2010; 42:111-7. [PMID: 20117747 DOI: 10.1016/j.pediatrneurol.2009.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 04/29/2009] [Accepted: 09/02/2009] [Indexed: 10/20/2022]
Abstract
This study assessed the prevalence rate of epilepsy and its causes in children and adolescents in one area of high deprivation in São Paulo, São Paulo, in Southeast Brazil. Between July 2005 and June 2006, 4947 families from a population of 22,013 inhabitants (including 10,405 children and adolescents between the ages of 0 and 16 years) living in the shantytown of Paraisópolis, were interviewed. In the first phase, a validated questionnaire was administered, to identify the occurrence of seizures. In the second phase, clinical history, neurologic examination, electroencephalography, and structural neuroimaging were performed. The diagnosis of epilepsy, including etiology, seizure types, and epileptic syndrome classification, was according to criteria of the International League Against Epilepsy. The screening phase identified 353 presumptive cases. In the second phase, 101 of these cases (33.8%) received the diagnosis of epilepsy. Crude prevalence of epilepsy was 9.7/1000 and prevalence of active epilepsy was 8.7/1000. Partial seizures were the most frequent seizure type (62/101). Symptomatic focal epilepsy was the most common form, and hypoxic-ischemic encephalopathy the most common etiology, reflecting the socioeconomic conditions of this specific population. Adequate public policies regarding perinatal assistance could help reduce the prevalence of epilepsy.
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Affiliation(s)
- Letícia P B Sampaio
- Department of Neurology, Hospital of the Clinics of the Faculty of Medicine, University of São Paolo, São Paolo, SP, Brazil.
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Campos BAG, Yasuda CL, Castellano G, Bilevicius E, Li LM, Cendes F. Proton MRS may predict AED response in patients with TLE. Epilepsia 2009; 51:783-8. [DOI: 10.1111/j.1528-1167.2009.02379.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ottman R, Barker-Cummings C, Leibson CL, Vasoli VM, Hauser WA, Buchhalter JR. Validation of a brief screening instrument for the ascertainment of epilepsy. Epilepsia 2009; 51:191-7. [PMID: 19694790 DOI: 10.1111/j.1528-1167.2009.02274.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To validate a brief screening instrument for identifying people with epilepsy in epidemiologic or genetic studies. METHODS We designed a nine-question screening instrument for epilepsy and administered it by telephone to individuals with medical record-documented epilepsy (lifetime history of >or=2 unprovoked seizures, n = 168) or isolated unprovoked seizure (n = 54), and individuals who were seizure-free on medical record review (n = 120), from a population-based study using Rochester Epidemiology Project resources. Interviewers were blinded to record-review findings. RESULTS Sensitivity (the proportion of individuals who screened positive among affected individuals) was 96% for epilepsy and 87% for isolated unprovoked seizure. The false positive rate (FPR, the proportion who screened positive among seizure-free individuals) was 7%. The estimated positive predictive value (PPV) for epilepsy was 23%, assuming a lifetime prevalence of 2% in the population. Use of only a single question asking whether the subject had ever had epilepsy or a seizure disorder resulted in sensitivity 76%, FPR 0.8%, and estimated PPV 66%. Subjects with epilepsy were more likely to screen positive with this question if they were diagnosed after 1964 or continued to have seizures for at least 5 years after diagnosis. DISCUSSION Given its high sensitivity, our instrument may be useful for the first stage of screening for epilepsy; however, the PPV of 23% suggests that only about one in four screen-positive individuals will be truly affected. Screening with a single question asking about epilepsy yields a higher PPV but lower sensitivity, and screen-positive subjects may be biased toward more severe epilepsy.
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Affiliation(s)
- Ruth Ottman
- G.H. Sergievsky Center and Department of Neurology, College of Physicians and Surgeons, Mailman School of Public Health, Columbia University, New York, New York 10032, USA.
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Banerjee PN, Filippi D, Hauser WA. The descriptive epidemiology of epilepsy-a review. Epilepsy Res 2009; 85:31-45. [PMID: 19369037 PMCID: PMC2696575 DOI: 10.1016/j.eplepsyres.2009.03.003] [Citation(s) in RCA: 530] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 02/22/2009] [Accepted: 03/01/2009] [Indexed: 10/20/2022]
Abstract
Epilepsy is a chronic disease experienced by millions and a cause of substantial morbidity and mortality. This review summarizes prevalence and incidence studies of epilepsy that provided a clear definition of epilepsy and could be age-adjusted: requirements if comparisons across studies are to be made. Although few exceptions, age-adjusted prevalence estimates from record-based studies (2.7-17.6 per 1000), are lower than those from door-to-door surveys (2.2-41.0 per 1000). Age-adjusted incidence ranged from 16 to 51 per 100,000, with one exception in Chile, where incidence was 111 per 100,000. Variation in reported prevalence and incidence may be related to factors such as access to health care, regional environmental exposures, or socioeconomic status. A higher proportion of epilepsy characterized by generalized seizures was reported in most prevalence studies. Epilepsy characterized by partial seizures accounted for 20-66% of incident epilepsies. Virtually all prevalence and incidence studies report a preponderance of seizures of unknown cause. Additional prevalence studies are needed in regions where data does not exist, and additional incidence studies in all regions. Interpretation of differences in prevalence and incidence will require understanding of the role of cultural, social and economic factors influencing epilepsy and its care.
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Affiliation(s)
- Poonam Nina Banerjee
- Department of Neurology, College of Physicians and Surgeons, Sergievsky Center, Columbia University, 630 W 168 Street, New York, NY 10032, Telephone: 212-305-8873, Fax: 212-305-2526, E-Mail:
| | - David Filippi
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, 309 E. Second Street, Pomona, CA 91766-1854
| | - W Allen Hauser
- Department of Neurology, College of Physicians and Surgeons, Sergievsky Center, Columbia University, 630 W 168 Street, New York, NY 10032, Telephone: 212-305-8873, Fax: 212-305-2526, E-Mail:
- Mailman School of Public Health, Columbia University, 622 W 168 Street, New York, NY 10032, Telephone: 212-305-8873, Fax: 212-305-2526, E-Mail:
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