measurement issues associated with epilepsy surveillance and describes sources for data collection. This chapter focuses on the gaps in epilepsy research in terms of what is known and not known related to incidence, prevalence, risk factors, comorbidities, and outcomes. These gaps suggest opportunities for prioritizing future epidemiologic studies in order to guide preventive and early intervention strategies. Improved epilepsy data collection and measurement, as described in Chapter 2, are necessary for better epidemiologic research, along with well-designed and targeted studies to illuminate significant trends and inform health care providers, policy makers, and the public.

To improve knowledge regarding preventing epilepsy and its outcomes, the committee’s vision is for well-designed epidemiologic studies that highlight areas ripe for preventive efforts. Some, but by no means all, key focus areas are discussed here, including prevention of epilepsy, its comorbidities, and its consequences, including death. Before discussing these research areas, the continuum of public health prevention is described as background.

PUBLIC HEALTH AND PREVENTION

In the context of public health, there are traditionally three levels of prevention: primary, secondary, and tertiary. Each aims to intervene at a different point along the continuum of a disease or disorder and involves different types of actions to ameliorate the condition or its impact.

“Primary prevention” is the prevention of a disease or disorder before it begins, with the goal of decreasing its incidence in a population. For example, public health agencies, policy makers, and others work to eliminate environmental hazards (e.g., through sanitary measures such as ensuring clean drinking water), to improve disease resistance (e.g., through immunization), and to decrease high-risk behavior (e.g., tobacco use) and promote healthy behavior (e.g., seatbelt use). In looking forward, future advances in biomedical research hold the promise of greater understanding of epileptogenesis or possibly a cure; meanwhile, it may be possible to prevent some known causes of epilepsy, such as neurocysticercosis through education and sanitary measures, other brain infections through vaccines, traumatic brain injury (TBI) through seatbelt and helmet use, and stroke through reduction of known risk factors.

“Secondary prevention” is the early identification and mitigation of a disease or disorder once it is present in the body but before it is symptomatic. For example, public health agencies collaborate with health professionals to screen a population (e.g., blood glucose or blood pressure screenings) and follow up to manage early symptoms and forestall the development of full-blown disease. Secondary prevention of epilepsy may be possible in the future, if biomarkers of epileptogenesis are identified and early intervention measures are developed.



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