Neurological, Psychiatric, and Developmental Disorders Meeting the Challenge in the Developing World (2001) / Chapter Skim
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6 Epilepsy
6 Epilepsy
Pages 179-216
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From page 179... ...
Epilepsy manifests with several types of seizures, differing in age of onset, response to treatment, prognosis, electroencephalographic correlates, and risk factors.tl2] Moreover, epilepsy that is secondary to a parasitic infestation ofthe brain is a disorder altogether different from genetically determined epilepsies.
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From page 181... ...
Stigma and Discrimination Epilepsy remains among the most stigmatized brain disorders.~13,20] The associated stigma is more obvious in developing countries because of illiteracy
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From page 182... ...
Traditional medicines dispensed for epileptic seizures may be administered to children with febrile seizures with devastating consequences, such as oral burns and aspiration pneumonia.~24] Those afflicted also frequently suffer crippling malformations or death due to burns, drowning, or other accidents.~25]
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From page 183... ...
Additionally, local variations in the prevalence of risk factors and genetic factors that may predispose individuals to develop epilepsy have undoubtedly contributed to the marked heterogeneity in epilepsy prevalence and incidence throughout the world.t 1 1,40~2]
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From page 184... ...
of Bangalore urban and rural populations and showed a prevalence rate of 8.8/1000. The prevalence rate in the rural population was 11.9/1000 and in the urban population was 5.7/]
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From page 185... ...
This fact may be explained by the increased mortality of patients with epilepsy, spontaneous remission, and the low survival of individuals with seizure disorders due to stroke and brain tumors. Only in Rochester, Minnesota, in the United States has the population above age 60 shown an increased prevalence rate, probably reflecting the improved medical care and follow-up of such individuals.[l7]
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From page 186... ...
It will be important for the development of efficacious and comprehensive programs for the prevention and treatment of epilepsy to further investigate and identify risk factors in developing country populations. More recently, researchers have emphasized the importance of studying risk factors separately according to the different epilepsy types.
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From page 187... ...
, prematurity, perinatal hypoxia, sleep disorders in the first 3 months of life, and febrile seizures; for epilepsy starting at age 20 and above, only prematurity was found to be a significant risk factor. When the analysis was done according to seizure type, it was found that for generalized seizures, family history and febrile convulsions were significant risk factors, whereas for partial seizures, family history, prematurity, perinatal hypoxia, and sleep disorders were statistically significant factors.tl2,74]
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From page 188... ...
Acute schistosomiasis may produce a serious encephalopathy with coma, papilledema, and partial or generalized seizures. Chronic forms of cerebral schistosomiasis, caused by embolized schistosoma eggs, are commonly manifested in epileptic attacks.~102]
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From page 189... ...
The rising epidemic of HlV/AlDS in Africa may soon be the leading cause of seizure disorders. Head Injuries In the United States severe head trauma accounted for 12 percent of epilepsy cases.[l25]
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From page 190... ...
Febrile seizures occur in 2 - percent of children, but rates as high as 14 percent have been reported in selected populations. Untreated fevers that lead to febrile seizures can increase the risk of developing epilepsy; however, studies show a low range of occurrence (from 1.5-7 percent)
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From page 191... ...
Phenobarbital is recommended as the first-line drug for the treatment of partial and generalized tonic-clonic epilepsies in developing countries.~3 134,76,135,139-142] Use of this old and simple drug is encouraged because of its efficacy for a wide range of seizure types and its low cost makes it suitable for use in primary health care in developing countries.
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From page 192... ...
Primary Care. The use of primary health care workers and key community informants to identify and follow patients under treatment with either phenobarbital or phenytoin appears to be the most cost-effective intervention for reducing the treatment gap for epilepsy in developing countries.
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From page 193... ...
EPILEPSY 193 ~~ BOX;6~ Model~r~ a i iep Ski - I : ~ ~~-~ I- .~ , , -I.
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From page 194... ...
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From page 195... ...
The role of medical specialists and general practitioners will be essential for conducting appropriate training, developing safe and cost-effective protocols for phannacotherapy, confirming diagnosis, initiating treatment, and overseeing the operation of general medical clinics and community health care centers (see Box 6-3~.~12,76,136]
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From page 196... ...
Community mental health and social workers can often assist patients and families in coping with the social, financial, and psychological consequences of the diseased l 62]
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From page 197... ...
~ ne tr '-n'ng-prQg~m~was mndu~sO as ad d ~ ~ ho .: ~ I-: NeurolOg~stsw~th;spec~al~intere~-:and~experise;in~ -tile s ~9 edit e:~~resource faculty-:F~y-seven-distri~ medial offices d:~-:0m~-1Q:states-~: -~have-already-~cor oleted~the~-~:oroura-r s.:~D:u:nna:~the~-tra-inina~:~-a~:-standard~ed:~va i a ed ques ionnalre cove ring the va ous elemen of he raining were administered to he~district medical forcers Pre and posMraining analysis has~shown that;the traioing~:program had s~gn'ficarit impact (70~0%~n the kr owledge and skills -~-n-~the management of-apile ~ -I ~ ~ ~ ~ i; :- ~ ~ i: - ~ i; ~-~-~ It ~s~:planned:-to:extend this p~gr~m:~to;:~— er Tally th; i i heountry:~identi~ing~ nodal neurologists~in the didere~nt~:~0tes:::who in::turrl:~ would~ -- sucew~se th~e~eDilensv control Dro~oram~-; -- ~ -aid ;~ -- :~ -- :-: ~ -I S~- ~ ~:::~ :~ it: ~ ~:~: : ~ : rid ^~ hi:' ~: ~~- our£s:~ll~0*
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From page 198... ...
One of the main activities within the second track of the GCAE is development of demonstration projects, being carried out in a number of countries in Africa, Asia, and Latin America. The objectives of the demonstration projects are: · To reduce the treatment gap and the physical and social morbidity of people suffering from epilepsy through intervention at the community level; · To train and educate health professionals; To dispel stigma and promote a positive attitude toward people with epilepsy in the community; To identify and assess the potential for prevention of epilepsy; and To develop a model for promotion of epilepsy control worldwide and for its integration into the health systems of participating countries.
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From page 199... ...
Specific programs of operational research for implementing training, prevention, and treatment should include the following: . Specialists and general practitioners who are well-informed about current knowledge on the management and prevention of epilepsy and sensitized to the cultural attitudes within their societies that will impact the training they provide to other levels of health care personnel.
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From page 200... ...
Collaborative research between national centers and research centers in developed countries should be supported. Collaborative research should include but not be limited to the following investigations: Risk factors for epilepsy related to infectious diseases that remain common and endemic in most developing countries; Exploration of genetic risk factors for epilepsy among different geographic and ethnic populations; Nutritional status, genetic factors, and dietary factors that will affect dosage recommendations for AEDs; and Immunological research directed at developing a cost-effective vaccine against porcine and, eventually, human cysticercosis.
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From page 201... ...
induces epilepsy in a high proportion of cases, and is now being diagnosed in numerous countries throughout Africa, Asia, and Latin America, where this zoonosis still constitutes a serious public health problem.~79,80,90,97] In these studies, up to 50 percent of epilepsy cases have been shown to have cysticercosis as a putative factor.
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From page 202... ...
.~93,97,175] To assess cysticercosis as a significant risk factor for epilepsy, researchers from Ecuador conducted an epidemiological study in the village of San Pablo del Lago, 80 miles north of Quito, the capital city, where T
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From page 203... ...
were classified as having generalized seizures and 15 (48.4 percent) as having partial seizures.
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From page 204... ...
Given political and economic realities in countries where NCC is endemic, there is little hope that all these measures can be implemented in the near future. To achieve more rapid progress in reducing active transmission of the disease, community-based interventions for the detection and mass treatment of endemic foci with taenicidal drugs have been proposed and implemented successfully in Ecuador and Mexico.~176l Progress in control can be attained by integrating these activities within primary health care systems.
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From page 205... ...
in the Ecuadoran study, two of three patients with epilepsy secondary to NCC presented with partial seizures. Although anticonvulsants are routinely prescribed, Latin American researchers advocate the concomitant use of antiparasitic drugs and steroids where there is evidence of active NCC [179-181~.
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From page 206... ...
introduction of Taenia solium into West New Guinea with a note on an epidemic of burns from cysticercus epilepsy in the Ekari people of the Wissel Lalces area. Papua New Guinea Medical Journal 21 :329-342, 1978.
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From page 207... ...
Comprehensive primary health care antiepileptic drug treatment programme in rural and semi-urban Kenya. Lancet 337:400409, 199]
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From page 208... ...
Community-based study of neurological disorders in rural central Ethiopia.Neuroepidemiolo.gy9~5~:263-277, 1990.
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From page 209... ...
Suarez, et al. Epileptic seizures in an Andean region of Ecuador: Incidence and prevalence and regional variation.
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From page 210... ...
Magnitude of the disease burden from neurocysticercosis in a developing country. Clinical Infectious Diseases 29:1203-1209, 1999.
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From page 211... ...
Childhood epilepsy in Papua, New Guinea. Papua New Guinea Medical Journal Mar;37( 1~:3~.
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From page 212... ...
Japanese encephalitis in children in northern Thailand. South-East Asian Journal of Tropical Medicine and Public Health 20:599-603, 1989.
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From page 213... ...
Bimos, et al. Antiepileptic drug treatment in a community health-care setting in northern Ecuador: A prospective 12-month assessment.
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From page 214... ...
An evaluation of the management of epilepsy by primary health care nurse in Chitungwiza, Zimbabwe. Epilepsy Research May;39~3~: 177-181, 2000.
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From page 215... ...
Prognostic factors for seizure recurrence after withdrawal of antiepileptic drugs in patients with neurocysticercosis. Neurology 44: 170~1709, 1994.
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From page 216... ...
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