Global Health: Epilepsy

 

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Abstract

Epilepsy is a frequently misunderstood and highly stigmatized condition. Major treatment gaps exist across the world, most so in areas of financial constraint. Classification permits the best approaches to treatment and to ascertaining prognosis. The International League Against Epilepsy's new classification system emphasizes clinical aspects and utilizes all available resources to determine whether it is a focal or generalized epilepsy. The most important tools are a careful history, clinical examination, electroencephalography, and appropriate neuroimaging. Inadequate, delayed, and incomplete evaluation may lead to misdiagnosis and costly mismanagement. Treatment is generally pharmacological, with approximately 20 to 30% of patients eventually proving refractory to medications and thus becoming potential surgical candidates. The type of epilepsy, age, gender, comorbidities, drug interactions, and drug cost are important factors in choosing an antiepileptic drug (AED). The teratogenic potential of some AEDs, weight gain, and menstrual hormone–related issues are important considerations in women. The impact of AEDs on bone health is critical in all age groups, particularly in the elderly. Psychiatric problems, mostly depression and anxiety, can have a great impact on seizure control and overall quality of life. Finally, effective partnerships and collaborations can bring resources, both human and financial, to regions that would otherwise find it impossible to effect change on their own.

• References

• 1 Magiorkinis E, Sidiropoulou K, Diamantis A. Hallmarks in the history of epilepsy: epilepsy in antiquity. Epilepsy Behav 2010; 17 (01) 103-108
  CrossrefPubMedGoogle Scholar
• 2 Temkin O. The Falling Sickness. Baltimore, MD: J. Hopkins Press; 1945
  Google Scholar
• 3 Jackson JH. The Lumleian lectures on convulsive seizures. Lancet 1890; 135 (3476): 785-788
  CrossrefPubMedGoogle Scholar
• 4 Ferrier D. Experimental researches in cerebral physiology and pathology. J Anat Physiol 1873; 8 (Pt 1): 152-155
  PubMedGoogle Scholar
• 5 Meinardi H, Scott RA, Reis R, Sander JW. ; ILAE Commission on the Developing World. The treatment gap in epilepsy: the current situation and ways forward. Epilepsia 2001; 42 (01) 136-149
  CrossrefPubMedGoogle Scholar
• 6 Senanayake N, Román GC. Epidemiology of epilepsy in developing countries. Bull World Health Organ 1993; 71 (02) 247-258
  PubMedGoogle Scholar
• 7 Bharucha NE, Shorvon SD. Epidemiology in Developing Countries. In: Engel J, Pedley T. , eds. Epilepsy: A Comprehensive Textbook. Vol 1. Philadelphia, PA: Lippincott-Raven; 1997: 105-118
  Google Scholar
• 8 Medina MT, Rosas E, Rubio-Donnadieu F, Sotelo J. Neurocysticercosis as the main cause of late-onset epilepsy in Mexico. Arch Intern Med 1990; 150 (02) 325-327
  CrossrefPubMedGoogle Scholar
• 9 Ogunniyi A, Osuntokun BO, Bademosi O, Adeuja AO, Schoenberg BS. Risk factors for epilepsy: case-control study in Nigerians. Epilepsia 1987; 28 (03) 280-285
  CrossrefPubMedGoogle Scholar
• 10 Bharucha NE, Bharucha EP, Bharucha AE, Bhise AV, Schoenberg BS. Prevalence of epilepsy in the Parsi community of Bombay. Epilepsia 1988; 29 (02) 111-115
  CrossrefPubMedGoogle Scholar
• 11 Scheffer IE, Berkovic S, Capovilla G. , et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia 2017; 58 (04) 512-521
  CrossrefPubMedGoogle Scholar
• 12 Alsaadi TM, Marquez AV. Psychogenic nonepileptic seizures. Am Fam Physician 2005; 72 (05) 849-856
  PubMedGoogle Scholar
• 13 Rao MB, Radhakrishnan K. Is epilepsy surgery possible in countries with limited resources?. Epilepsia 2000; 41 (Suppl. 04) S31-S34
  PubMedGoogle Scholar
• 14 Kale R. Global campaign against epilepsy: the treatment gap. Epilepsia 2002; 43 (Suppl. 06) 31-33
  CrossrefPubMedGoogle Scholar
• 15 Shorvon SD, Farmer PJ. Epilepsy in developing countries: a review of epidemiological, sociocultural, and treatment aspects. Epilepsia 1988; 29 (Suppl. 01) S36-S54
  CrossrefPubMedGoogle Scholar
• 16 Bharucha NE. Epidemiology of epilepsy in India. Epilepsia 2003; 44 (Suppl. 01) 9-11
  CrossrefPubMedGoogle Scholar
• 17 Durkin MS, Davidson LL, Hasan ZM. , et al. Estimates of the prevalence of childhood seizure disorders in communities where professional resources are scarce: results from Bangladesh, Jamaica and Pakistan. Paediatr Perinat Epidemiol 1992; 6 (02) 166-180
  CrossrefPubMedGoogle Scholar
• 18 Chadwick D, Smith D. The misdiagnosis of epilepsy. BMJ 2002; 324 (7336): 495-496
  CrossrefPubMedGoogle Scholar
• 19 Fisher RS, Acevedo C, Arzimanoglou A. , et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia 2014; 55 (04) 475-482
  CrossrefPubMedGoogle Scholar
• 20 Krauss G, Sandy S, Corbin DOC. , et al. Epilepsy care in the southern Caribbean. Epilepsy Behav 2015; 51: 267-272
  CrossrefPubMedGoogle Scholar
• 21 World Economic Forum. The Global Gender Gap Report. 2016 ; Available at: http://reports.weforum.org/global-gender-gap-report-2016/the-global-gender-gap-report-2016/ . Accessed May 28, 2017
  PubMed
• 22 Morrell MJ. Epilepsy in women: the science of why it is special. Neurology 1999; 53 (04) (Suppl. 01) S42-S48
  PubMedGoogle Scholar
• 23 Walker SP, Permezel M, Berkovic SF. The management of epilepsy in pregnancy. BJOG 2009; 116 (06) 758-767
  CrossrefPubMedGoogle Scholar
• 24 Herzog AG. Progesterone therapy in women with complex partial and secondary generalized seizures. Neurology 1995; 45 (09) 1660-1662
  CrossrefPubMedGoogle Scholar
• 25 Beghi E, Roncolato M, Visonà G. Depression and altered quality of life in women with epilepsy of childbearing age. Epilepsia 2004; 45 (01) 64-70
  CrossrefPubMedGoogle Scholar
• 26 EURAP Study Group. Seizure control and treatment in pregnancy: observations from the EURAP epilepsy pregnancy registry. Neurology 2006; 66 (03) 354-360
  CrossrefPubMedGoogle Scholar
• 27 Harden CL, Meador KJ, Pennell PB. , et al; American Academy of Neurology; American Epilepsy Society. Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): teratogenesis and perinatal outcomes: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology 2009; 73 (02) 133-141
  CrossrefPubMedGoogle Scholar
• 28 Bangar S, Shastri A, El-Sayeh H, Cavanna AE. Women with epilepsy: clinically relevant issues. Funct Neurol 2016; 31 (03) 127-134
  Google Scholar
• 29 Pack AM, Morrell MJ, Marcus R. , et al. Bone mass and turnover in women with epilepsy on antiepileptic drug monotherapy. Ann Neurol 2005; 57 (02) 252-257
  CrossrefPubMedGoogle Scholar
• 30 Browne TR, Holmes GL. Handbook of Epilepsy. Philadelphia, PA: Jones & Bartlett Learning; 2008
  Google Scholar
• 31 American Academy of Pediatrics Committee on Fetus and Newborn. Controversies concerning vitamin K and the newborn. Pediatrics 2003; 112 (1 Pt 1): 191-192
  CrossrefPubMedGoogle Scholar
• 32 Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med 2000; 342 (05) 314-319
  CrossrefPubMedGoogle Scholar
• 33 Polkey C. The history of epilepsy surgery in the United Kingdom. In: Textbook of Epilepsy Surgery. London: Informa Healthcare; 2009: 24-31
  Google Scholar
• 34 McNaughton FL. Wilder Penfield: his legacy to neurology. Impact on medical neurology. Can Med Assoc J 1977; 116 (12) 1370
  PubMedGoogle Scholar
• 35 Kim W-J, Park S-C, Lee S-J. , et al. The prognosis for control of seizures with medications in patients with MRI evidence for mesial temporal sclerosis. Epilepsia 1999; 40 (03) 290-293
  CrossrefPubMedGoogle Scholar
• 36 Rossi MA. Where have all the temporal lobe epilepsy surgeries gone?. Epilepsy Curr 2015; 15 (03) 126-128
  CrossrefPubMedGoogle Scholar
• 37 Yoon HH, Kwon HL, Mattson RH, Spencer DD, Spencer SS. Long-term seizure outcome in patients initially seizure-free after resective epilepsy surgery. Neurology 2003; 61 (04) 445-450
  CrossrefPubMedGoogle Scholar
• 38 Binder JR, Swanson SJ, Hammeke TA. , et al. Determination of language dominance using functional MRI: a comparison with the Wada test. Neurology 1996; 46 (04) 978-984
  CrossrefPubMedGoogle Scholar
• 39 Richardson MP, Strange BA, Thompson PJ, Baxendale SA, Duncan JS, Dolan RJ. Pre-operative verbal memory fMRI predicts post-operative memory decline after left temporal lobe resection. Brain 2004; 127 (Pt 11): 2419-2426
  CrossrefPubMedGoogle Scholar
• 40 Janszky J, Jokeit H, Kontopoulou K. , et al. Functional MRI predicts memory performance after right mesiotemporal epilepsy surgery. Epilepsia 2005; 46 (02) 244-250
  CrossrefPubMedGoogle Scholar
• 41 Alamri Y, Al-Busaidi IS. Anxiety and depression in Saudi patients with epilepsy. Epilepsy Behav 2015; 53: 25
  CrossrefPubMedGoogle Scholar
• 42 Brandt C, Mula M. Anxiety disorders in people with epilepsy. Epilepsy Behav 2016; 59: 87-91
  CrossrefPubMedGoogle Scholar
• 43 Gaitatzis A, Trimble MR, Sander JW. The psychiatric comorbidity of epilepsy. Acta Neurol Scand 2004; 110 (04) 207-220
  CrossrefPubMedGoogle Scholar
• 44 Gordon-Perue G, Gayle F, Fraser R, Ali A. Quality of life of patients with epilepsy living in Kingston, Jamaica. Epilepsy Behav 2011; 21 (01) 23-26
  CrossrefPubMedGoogle Scholar
• 45 Taylor J, Jacoby A, Baker GA, Marson AG, Ring A, Whitehead M. Factors predictive of resilience and vulnerability in new-onset epilepsy. Epilepsia 2011; 52 (03) 610-618
  CrossrefPubMedGoogle Scholar
• 46 Schachter SC. Complementary and alternative medical therapies. Curr Opin Neurol 2008; 21 (02) 184-189
  CrossrefPubMedGoogle Scholar
• 47 Fernandes PT, Snape DA, Beran RG, Jacoby A. Epilepsy stigma: what do we know and where next?. Epilepsy Behav 2011; 22 (01) 55-62
  CrossrefPubMedGoogle Scholar
• 48 Ali A, Ali TE, Kerr K, Ali SB. Epilepsy awareness in a Jamaican community: driven to change!. Epilepsy Behav 2011; 22 (04) 773-777
  CrossrefPubMedGoogle Scholar
• 49 Jacoby A, Gorry J, Baker GA. Employers' attitudes to employment of people with epilepsy: still the same old story?. Epilepsia 2005; 46 (12) 1978-1987
  CrossrefPubMedGoogle Scholar
• 50 Reynolds EH. The ILAE/IBE/WHO Global Campaign against Epilepsy: Bringing Epilepsy “Out of the Shadows”. Epilepsy Behav 2000; 1 (04) S3-S8
  PubMedGoogle Scholar
• 51 Ahmed SN, Mann C, Sinclair DB. , et al. Feasibility of epilepsy follow-up care through telemedicine: a pilot study on the patient's perspective. Epilepsia 2008; 49 (04) 573-585
  CrossrefPubMedGoogle Scholar
• 52 Fisher RS, Cross JH, D'Souza C. , et al. Instruction manual for the ILAE 2017 operational classification of seizure types. Epilepsia 2017; 58 (04) 531-542
  CrossrefPubMedGoogle Scholar