As mentioned in other parts of this volume, close attention should be paid to the possible relationship between seizure occurrence and seizure-provoking factors. Developing country environments increase the likelihood of several factors that can precipitate seizures. Foremost is suboptimal compli ance with the intake of antiepileptic drugs. Such noncompliance may be driven by cultural factors (such as the perception by relatives that the patient is taking too much medication, or that the medication will prove harmful in the future), by the inconsistent availability of antiepileptic medications in public pharmacies, and/or by inadequate personal resources to access these medications. The temporal relationship between seizure occurrence and missed medication, as well as with other known provoking factors (such as excessive alcohol intake and sleep deprivation) should always be considered.
Illicit Drug Abuse and Other Habits Illicit use of central nervous system-active drugs is a universal phenomenon. Drug producing and poorly enforced drug-restricting regulations lead to major drug-related casualties in developing countries. Large-scale drug availability leads to high rates of drug use and abuse, which in turn may produce both seizures related to overdose and secondary brain lesions, causing subsequent epilepsy. Furthermore, persons who already have epilepsy may experience periods of seizure recurrence or increase in frequency when using illicit drugs. Alcohol use, abuse, and withdrawal can cause similar problems. History should clarify whether drug-related seizures in a given individual represent the overuse of a stimulant drug or the sudden withdrawal of a sedative drug in someone who is known to have epilepsy, or if the seizures are an acute reaction of a normal brain. In the latter case, a diagnosis of epilepsy is unwarranted, but in either situation, counseling should be instituted to prevent further seizures.
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