Yasuko Yamatogi and Shunsuke Ohtahara

Most of the epilepsy has long been believed to commence in childhood and thereafter decline with age. However, in developed countries increased incidence of epilepsy in the elderly has been reported with the progressive aging of the popula-tion,1,2 whereas that in childhood has decreased nearly by 40 .3 Two incidence peaks early in the childhood and in the senescence over 60 years of age has been ob-served.3,4 When compared to developed countries the incidence of epilepsy in childhood in...

Nimal Senanayake

The impact of geographic, climatic, demographic, social, and economic characteristics in developing countries is adverse in terms of the frequency of epilepsy. Information is relatively limited, and actions have to be based frequently on dramatic numbers in Malawi between 1983 and 1986, 60 of psychiatric outpatients and 30 of all psychiatric and neurological cases were related to epilepsy.1 Most of the earlier epidemiological studies on epilepsy in developing countries derived the information...

Immunological Tests

Image Brain Enhancement

Tests directed to the detection of anticysticercal antibodies in serum and CSF are a valuable complement to neuroimaging in the evaluation of patients with suspected NCC, but they should never be used alone to exclude or confirm the diagnosis of the disease.28 From the many tests performed in serum, current data indicate that the most effective is the enzyme-linked immunoelectrotransfer blot (EITB). Such assay has been claimed to have 100 specificity and 98 sensitivity.37 However the serum EITB...

Definitions and Classification

The International Classification of Epileptic Syndromes and Epilepsies was first proposed in 1970.8 This classification takes into consideration the fundamental dichotomy between partial and generalized seizures, and also a second essential dichotomy between age-related idiopathic or cryptogenic epilepsies on the one hand, and symptomatic epilepsies on the other. The revised classification in 19859 created two new categories epilepsies undetermined as to whether focal or generalized, and...

Knowledge Attitude and Practice of Epilepsy in Developing Countries

Epilepsy is a worldwide problem with a major impact on the personal, family, and social life of the affected individual and also on the society. The reported prevalence rates of epilepsy in various epidemiological studies vary from 1.5 to 19.5 per 1,000 population with higher prevalence rates in developing countries.1-5 The average accepted prevalence rate is 5 per 1000.2 Stigmatization, low literacy, sub-optimal employment, and social and economical marginalization are the commonly faced...

References

Epidemiology of the epilepsies. J Neurol Neurosurg Psychiatry 1996 61 433-43. 2. Pedley T, Kale R. Epilepsy information for the developing world. Epilepsia Digest 1996 1 1. 3. Senanayake N, Roman GC. Epidemiology of epilepsy in developing countries. Bull WHO 1993 71 247-58. 4. de Bittencourt PRM, Adamolekum B, Bharucha N et al. ILAE Commission Report. Epilepsy in tropics. I. Epildemiology, socioeconomic risk factors and etiology. Epilepsia 1996 37 1121-7. 5. Sridharan...

Clinical History Screening Questionnaire

Diagnosis of epilepsy is fundamentally a clinical judgment. Clinical history should elicit details of seizure semiology, seizure provoking factors, and seizure frequency in the preceding five years.7 At times there can be discrepancy in the diagnosis of epilepsy when it is based only on a screening questionnaire. In a recent epidemiological survey in Togo of the 9,155 subjects screened by a screening questionnaire, 285 subjects (3.1 ) reported loss of consciousness, 263 (2.9 ) had seizures and...

Table 1 Common sources of misinterpretation of scalp EEGs

Seizure Eeg Chart

Electrode artifacts Myogenic artifacts ECG and pulse artifacts Benign epileptiform variants Benign sporadic sleep spikes Wicket waves 14 and 6 Hz positive spikes 6 Hz spike-waves Rhythmic temporal theta burst of drowsiness Subclinical rhythmic electroencephalographs discharge of adults Atypical responses to photic stimulation Bifrontal delta activity on hyperventilation Posterior slow waves of youth Breach activity tropical world. In India, there are no defined minimum standards for EEG...

Status Epilepticus in Developing Countries An Account

Pierre-Marie Preux, Mouhamadou Diagana and Michel Druet-Cabanac Status epilepticus is a common neurological emergency and is associated with a significant mortality. It may occur in association with epilepsy and in the context of acute central nervous system insults and the systemic illness.1 There is very few published data about status epilepticus in developing countries. Generalized tonic-clonic status epilepticus is readily recognized. But other forms of status epilepticus may not be...

Eating Provoked Seizures Kaul Razdan

Photosensitive epilepsy. A review of the literature and a study of 460 patients. London William Heinemann, 1975. 2. Newmark ME, Penry JK. Photosensitive epilepsy A review. New York Raven Press, 1979. 3. Wilkins AJ, Binnie CD, Darby CE. Visually-induced seizures. Prog Neurobiol 1980 15 85-117. 4. Kasteleijn-Nolst Trenite DG. Photosensitivity in epilepsy. Electrophysiological and clinical correlates. Acta Neurol Scand Suppl 1989 125 3-149. 5. Merlis JK. Reflex epilepsy....

Epilepsy Knowledge and Attitude

Over all the level of knowledge and awareness of epilepsy is poor in developing countries. Many might have heard or read about epilepsy, but a majority lack adequate information about its cause, nature and treatment. Even among parents of a child with epilepsy, understanding of the disorder is inadequate and negative.18 The knowledge of epilepsy is also low among highly educated groups,19-21 professors,20,21 and school teachers.22,23 In a study in Senegal, 25 of primary school teachers...

Nonconvulsive Status Epilepticus

Nonconvulsive status epilepticus NCSE accounts for over one-quarter of all cases of status epilepticus and is more common in patients admitted to intensive care units.69 The most important diagnostic procedure in the evaluation of patients with NCSE is the EEG. In a recent study, 8 of patients in altered sensorium with no overt seizure phenomena were found to have NCSE by EEG monitoring.70 Nonconvulsive status epilepticus is broadly divided into generalized absence or partial complex partial...

Epilepsy and Driving

Epileptic seizures are accountable for a small proportion of road traffic accidents. Driving laws for persons with epilepsy vary in different countries, from a life-term ban to no regulations at all. In the United Arab Emirates and Sri Lanka there are no laws restricting a person with epilepsy from driving.53,54 In most countries, patients with good seizure control for at least one year and also with good drug compliance are allowed to drive a private vehicle, but professional driving is...

Developing Countries Perspective

Febrile seizure is the most common seizure disorder in childhood. Often the terms febrile convulsion and febrile seizure are used synonymously or interchangeably. In the newly proposed classification this seizure disorder has been recognized as a special syndrome and the term febrile seizures FS has been proposed.1'2 Epidemiological studies of FS are very few from the developing countries and show some differences not only in the incidence and prevalence rates but also in the clinical features'...

Food and Eating Habits

The relation between the seizures and the type of food, time of eating, eating pattern, and environment is uncertain.26,28,37 In our series 55 observed that the seizures occurred only when they ate a rice meal and in three patients the seizures were related to eating fish. No such consistent relation has been found in other studies.43 One of the earlier reports documented a patient in whom eating apple consistently precipitated seizures.17 Rice is the staple diet that makes the bulk of the meal...

Special Issues in Developing Countries

Thomas Introduction Epilepsy is one of the most common chronic disorders affecting women of child-bearing age and 3 to 5 of every 1000 births are to mothers with epilepsy.1 Women with epilepsy WWE in developing countries have many concerns and face many social and cultural taboos related to the diversity in ethnic, racial, religious, economic, educational, and cultural spheres. In addition, in developing countries child-bearing for WWE has not always been acceptable...

Mortality Associated with Epilepsy Developing Countries Perspective

Allen Hauser and Nimal Senanayake Studies consistently suggest that patients with epilepsy have higher mortality rates than the general population. This is true for all types of epilepsy, especially among younger patients and those with severe epilepsy. Age, sex, race, socioeconomic status, interval from the diagnosis, seizure frequency, and seizure type have all been suggested to be relevant factors affecting mortality.1 A higher mortality rate is expected...

And Etiological Profile in Developing Countries

Acute symptomatic seizures are those caused or provoked by an acute medical or neurological insult1 and, in the aggregate are almost as common as febrile seizures or epilepsy.2 They make up 40 of all the newly diagnosed seizure disorders.3 Acute symptomatic seizures show clearly differentiated characteristics with regard to true epileptic seizures 1 a clearly identified causal association, 2 generally tend not to recur, 3 usually long-term antiepileptic drug AED treatment is not necessary. The...

Epilepsy and Employment

There is no legal bar on employment of persons with epilepsy, however discrimination towards their employment is highly prevalent. World-over persons with epilepsy are sub-optimally employed. This is more so in developing countries. Employers are found to be unaware of employment problems faced by people with epilepsy.64 The seizure status is a major factor determining employment opportunities of a patient with intractable epilepsy. Persons with good seizure control and with no other handicap...

Epilepsy in Developing Countries Diagnostic Evaluation

Joseph Cherian and Kurupath Radhakrishnan Careful history taking and interpreting, and minute and repeated clinical examinations are time consuming. It is particularly the busy physician who is inclined to delegate the diagnosis to the laboratory in the vain hope of saving time. Laboratory procedures often seem necessary because the clinical examination has not been adequate. They are all too often superfluous, and a thorough clinical examination would have provided grounds for correct...

Diagnostic Sensitivity

Dystonic Posturing Seizures

An awake standard EEG record will record IEDs in 50 of adults with epilepsy.12 The chance of recording IEDs increases with multiple EEGs and it is 92 with four recordings.19 The yield substantially increases by recording during sleep, more so after overnight sleep deprivation.20,21 Sleep recordings are of special value for ascertaining focal IEDs in partial epilepsies22,23 and establishing the presence of generalized IEDs in patients with idiopathic generalized epilepsy syndromes.12,13 A single...

P Satishchandra Gautam R Ullal and SK Shankar

Seizures precipitated by a sensory stimulus are described as reflex or sensory epilepsy. Reflex epilepsies are interesting, not merely as 'collector's item' but provide extremely important information regarding the pathogenesis of epilepsy in general, and reflex epilepsy in particular. As the seizure-inducing mechanisms rather than the etiology constitutes the common factor in these seizures, the term 'sensory precipitation of seizures' proposed by Penfield is probably more appropriate.1...

Contributors

Department of Neurology Johns Hopkins University Baltimore, Maryland, U.S.A. Hasan Aziz, M.B.B.S., F.R.C.P. Department of Neurology Jinnah Post Graduate Medical Centre Karachi, Pakistan Chapter 5 Agnon Ay lola Koffi Balogou, M.D., Ph.D. Nadir E. Bharucha, M.D., F.R.C.P. Lond. , F.A.M.S. India , F.R.C.P. Neurology Canada Bombay Hospital Institute Department of Neuroepidemiology Medical Research Centre Bombay Hospital Mumbai, India Arturo Carpio, M.D. School of Medicine and...

Prenatal Factors

Prenatal etiologic factors include gene abnormalities, chromosomal abnormalities and various prenatal environmental factors affecting embryo and fetus. Prenatal factors usually cause developmental brain abnormalities, patterns of which are mainly depend on the timing of CNS development that the causative factors are applied, usually not specific to the kinds of insults. Gross brain malformations are caused by the teratogenic factors during organogenesis, mainly 3 to 8 weeks of conception, or by...

References 1

Prevalence of epilepsy in Bogota. Columbia Neurology 1978 28 90-5. Hauser WA Epidemiology of epilepsy. In Schoenburg BS, ed. Advances in Neurology - Neurological epidemiology Principles and clinical applications. New York Raven Press, 1978 19 313-38. Aziz H, Ali SM, Francis P et al. Epilepsy in Pakistan A population-based epide-miological study. Epilepsia 1994 35 950-8. Placencia M, Shorvon SD, Paredes V et al. Epileptic seizures in an Andean region of Ecuador...

Premature Birth Low Birth Weight

With improvement in the survival of very premature, the risk of epilepsy has been shown to be high in infants with low birth weight. The risk of developing epilepsy in the later life is very high in neonates with gestational age less than 27-weeks and birth weight less than 1000 g.39 Of the 29 neonates with ELBW lt 1,000 g followed for a period of 11 to 14 years, 17.2 had epilepsy and 10.3 with active epilepsy. The corresponding figures for the 197 neonates with VLBW lt 1,500 g were 4.1 and 2.5...

Clinical Features

Of the 8 patients in our series, five were males. The age range at presentation was 9-38 years and the age at onset of epilepsy was between 6-16 years. Three patients were mentally subnormal. Generalized seizure was the seizure type in five, and in three the seizure type could not be classified. Photosensitivity was demonstrable on EEG in four. A female aged 22 years had her first seizure at the age of nine years. It happened one morning when she was in the schoolyard. She felt a 'funny...

Kouadjo Epilepsy Cote D Ivoire

Bittencourt PRM, Adamolekum B, Bharucha N et al. ILAE Commission report Epilepsy in the tropics I. Epidemiology, socioeconomic risk factors, and etiology. Epilepsia 1996 37 1121-7. 2. Epilepsy in the developing countries. WHO Chron 1979 33 183-6. 3. World Health Organization. Research protocol for measuring the prevalence of neurological disorders in developing countries. Neurosciences program. Geneva World Health Organization, 1981. 4. Schoenberg BS. Clinical neuroepidemiology in developing...

Prenatal and Perinatal Pathology

Poor prenatal or perinatal care resulting in brain damage of the child is often claimed to be a reason for the high prevalence of epilepsy in the tropics.3,31 Unfortunately, very few studies in the tropics define inclusion criteria for this category. In studies in developed countries the presence of prenatal and perinatal events do not appear to be associated with the occurrence of childhood epilepsy when children with cerebral palsy and mental retardation are excluded.32 The USA Collaborative...

Neuroimaging Studies

Ncc Images Mri

Both CT and MRI have drastically improved our diagnostic accuracy for NCC by providing objective evidence about the topography of the lesions and the degree of the host inflammatory response against the parasite.30,31 CT scan and MRI findings in parenchymal NCC depend on the stage of development of cysticerci, and include cystic lesions imaging the scolex as a brilliant nodule hole-with-dot image , ring like or nodular enhancing lesions, and punctate calcifications Fig. 2 . Neuroimaging...

Spontaneous Remission Rate in Epilepsy

In developing countries, patients may have had epilepsy for long period of time.1 If these patients never remit, prevalence rates for epilepsy in developing countries should be much higher than those found in the developed world.20,21 Indeed some studies in developing countries have reported higher prevalence rates for epilepsy. However, these were all small scale studies of selected populations that may have high rates of CNS degenerative diseases, parasitic diseases or specific epilepsy...

Remote Symptomatic Epilepsies and Epileptic Syndromes Etiological Spectrum

Most of the tropical countries in the world are underdeveloped or developing countries that form part of the so-called Third World. These countries not only have geographic but also social, economic, and ethnic differences as compared to the northern countries of the world. Consequently, there are substantial differences in the relationship between health and disease. The socioeconomic structure of developing countries is marked by profound contrasts. A small percentage of the population has...

Digital EEG

The advantages of digital EEG over analog EEG include paperless storage, quantification, automatic event detection and networking capabilities.46,47 The flexibility of digital EEG allows modification of the recording parameters, such as montage, filters, amplitude and duration display scales retrospectively during review of the recording. These capabilities allow for more accurate interpretation of the EEG data.48 Since digital EEG machines are comparable in cost to analog EEG machines, they...

Epidemiology

Self-induced epilepsy is a rare condition.5,77 This phenomenon was observed in only one patient, of the 10,000 patients with epilepsy studied,78 in only two records, of the 20,000 EEG records studied,79 and in five patients, of the 460 patients with photosensitivity.1 Of the 22 patients with epilepsy and photosensitivity, studied by Darby et al,76 seven had self-induced paroxysmal activity and or seizures by slow eye closure. Self-induced epilepsy is more frequently reported from the Indian...

Pathogenic Mechanisms

As to why some patients with epilepsy deliberately evoke seizures remains a puzzle. Most of these patients are compulsively attracted to sunlight. They cannot offer a good explanation for their abnormal behavior, although some admit that it gives them a pleasurable or relaxing feeling. Many authors, including Radovici,71 have thought that psychological factors and stressful situations influenced the frequency of self-induced seizures. Associated behavioral abnormalities leading to social...

Neonatal Seizures Developing Countries Perspective

Seizures in the newborn period are a frequent clinical problem and represent the most distinctive signal of neurological disease. Neonatal seizures are usually related to specific illness requiring prompt therapy. Early diagnosis of underlying cause is important, as some of the risk factors are associated with high mortality or adverse neurological sequelae. Neonatal seizures show clearly differentiated characteristics from seizures in older children. Several unique characteristics of neonatal...

Neurocysticercosis

Neurocysticercosis NCC is not necessarily a tropical disease, it is related to unsanitary conditions, poverty and poor health-care systems of a country, regardless of its geographical location. Studies of highly selected patients with epilepsy or seizures in neurologic services of hospital settings from some developing countries report NCC as the main cause of epilepsy, accounting for 30 to 50 of patients.16,31 However, in the recent prospective multicenter study carried out in Ecuador, NCC was...

Periventricular Leukomalacia

Periventricular leukomalacia PVL is a ischemic cerebral white matter disorder and occurs in the premature brain of about 24-35 weeks of gestation.29,38 In addition to arterial ischemia, other factors involved in the pathophysiology of these changes include immaturity of the brain, underdeveloped cerebral vasculature and nature of cell component such as intrinsic vulnerability of the oligodendroglia, hemorrhage during later pregnancy and perinatal period, vascular anastomosis in the placenta,...

Eating Epilepsy

In 1945, Allen12 first documented eating as a precipitating factor for epileptic seizures in a 35-year old male. Later in 1951 Boudouresques and Gastaut13 documented the electroencephalographic EEG correlate of eating epilepsy. They reported epileptiform activity in the temporal leads in four patients with postprandial seizures attributed to gastric distension. Symonds14 stressed the need for detailed interrogation of patient with epilepsy for seizure precipitants like eating. Subsequently...