Remote Symptomatic Epilepsies and Epileptic Syndromes Etiological Spectrum

Arturo Carpio and W. Allen Hauser

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 access to institutions, frequently privately owned, equipped with the latest and most sophisticated methods of diagnosis, which offer high quality service. But the majority of the populations seek health care from the few public institutions that cannot provide optimal services because of economic and administrative limitations. Most of the population suffers the effects of poverty, illiteracy, and malnutrition. Infectious and parasitic diseases remain the leading cause of mortality in these developing countries.1

Epilepsy is a major health problem worldwide, however, the burden frequency of epilepsy appears to be greater in developing countries than in developed countries.2,3 Whether this difference is related to methodological issues or to the factors that potentially increase the risk of epilepsy such as poor perinatal care, head injury, and infectious and parasitic diseases, remains to be unanswered. Worldwide epilepsy carries a strong social stigma, but factors such as poor education and superstition in developing countries lead to even greater stigma, as a consequence, the majority of the population with epilepsy in these countries remain untreated.4,5 These circumstances have an impact on both medical and social approaches to epilepsy. Poor health-care facilities and lack of technology not only reflect the quality of health care; but also make research in this area very difficult. There is a relative absence of reliable medical records and hospital registers for use in epidemiological and clinical studies. As a consequence, information related to causal or risk factors of epilepsy in developing countries is very scarce.6,7 This chapter reviews the available information about the clinical studies of epilepsy syndromes and the etiology of epilepsy in tropical and developing countries.

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