Abstract
ObjectivesTo describe clinical characteristics of a community‐based epilepsy cohort from resource‐limited communities in Punjab, Northwest India.MethodsThe cohort was gathered following a two‐stage screening survey. We cross‐sectionally examined and followed up the cohort for one year. A panel of neurologists assigned seizure types, syndromes, and putative etiologies and categorized drug responsiveness.ResultsThe cohort of 240 included 161 (67.1%) men, 109 (45.4%) illiterates and 149 (62.1%) unemployed. Current age was >18 years in 155 (64.6%) but age at epilepsy onset was <18 years in 173 (72.1%). Epilepsies due to structural and metabolic causes were diagnosed in 99 (41.3%), but syndromic assignments were not possible in 97 (40.4%). After one year, drug‐resistant epilepsy was established in 74 (30.8%). Perinatal events (n = 35; 14.6%) followed by CNS infections (n = 32; 13.3%) and traumatic brain injury (n = 12; 5.0%) were common risk factors. Most of those with CNS infections (n = 19; 63.3%), perinatal antecedents (n = 23; 76.7%), and other acquired risk factors (n = 27; 90.0%) presented with epilepsy due to structural and metabolic causes. Perinatal events were the putative etiology for nearly 40.7% of generalized epilepsies due to structural and metabolic causes and 28.2% of all epilepsies with onset <10 years.SignificanceExisting classifications schemes should be better suited to field conditions in resource‐limited communities in low‐ and middle‐income countries. The finding of drug‐resistant epilepsy in nearly at least a third in a community‐based sample underscores an unmet need for enhancing services for this segment within healthcare systems. Perinatal events, CNS infections, and head injury account for a third of all epilepsies and hence preventative interventions focusing on these epilepsy risk factors should be stepped up.
Highlights
We describe the clinical characteristics of epilepsy using current classification and criteria in a representative community-based sample from communities with limited resources in the Punjab, Northwest India
People were recruited to a cluster-randomized trial of home-based care following a community-based, two-step survey during which 59 509 people were screened for epilepsy in urban and periurban rural areas of Ludhiana in the Northwest Indian state of Punjab
People with focal epilepsies due to structural and metabolic causes were less likely to be employed (P = .041; RR: 0.34; 95%CI, 0.13-0.96), and those with perinatal events were less likely to have undergone any schooling (P = .024; RR: 0.20; 95%CI, 0.05-0.81)
Summary
The WHO South-East Asian Region is home to nearly 30 million people with epilepsy, representing more than half of the world's epilepsy burden.[1,2] Countries in this region shoulder high disease burdens because of the sheer enormity of untreated epilepsy and excess of premature mortality associated with it.[3,4] The characteristics, patterns, and outcomes of epilepsy in South Asia are distinctive due to differing risk factors in comparison with western countries, high treatment gaps, and resource limitations.[5,6] The Commission of Asian and Oceanian Affairs of the International League Against Epilepsy (ILAE) recognizes the understanding of the causes of epilepsy in the Asian-Oceanian region as a research priority.[2] Studies from selected regions within Africa, South America, and China have described clinical, electroencephalographic and imaging features, and attributable causes of epilepsy in community-based samples.[7,8,9,10] A systematic review could, find only a few similar studies from South/east Asia.[11] Most available reports are hospital-based, and susceptible to referral and selection biases.[12] from across India, these have been reports of prevalence and treatment gap in different communities, albeit small.[13] Some more recent reports have only partially addressed clinical characteristics.[14,15] None seem to have used the most current International League Against Epilepsy (ILAE) operational definitions, classifications and criteria applicable to seizures, epilepsy and (antiseizure) drug resistance.[16,17,18,19] We describe the clinical characteristics of epilepsy using current classification and criteria in a representative community-based sample from communities with limited resources in the Punjab, Northwest India
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