Profiles of Indigenous Epileptic Patients in a Brazilian Village

Abstract

Background: Epilepsy affects 50 million people worldwide, most of whom are low-income countries. Patients with epilepsy who live in socially isolated communities often require more medical attention. In Brazil, the estimated prevalence of epilepsy is approximately 2 million. Methods: This descriptive, cross-sectional study investigated the incidence of epilepsy among indigenous people residing in Jaguapiru Village, Dourados, Mato Grosso do Sul, Brazil. We reviewed the clinical histories of the participants and the results of electroencephalography (EEG), neuroimaging, and/or laboratory tests. Additionally, patients with nonepileptic paroxysmal events were identified. Findings: Of the 2,994 respondents, 49 had a confirmed diagnosis of epilepsy, and 22 had self-limited epileptic syndromes; these numbers exceeded the global prevalence but were similar to those reported in the Brazilian population. Focal epilepsy, predominantly of temporal lobe origin, was the most prevalent epileptic syndrome (71.4%). Febrile seizures occurred in only 0.4% of respondents -- much lower than that reported in the general population, which can be attributed to the cross-sectional study design. The aetiology of epilepsy was undetermined in 82.6% of cases, with the remaining cases attributed to head trauma, hypoxic-ischaemic encephalopathy, and brain malformations. A history of delayed neuropsychomotor development was significantly associated with epilepsy. Monotherapy with first-generation antiepileptic drugs was greatly effective in most epilepsy cases (87.7%). EEG helped to define focal epilepsies and diagnose seizures of nonepileptic origin; the latter mostly included cases of psychogenic crises and, less frequently, syncope. Interpretation: Identifying the epidemiological determinants of epilepsy in traditional communities is essential to establish public policies in countries such as Brazil. Funding: This study was conducted without external financial support. EEG was performed using the authors’ own equipment. Travel to the village for questionnaire application was funded by the authors as well. Imaging examinations (cranial computed tomography, magnetic resonance imaging) and laboratory tests, when performed, were provided by the National Health System. Declaration of Interest: The authors declare no financial conflicts of interest. Ethical Approval: This study was performed between November 2012 and November 2017 and was approved by the Research Ethics Committee Involving Human Beings of the Federal University of Grande Dourados and by the National Research Ethics Commission (CONEP; references 6810 and 64479, respectively), as well as the appropriate regulatory bodies and indigenous authorities. All of the participants or their legal representatives signed a free and informed consent form translated into the Guarani-Kaiwa language.