The geography of epilepsy

Abstract

Physicians who care for people with epilepsy (PWE) are all too familiar with their risk of seizure-related injuries. For more severely affected patients, brain injury or death due to status epilepticus is of concern, particularly during periods of medication adjustments or poor antiepileptic drug (AED) adherence. More recently, the realities and risks of sudden unexplained death in epilepsy have become an additional cause for anxiety.1 Are PWE at increased risk of early death? Studies in the United States have shown that the mortality risk for PWE is ∼2–3 times that of the general population,2 with the risk being highest in those with refractory epilepsy and decreasing over time. But what about PWE who live in settings with more inherent physical risks and with poorer access to treatment? Reports from resource-poor countries have long suggested that seizure-related deaths from falls, burns, and drownings as well as from status epilepticus (often related to lapses in AED availability) are disturbingly frequent.3 Of course, clinic- or hospital-based reports may be biased toward more severe illness. Epidemiologic studies from resource-poor, non-Western settings have shown higher than expected incidence rates (meaning the number of new cases of epilepsy per …