Summary: Purpose:The worldwide prevalence of epilepsy is variable, estimated at 10//1,000 people, and access to treatment is also variable. Many people go untreated, particularly in resourcepoor countries.Objective: To estimate the prevalence of epilepsy and the proportion of people not receiving adequate treatment in different socioeconomic classes in Brazil, a resource-poor country.Methods: A door-to-door survey was conducted to assess the prevalence and treatment gap of epilepsy in three areas of two towns in Southeast Brazil with a total population of 96,300 people. A validated screening questionnaire for epilepsy (sensitivity 95.8%, specificity 97.8%) was used. A neurologist further ascertained positive cases. A validated instrument for socioeconomic classification was used.Results: Lifetime prevalence was 9.2/1,000 people [95% CI 8.4-10.0] and the prevalence of active epilepsy was 5.4/1,000 people. This was higher in the more deprived social classes (7.5/1,000 compared with 1.6/1,000 in the less deprived). Prevalence was also higher in elderly people (8.5/1,000). Thirty-eight percent of patients with active epilepsy had inadequate treatment (19% on no medication); the figures were similar in the different socioeconomic groups.Conclusion: The prevalence of epilepsy in Brazil is similar to other resource-poor countries, and the treatment gap is high. Epilepsy is more prevalent among less wealthy people and in elderly people. There is an urgent need for education in Brazil to inform people that epilepsy is a treatable, as well as preventable, condition.
-The aim of this study was to determine the prevalence of epilepsy in the urban population of São José do Rio Preto. This is a medium-sized city of 336000 inhabitants, located in the northwest of the state of São Paulo, Brazil. Method:A cross-sectional epidemiological investigation with a randomized sample was performed in two phases, a screening phase and a confirmation of the diagnosis phase. The gold standard was a clinical investigation and neurological examination. The chi-square test was used in analysis of the results and p-value value < 0.05 was considered significant. Prevalence was calculated with 95% confidence interval. Results: The study sample size was 17293 individuals, with distributions of gender, age, and race similar to the general population.The prevalence per 1000 inhabitants of epilepsy was 18.6, of these 8.2 were active, defined as at least one seizure within the last two years. The prevalence per 1000 inhabitants for the age groups (years) was 4.9 (0-4), 11.7 (5-14), 20.3 (15-64) and 32.8 (65 or over). Conclusion: Prevalence of both accumulated and active epilepsy was elevated, comparable to other developing nations, in particular those of Latin America. However, the prevalence of epilepsy in childhood was low, whilst in aged individuals it was high similar to industrialized nations.KEY WORDS: epilepsy, epidemiology, prevalence, Latin America. Prevalência urbana da epilepsia: estudo populacional em São José do Rio Preto -cidade de médio porte do BrasilRESUMO -Antecedentes: O objetivo deste estudo foi determinar a prevalência da epilepsia na população urbana de São José do Rio Preto, com 336000 habitantes, localizada no noroeste do Estado de São Paulo/ Brasil. Método: O estudo populacional, tipo corte transversal, em amostra aleatória, constituiu-se de uma fase de rastreamento, mediante um questionário. O padrão ouro para confirmação diagnóstica foi a história clínica e o exame neurológico. Os testes do χ 2 e intervalo de confiança de 95% (IC-95%) foram usados para análise dos resultados, tendo sido considerados significantes os de valor p≤ 0,05. Resultados:A amostra estudada foi de 17293 pessoas, cuja distribuição quanto ao sexo, à faixa etária e à raça foram semelhantes à da população em geral. A prevalência de epilepsia por 1000 hab. foi 18,6, sendo 8,2 para ativa considerando-se, pelo menos, uma crise no período dos últi-mos 2 anos. A prevalência na faixa etária de 0 a 4 anos foi 4,9, de 5 a 14, 11,7; de 15 a 64, 20,3; e acima dos 65 anos foi 32,8. Conclusão: As prevalências de epilepsia acumulada e ativa foram elevadas, semelhantes às dos países em desenvolvimento, em particular, aos da América Latina. A prevalência de epilepsia na infância foi baixa, enquanto que nos idosos foi elevada, semelhantes às observadas em países desenvolvidos. Estes resultados são relevantes no planejamento de medidas sanitárias, adequação ao tratamento da população, considerando a alta prevalência encontrada, para minimizar o impacto da epilepsia na população.
-Purpose: To provide a situation assessment of services for people with epilepsy in the context of primary health care, as part of the Demonstration Project on Epilepsy in Brazil, part of the WHO/ILAE/IBE Global Campaign 'Epilepsy out of the shadows'. Methods: We performed a door-to-door epidemiological survey in three areas to assess the prevalence of epilepsy and its treatment gap. We surveyed a sample of 598 primary health care workers from diff e rent regions of Brazil to assess their perceptions of the management of people with epilepsy in the primary care setting. Results: The lifetime prevalence of epilepsy was 9.2/1,000 people [95% CI 8.4-10.0] and the estimated prevalence of active epilepsy was 5.4/1,000 people. Thirty-eight percent of patients with active epilepsy were on inadequate treatment, including 19% who were taking no medication. The survey of health workers showed that they estimated that 60% of patients under their care were seizure -f ree. They estimated that 55% of patients were on monotherapy and that 59% had been re f e rred to neurologists. The estimated mean percentage of patients who were working or studying was 56%. Most of the physicians (73%) did not feel confident in managing people with epilepsy. Discussion: The epidemiological survey in the areas of the Demonstration Project showed that the prevalence of epilepsy is similar to that in other resource-poor countries, and that the treatment gap is high. One factor contributing to the treatment gap is inadequacy of health care delivery. The situation could readily be improved in Brazil, as the primary health care system has the key elements re q u i re d for epilepsy management. To make this effective and efficient re q u i res: i) an established re f e rral network, ii) continuous provision of AEDs, iii) close monitoring of epilepsy management via the notification system (Sistema de Informação da Atenção Básica -SIAB) and iv) continuous education of health pro f e s s i o n a l s . The educational program should be broad spectrum and include not only medical management, but also psycho-social aspects of epilepsy.KEY WORDS: epilepsy, anti-epileptic drug, primary care, seizure.Projeto demonstrativo em epilepsia no Brasil: avaliação situacional RESUMO -Objetivo: Avaliar a situação da assistência à epilepsia no contexto da atenção primária sob o P rojeto Demonstrativo em epilepsia no Brasil, parte da Campanha Global Epilepsia Fora das Sombras da W H O / I L A E / I B E . Método: Fizemos um levantamento epidemiológico para definir a prevalência e lacuna de tratamento em epilepsia. Avaliamos a percepção de 598 profissionais de saúde da atenção básica de d i f e rentes regiões do Brasil sobre epilepsia e seu manejo na rede básica de saúde. Resultados: A pre v a l ê ncia acumulada de epilepsia foi de 9,2/1000 pessoas (95%IC= 8,4-10) e a prevalência estimada de epilepsia ativa foi de 5,4/1000 pessoas. Trinta e oito porcento dos pacientes com epilepsia ativa estavam sendo tratados inadequadamente, incluindo 19% que estavam sem medica...
-Purpose: To assess the outcome of patients with epilepsy treated at primary care health units under the framework of the demonstration project on epilepsy in Brazil, part of the WHO/ILAE/IBE Global Campaign Against Epilepsy. Method: We assessed the outcome of patients treated at four primary health units. The staff of the health units underwent information training in epilepsy. The outcome assessment was based on: 1) reduction of seizure fre q u e n c y, 2) subjective perception from the patient's and the physic i a n 's point of view, 3) reduction of absenteeism, 4) social integration (school and work), and 5) sense of independence. Results: A total of 181 patients (93 women -51%) with a mean age of 38 (range from 2 to 86) years were studied. The mean follow-up was 26 months (range from 1 to 38 months, 11 patients had follow-up of less than 12 months). Seizure frequency was assessed based on a score system, ranging f rom 0 (no seizure in the previous 24 months) to 7 (>10 seizure/day). The baseline median seizure -f re q u e ncy score was 3 (one to three seizures per month). At the end of the study the median seizure -f re q u e n c y score was 1 (one to three seizures per year). The patients' and relatives' opinions were that in the majority (59%) the health status had improved a lot, some (19%) had improved a little, 20% experienced no change and in 2% the health status was worse. With regard to absenteeism, social integration and sense of independence, there were some modest improvements only. Discussion: The development of a model of epilepsy treatment at primary health level based on the existing health system, with strategic measu res centred on the health care providers and the community, has proved to be effective providing important reductions in seizure fre q u e n c y, as well as in general well being. This model can be applied nationwide, as the key elements already exist provided that strategic measures are put forw a rd in accord a n c e with local health providers and managers.KEY WORDS: epilepsy, anti-epileptic drug, seizure, primary care.Projeto demonstrativo em epilepsia no Brasil: avaliação do desfecho RESUMO -Objetivo: Avaliar o resultado do tratamento de pacientes com epilepsia na atenção básica sob o modelo proposto pelo Projeto Demonstrativo no Brasil, como parte da Campanha Global Contra a Epilepsia da WHO/ILAE/IBE. Método: Avaliamos o resultado do tratamento nos pacientes acompanhados em quat ro unidades básicas de saúde. As equipes de saúde fizeram um treinamento padrão. O resultado do tratamento foi baseado em cinco aspectos: 1) redução da freqüência das crises, 2) percepção subjetiva dos pacientes e dos médicos, 3) redução de absenteísmo, 4) integração social (escola, trabalho), e 5) senso de independência. Resultados: Um total de 181 pacientes (93 mulheres -51%), com uma média de 38 anos (variando de 2 a 86 anos) entraram nesta análise. O tempo médio de seguimento foi de 26 meses (variou de 1 a 38 meses, 11 pacientes tinham seguimento menos de 12 meses). A freqüência das cr...
Objective: This study aimed to evaluate oral and maxillofacial trauma caused by falls during epileptic seizures. Method: A prospective case-control study was carried out among patients recruited from both the Epileptic Outpatient Clinic and the Emergency Room of Hospital de Base during 2006. The study group was composed of patients with epilepsy that had been diagnosed by a specialist. Oral and maxillofacial trauma was diagnosed using a questionnaire together with physical and radiographic examinations. A control group was formed from non-epileptic relatives or neighbors of the patients. The two groups were compared with regard to the number and type of oral and maxillofacial trauma events suffered. Odds ratios with a 95% confidence interval, dependency analysis and the Pearson c 2 test were used for statistical analysis, and the significance level was set at p≤0.05. Results: A total of 159 patients with epilepsy (91 males; 57.3%) and 68 control individuals (28 males; 41.1%) were enrolled in the study. The frequencies of oromaxillary trauma in the study and control groups were 23.9% and 4.4%, respectively. Generalized tonic-clonic, generalized and non-classified seizures were strongly associated with trauma. The commonest lesions were fractures of dental tooth crowns (32.9%), followed by tooth avulsion (7.6%), tooth luxation (5%) and fracturing of prostheses in edentulous patients (3.8%). Conclusion: This work shows that injuries to the face and teeth are statistically more common in patients with epilepsy than in the general population, and that individuals who suffer seizures without aura are the most affected. Key words: epilepsy, oral trauma, maxillofacial trauma.Trauma oral e maxilofacial em pessoas com epilepsia: estudo prospectivo com base ambulatorial RESUMO Objetivo: O objetivo desse estudo foi avaliar a relação da epilepsia sobre as ocorrências de trauma dento-alveolar e maxilofacial causados por quedas. Método: Estudo casocontrole prospectivo foi conduzido no ambulatório de epilepsia e do Pronto Atendimento do Hospital de Base de São José do Rio Preto-SP no ano de 2006. Pacientes do grupo caso foram diagnosticados pelo neurologista chefe (sênior) especialista em epilepsia e avaliados quanto ao trauma oral e maxilo-facial pelo pesquisador, por meio de questionário, exame clínico e radiográfico, por ordem de chegada. O grupo controle (GC) foi constituído incluindo indivíduos sem crises, que fossem familiares ou vizinhos próximos dos pacientes com diagnóstico de epilepsia. Intervalo de confiança 95%, ODD, análise de dependência (ANADEP) e c 2 de Pearson foram utilizados para análise estatística e se adotou nível de significância de p≤0,05. Resultados: Analisaram-se 159 pacientes com epilepsia, dos quais 91(57,3%) masculinos e 68 do GC, dos quais 28 (41,1%) masculinos. A frequência do trauma oro-maxilar em paciente com epilepsia foi 23,9% e no GC foi de 4,4. As crises tônico-clônicas generalizadas, crises generalizadas e as não classificadas estão fortemente co-relacionadas ao trauma. Fraturas das...
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