Medication prescribing and patient-reported outcome measures in people with epilepsy in Bhutan

McKenzie, Erin; Nirola, Damber Kumar; Deki, Sonam; Tshering, Lhab; Patenaude, Bryan; Clark, Sarah J.; Cash, Sydney S.; Thibert, Ronald L.; Zepeda, Rodrigo; Leung, Edward; Lam, Alice; Lim, Andrew; Mantia, Jo; Cohen, Jerome Alan; Cole, Andrew J.; Mateen, Farrah J.

doi:10.1016/j.yebeh.2016.03.035

Cited by 11 publications

(9 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…With no neurologist in the country, PWE in Bhutan rely on practitioners who have not received specialised training in epilepsy diagnosis and management. Overall, participants in this study had poor seizure control, with <25% of adults and just 5% of children free from seizures for at least one year, a finding consistent with prior evidence of suboptimal medical management of epilepsy in Bhutan [24]. Many PWE experienced seizures on a weekly or daily basis, with significant potential to disrupt their daily activities and productivity.…”

Section: Discussionsupporting

confidence: 76%

The economic burden of epilepsy in Bhutan

Wibecan

Fink

Tshering

et al. 2018

Tropical Med Int Health

Self Cite

View full text Add to dashboard Cite

Summary Objective: To assess the economic impact of epilepsy in Bhutan, a lower-middle-income country with a universal health care system, but with limited access to neurological care. Methods: A cross-sectional survey was conducted of patients with epilepsy receiving care at Jigme Dorji Wangchuk National Referral Hospital from January to August, 2016. Data were collected on clinical features of epilepsy, cost of care, impact of epilepsy on school or work, and household economic status of participants and matched comparisons (a sibling or neighbor from a separate household without epilepsy). Results: A total of 172 individuals were included in the study (130 adults and 42 children). One-third of adults and 20 (48%) children had seizures at least once per month. Mean annual direct out-of-pocket costs for epilepsy care was 6,054 BTN (91 USD), of which transportation formed the greatest portion (53%). Direct costs of epilepsy were an average of 3.2% of annual household income. Adults missed 6.8 ± 9.0 days of work or school per year on average, and children missed 18.6 ± 34.7 days of school. Of adult participants, 23 (18%) abandoned employment or school because of epilepsy; among school-age children, seven (18%) stopped school because of epilepsy. Households with a person with epilepsy had lower monthly per-person income (6,434 BTN) than comparison households without epilepsy (8,892 BTN; p = 0.027). Significance: In this lower-middle-income country, despite universal health care services, households of people with epilepsy face a significant economic burden. Cost of transportation for epilepsy care contributes a major proportion of the direct cost burden. Indirect costs, including negative effects on school achievement and employment, disrupt the economic potential of people with epilepsy in Bhutan. Household economic well-being is impacted by the direct and indirect costs of epilepsy.

show abstract

Section: Discussionsupporting

confidence: 76%

The economic burden of epilepsy in Bhutan

Wibecan

Fink

Tshering

et al. 2018

Tropical Med Int Health

Self Cite

View full text Add to dashboard Cite

show abstract

“…Advertisements were made through a local newspaper, The Kuensel , as well as radio. Details of our study recruitment and design have been reported previously (Brizzi et al, 2016; McKenzie et al, 2016). …”

Section: Methodsmentioning

confidence: 99%

Yield of Brain MRI in Clinically Diagnosed Epilepsy in the Kingdom of Bhutan: A Prospective Study

Bruno

Klein

Nidup³

et al. 2017

Annals of Global Health

Self Cite

View full text Add to dashboard Cite

Introduction To report the diagnostic yield of brain MRI and identify clinical associations of abnormal MRI findings among people with epilepsy (PWE) in a neurocysticercosis-endemic, resource-limited setting, and to identify the proportion and putative structural brain causes of drug resistant epilepsy cases. Methods PWE were prospectively enrolled at the Jigme Dorji Wangchuck National Referral Hospital in Bhutan (2014–2015). Each participant completed clinical questionnaires and a 1.5 tesla brain MRI. Each MRI was reviewed by at least one radiologist and neurologist in Bhutan and the U.S.A. A working definition of drug resistant epilepsy for resource-limited settings was given as (a) seizures for >1 year, (b) at least one seizure in the prior year, and (c) presently taking 2 or more antiepileptic drugs (AEDs). Logistic regression models were constructed to test the cross-sectional association of an abnormal brain MRI with clinical variables. Results 217 participants [125 (57%) female; 54 (25%) <18 years old; 199 (92%) taking AEDs; 154 (71%) with a seizure in the prior year] were enrolled. There was a high prevalence of abnormal brain MRIs (176/217, 81%). Mesial temporal sclerosis was the most common finding (n=115, 53%, including 24 children), exceeding the number of PWE with neurocysticercosis (n=26, 12%, including one child) and congenital/perinatal abnormalities (n=29, 14%, including 14 children). The number of AEDs (odds ratio=0.59, p=0.03) and duration of epilepsy (odds ratio=1.11, p=0.02) were significantly associated with an abnormal MRI. Seizure in the prior month was associated with the presence of mesial temporal sclerosis (odds ratio=0.47, p=0.01). 25 (12%) participants met our definition of drug resistant epilepsy with mesial temporal sclerosis (n=10), congenital malformations (n=5), and neurocysticercosis (n=4) being the more frequent findings. Conclusions The prevalence of abnormalities on brain MRI for PWE in resource-limited settings is high due to a diffuse range of etiologies, most commonly mesial temporal sclerosis. Drug resistant epilepsy accounted for 12% of the referral population in a conservative estimation.

show abstract

“…Participants were identified through an existing hospital registry of epilepsy patients at JDWNRH and were enrolled in the larger cohort study including neuroimaging, electroencephalogram (EEG), and often serum neurocysticercosis testing to help confirm the diagnosis and elucidate the potential etiologies of epilepsy. (Brizzi, 2016B, McKenzie, 2016, Bruno, 2017) Data on age, education, employment, seizure characteristics, and AEDs are derived from the initial enrollment evaluation we performed between 2014 and 2016.…”

Section: Methodsmentioning

confidence: 99%

“…From prior surveys of these same participants, we had access to demographic information, seizure frequency, AED use, education, and employment. (McKenzie, 2016, Saadi, 2016) The final survey instrument developed and used can also be found online for free public use at: goo.gl/k7H2PC.…”

Section: Methodsmentioning

confidence: 99%