Prevalence and Pattern of Epilepsy Treatment in Different Socioeconomic Classes in Brazil

Abstract

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.

Epilepsy in the developing world

“…The differences are in part related to different study designs and differences regarding the defi nitions of active epilepsy. Some stud-ies require two or more unprovoked seizures in the year before the index date to be considered "active epilepsy" [4][5]8••]; others use a 2-year period [9] or 5-year period [10•,11-15,16•,17•]. Limiting assessment to studies that provide information for age-adjusted rates (Table 1), the average age-adjusted prevalence of active epilepsy is 8.5 per 1000 people.…”

“…Demonstration projects have been carried in China [4], Togo [56], Brazil [9], Senegal [6], and Vietnam [17•].…”

Training the trainers and disseminating information: a strategy to educate health professionals on epilepsy

“…An epidemiological study in São Paulo State found a lifetime prevalence of epilepsy of 9.2/1,000 [95% CI 8.4-10.0] 5 . Stigma is present in our s o c i e t y, excluding people with epilepsy from social activities, particularly because of misinformation but also due to lack of appropriate attitudes held by health professionals 3 .…”

Training medical students to improve the management of people with epilepsy

“…Based on our epidemiological surv e y 5 it is estimated that about one million people in Brazil have active epilepsy, of whom approximately 40% do not receive adequate t re a t m e n t 5 . Consequently, epilepsy is considered a public health problem, especially in re s o u rc e -p o o r countries.…”