The treatment gap of epilepsy in a rural district of Vietnam: A study from the EPIBAVI project

Tuấn, Nguyễn Anh; Tomson, Torbjörn; Allebeck, Peter; Chúc, Nguyễn Thị Kim; Cuong, Le Quang

doi:10.1111/j.1528-1167.2009.02298.x

Cited by 20 publications

(20 citation statements)

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“…With few data in hand on epilepsy [2] [5] and its treatment [6] [7] in Asia, it is most likely that these countries are unable to take appropriate evidence-based actions. We therefore aimed to conduct a first-ever population-based survey to examine various treatment-related aspects of epilepsy in Cambodia, a SEA country, to guide its agencies towards introducing evidence-based policies.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment brings necessary reductions in the physical, personal, and social burden consequent to epilepsy [4], yet it remains out of reach for a large number of PWEs [3]. Globally speaking, only few population-based surveys have been conducted on epilepsy in Asia [2] [5], more so on the aspects relating to the treatment [6] [7]. Little local data would mean little possibility of a public health action for the benefit of PWEs.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, many policy aspects such as estimates of the manpower gap, requirements for scaling-up of epilepsy care, the number of anti-epilepsy drug tablets required to be produced, are yet to be defined for many Asian countries. Earlier treatment programs from Asia and the South-East Asia (SEA) [6] [7] have shown major challenges towards achieving a desirable treatment coverage and meeting the needs of PWEs. Cambodia is one of the SEA countries, and in 2009 the lifetime prevalence of epilepsy was 5.8/1000, that translates into an average estimate of nearly 86000 PWEs in Cambodia [5].…”

Section: Introductionmentioning

confidence: 99%

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Epilepsy in Cambodia–Treatment Aspects and Policy Implications: A Population-Based Representative Survey

et al. 2013

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IntroductionWe tested two treatment strategies to determine: treatment (a) prognosis (seizure frequency, mortality, suicide, and complications), (b) safety and adherence of treatment, (c) self-reported satisfaction with treatment and self-reported productivity, and policy aspects (a) number of required tablets for universal treatment (NRT), (b) cost of management, (c) manpower-gap and requirements for scaling-up of epilepsy care.MethodsWe performed a random-cluster survey (N = 16510) and identified 96 cases (≥1 year of age) in 24 villages. They were screened by using a validated instrument and diagnosed by the neurologists. International guidelines were used for defining and classifying epilepsy. All were given phenobarbital or valproate (cost-free) in two manners patient’s door-steps (March 2009-March 2010, primary-treatment-period, PTP) and treatment through health-centers (March 2010-June 2011, treatment-continuation-period, TCP). The emphasis was to start on a minimum dosage and regime, without any polytherapy, according to the age of the recipients. No titration was done. Seizure-frequency was monthly and self-reported.ResultsThe number of seizures reduced from 12.6 (pre-treatment) to 1.2 (end of PTP), following which there was an increase to 3.4 (end of TCP). Between start of PTP and end of TCP, >60.0% became and remained seizure-free. During TCP, ∼26.0% went to health centers to collect their treatment. Complications reduced from 12.5% to 4.2% between start and end of PTP and increased to 17.2% between start and end of TCP. Adverse events reduced from 46.8% to 16.6% between start and end of PTP. Nearly 33 million phenobarbital 100 mg tablets are needed in Cambodia.ConclusionsEpilepsy responded sufficiently well to the conventional treatment, even when taken at a minimal dosage and a simple daily regimen, without any polytherapy. This is yet another confirmation that it is possible to substantially reduce direct burden of epilepsy through means that are currently available to us.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Epilepsy in Cambodia–Treatment Aspects and Policy Implications: A Population-Based Representative Survey

et al. 2013

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“…The mean of the treatment gap prevalence in urban and rural areas is 46.8% (95% CI = 34.1‐64.8) and 73.3% (95% CI = 49.5‐100), respectively. The treatment gap is the most common problem for epilepsy management in the low‐income regions of Asia (Table ) …”

Section: Psychosocial Diagnostic and Treatment Challengesmentioning

confidence: 99%

Epilepsy in Asia: Disease burden, management barriers, and challenges

et al. 2018

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This article reviews the burden of epilepsy in Asia, the challenges faced by people with epilepsy, and the management of epilepsy. Comparison is made with other parts of the world. For this narrative review, data were collected using specified search criteria. Articles investigating the epidemiology of epilepsy, diagnosis, comorbidities and associated mortality, stigmatization, and treatment were included. Epilepsy is a global health care issue affecting up to 70 million people worldwide. Nearly 80% of people with epilepsy live in low- and middle-income countries with limited resources. People with epilepsy are prone to physical and psychological comorbidities, including anxiety and depression, which can negatively impact their quality of life. Furthermore, people with epilepsy are at higher risk of premature death than people without epilepsy. Discrimination or stigmatization of people with epilepsy is common in Asia and can affect their education, work, and marriage opportunities. Access to epilepsy treatment varies throughout Asia. Although highly advanced treatment is available in some countries, up to 90% of people with epilepsy are not adequately treated or are not treated with conventional antiepileptic therapy in resource-limited countries. People in remote areas often do not receive any epilepsy care. First-generation antiepileptic drugs (AEDs) are available, but usually only in urban areas, and second-generation AEDs are not available in all countries. Newer AEDs tend to have more favorable safety profiles than first-generation AEDs and provide options to tailor therapy for individual patients, especially those with comorbidities. Active epilepsy surgery centers are present in some countries, although epilepsy surgery is often underutilized given the number of patients who could benefit. Further epidemiologic research is needed to provide accurate epilepsy data across the Asian region. Coordinated action is warranted to improve access to treatment and care.

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“…About 50 million people worldwide are estimated to have epilepsy. Approximately 80% of these people are thought to live in resource‐poor countries (2). The distribution of causes of epilepsy is different in these countries compared to the developed world, with a greater proportion being due to infectious causes (13).…”

Section: Commentarymentioning

confidence: 99%

The Natural History of Epilepsy: Spontaneous Remission and Mortality

Hesdorffer¹

2010

Epilepsy Curr

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M, Loring DW, NEAD Study Group. N Engl J Med 2009;360(16):1597-1605. BACKGROUND: Fetal exposure of animals to antiepileptic drugs at doses lower than those required to produce congenital malformations can produce cognitive and behavioral abnormalities, but cognitive effects of fetal exposure of humans to antiepileptic drugs are uncertain. METHODS: Between 1999 and 2004, we enrolled pregnant women with epilepsy who were taking a single antiepileptic agent (carbamazepine, lamotrigine, phenytoin, or valproate) in a prospective, observational, multicenter study in the United States and the United Kingdom. The primary analysis is a comparison of neurodevelopmental outcomes at the age of 6 years after exposure to different antiepileptic drugs in utero. This report focuses on a planned interim analysis of cognitive outcomes in 309 children at 3 years of age. RESULTS: At 3 years of age, children who had been exposed to valproate in utero had significantly lower IQ scores than those who had been exposed to other antiepileptic drugs. After adjustment for maternal IQ, maternal age, antiepileptic drug dose, gestational age at birth, and maternal preconception use of folate, the mean IQ was 101 for children exposed to lamotrigine, 99 for those exposed to phenytoin, 98 for those exposed to carbamazepine, and 92 for those exposed to valproate. On average, children exposed to valproate had an IQ score 9 points lower than the score of those exposed to lamotrigine (95% confidence interval [CI], 3.1-14.6; p = 0.009), 7 points lower than the score of those exposed to phenytoin (95% CI, 0.2-14.0; p = 0.04), and 6 points lower than the score of those exposed to carbamazepine (95% CI, 0.6-12.0; p = 0.04). The association between valproate use and IQ was dose dependent. Children's IQs were significantly related to maternal IQs among children exposed to carbamazepine, lamotrigine, or phenytoin but not among those exposed to valproate. CONCLUSIONS: In utero exposure to valproate, as compared with other commonly used antiepileptic drugs, is associated with an increased risk of impaired cognitive function at 3 years of age. This finding supports a recommendation that valproate not be used as a first-choice drug in women of childbearing potential. COMMENTARY

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The treatment gap of epilepsy in a rural district of Vietnam: A study from the EPIBAVI project

Cited by 20 publications

References 13 publications

Epilepsy in Cambodia–Treatment Aspects and Policy Implications: A Population-Based Representative Survey

Epilepsy in Cambodia–Treatment Aspects and Policy Implications: A Population-Based Representative Survey

Epilepsy in Asia: Disease burden, management barriers, and challenges

The Natural History of Epilepsy: Spontaneous Remission and Mortality

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