Epilepsy in Asia: A Cambodian Experience

Bhalla, Devender; Chan, Samleng; Gérard, Daniel; Oum, Sophal; Druet‐Cabanac, Michel; Preux, Pierre‐Marie

doi:10.1159/000345118

Cited by 9 publications

(21 citation statements)

References 18 publications

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“…[2] By taking an unconventional choice of Asia, our novel Cambodian activities have contributed to bridge this epilepsy literature gap in Asia. [4] Focus on correct risk factors and benefit as a result Factors other than infections have clearly far greater odds for epilepsy [ Table 1], yet for some reasons, infections receive far more respect and reportage as epilepsy causes and risk factors. In Cambodia, factors related to pregnancy and birth (PREB) had highest odds for epilepsy that, in fact, re-validate the 1954 concept of "reproductive causality" of epilepsy.…”

Section: What Did We Learn and Proposementioning

confidence: 99%

Epilepsy: Some controversies, some knowledge and some experience from Cambodia

Hun

Hok²,

Ros

et al. 2014

Neurol India

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Epilepsy-related health outcomes remain unacceptably low in much of the developing world. According to us, it is because of the failure since long to see, and address, epilepsy beyond its preset conventional image. The objective of this paper was to highlight the presence, and influence, of these conventional practices and also to demonstrate what happened when a bold unconventional approach to address epilepsy was taken in Cambodia. Data are taken from existing published literature on epilepsy as well as our field experience during several population-based surveys conducted in Cambodia. We complimented this with our knowledge gained over this long period. It is demonstrated that epilepsy is far more important in Asia that it is currently considered to be, and also vis-à-vis other geographic regions. Pregnancy and birth-related factors carry far higher odds for epilepsy than several "highly vocal" infections. A refocus in epilepsy is required to help move from its traditional negative image to an image where epilepsy is considered a "positive-looking" disorder that is full of "opportunities;" such as availability of safe effective inexpensive treatment, etc. Stigma is a two-side entity (i.e., it is present, and it is influential), and diligence should be therefore practiced before using the stigma label. Nevertheless, psychosocial aspects shouldn't be limited to stigma or Jacoby stigma scale alone. Quality of life is a subjective phenomenon, and patients should determine directly what affects them. It is highly desirable that if we want to find newer answers to old problems in epilepsy, we need to shed our conventional approach and preset conclusions. We should choose to move toward "opportunities" visibly present in epilepsy. Our Cambodian experience demonstrates more intimately that opportunities do get identified when preset conclusions are questioned, and an approach that goes beyond expected and by default is taken.

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Section: What Did We Learn and Proposementioning

confidence: 99%

Epilepsy: Some controversies, some knowledge and some experience from Cambodia

Hun

Hok²,

Ros

et al. 2014

Neurol India

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“…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]. Subsequent surveys in Cambodia have shown that 66.0% PWEs remain without optimal treatment or without treatment at all [8], [9]. Many opportunities and challenges with respect to epilepsy have already been identified in Cambodia [8], [9].…”

Section: Introductionmentioning

confidence: 99%

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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“…Apart from extensive teaching activities at various home institutions, they have raised a whole new generation of researchers, neurologists and epidemiologists in the last three decades, most of whom are working in their home countries. As an example, where no neurologists existed 15 years ago, today 7 neurologists and 1 neurorehabilitation specialist are available in Cambodia [20]. Besides this the two professors have also trained several provincial practitioners (primary health center staff and general practitioners) in several African and Asian countries; many of such training programs are currently going on as well [20].…”

Section: Capacity Buildingmentioning

confidence: 99%

“…As an example, where no neurologists existed 15 years ago, today 7 neurologists and 1 neurorehabilitation specialist are available in Cambodia [20]. Besides this the two professors have also trained several provincial practitioners (primary health center staff and general practitioners) in several African and Asian countries; many of such training programs are currently going on as well [20]. …”

Section: Capacity Buildingmentioning

confidence: 99%

“…Due to limitations of space, many of their contributions have not been discussed here in detail, for instance: (a) the facilitation of programs of professional and academic exchange [20]; (b) the prioritization of silent diseases and ‘silent countries' (e.g. ALS in Africa, MS in Cuba and Martinique, countries like Mali, Martinique, Burundi, Cambodia, etc.…”

Section: Miscellaneousmentioning

confidence: 99%

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Michel Dumas and Pierre-Marie Preux: Promoting Tropical Neurology Silently - The Gist of Their Contributions

Bhalla¹

2014

Neuroepidemiology

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This article presents the contribution by two senior French Neurologists over the past three decades in building, developing and promoting ‘tropical neurology' in a number of neglected countries of Asia, Africa and Latin America. It talks about the ‘human, dedicational and contributive value' of these two experts who do not come from an English-speaking world. It highlights meaningful changes that have been achieved in different tropical countries as a result of their direct contribution. This overview may likely be a cause for learning and motivation to others to really work in and for tropical countries, where a large proportion of global health burden is to be found.

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Epilepsy in Asia: A Cambodian Experience

Cited by 9 publications

References 18 publications

Epilepsy: Some controversies, some knowledge and some experience from Cambodia

Epilepsy: Some controversies, some knowledge and some experience from Cambodia

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

Michel Dumas and Pierre-Marie Preux: Promoting Tropical Neurology Silently - The Gist of Their Contributions

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