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

Abstract

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.

High mobility group box 1 (HMGB1) as a novel frontier in epileptogenesis: from pathogenesis to therapeutic approaches

“…Epilepsy has emerged as a serious health concern affecting 50–70 million people globally accounting 0.75% of global health burden (Trinka et al . ). Frequent and serious epileptic seizures are thought to contribute to further brain injury and persistent neurobehavioral and neuropsychiatric disorders, with significant consequences for patients, their families, and society (Yang et al .…”

Investigative practice into sudden death in epilepsy: A global survey

“…Access to pathology was not considered to be a main barrier in Asian and Oceania to the identification of the cause of death. This could be for several reasons, namely established well developed pathology services in some countries; however, in a general way, it is more likely that other factors out‐weigh concerns regarding pathological assessment given the treatment gap that exists in many Asian countries . In Europe and North America, the legal system was more likely to be a barrier, this likely refers to the coronial processes in investigation of sudden death.…”

Sodium valproate protects against neuronal ferroptosis in epilepsy via suppressing lysyl oxidase

“…According to statistics, about 70 million people around the world are shrouded in the shadow of epilepsy [3] . Several syndromes including cognitive decline and depression, usually occur in the epileptogenesis [4,5] , which have a detrimental effect on the life quality of patients. The prevalence of major depression in the general population is 4.9%~7% while the prevalence of depression in patients with epilepsy is as high as 11%-60% [6] .…”