Prevalence, Incidence, and Etiology of Epilepsies in Rural Honduras: The Salamá Study

Abstract

Summary:Purpose: Determination of epilepsy etiology in population-based studies is difficult because of the high cost of diagnostic tests. However, cost-effectiveness may be proven if preventive public-health strategies can be established from the test results. We report an epilepsy population-based study using clinical and laboratory techniques.Methods: A medical team administered an epilepsy survey to 88% of the residents by census in the rural county of Salamá, Honduras. Ninety of 100 participants identified with active epilepsy underwent a neurologic examination, videoelectroencephalography (video-EEG), brain computed tomography (CT) scan, and serum enzyme-linked immunoelectrotransfer blot (EITB) for cysticercosis. Final diagnoses were based on the International League Against Epilepsy classifications for seizures and epilepsy syndromes. Combined epidemiologic, clinical, video-EEG, neuroimaging, and serum EITB assays were used for the diagnosis of epilepsy etiologies.Results: Among 6,473 residents surveyed, 151 persons with epilepsy (prevalence rate, 23.3/1,000) were identified, 100 of whom had active epilepsy (15.4/1,000) on the prevalence day. Incidence was determined to be 92.7/100,000. Partial seizures with or without secondary generalization were common (92.2%). Symptomatic epilepsy (62%) was primarily due to neurocysticercosis (37%), perinatal brain damage (8%), post-traumatic (3%), and poststroke (2%). Eight percent were idiopathic, and 30% were cryptogenic (unknown cause).Conclusions: Symptomatic epilepsies primarily explained the high prevalence and incidence of epilepsy in Salamá. Integration of video-EEG and brain CT scan with clinical-epidemiologic evaluation was critical for determination of epilepsy etiology. Establishment of specific programs for continuation of epidemiologic surveillance, education, intervention, and long-term follow-up will benefit the Salamá region. Key Words: Honduras-Epilepsy-Epidemiology-Etiology-IncidencePrevalence-Neurocysticercosis.Epilepsy is a worldwide health problem (1-3). Recent analyses concluded that Latin America, especially Central America, has high epilepsy prevalence rates that appear to be secondary to a high frequency of symptomatic "preventable" epilepsies (4,5). Comparison data are not always available because few worldwide epidemiologic studies used standardized case-ascertainment criteria (1,3,(6)(7)(8). Primarily because of the high costs and/or multiple logistic factors, the vast majority of previous epidemiologic studies were two-phased and did not use neuroimaging or electroencephalography (EEG) to determine the etiology and syndromic classification of the epilepsies (9).The International League Against Epilepsy (ILAE) has published standardized diagnostic criteria for epileptic seizures and syndromes (10,11) and recently proposed the use of a five-axes approach to include ictal phenomena, seizure type, syndrome, etiology, and impairment (12). The cost-effectiveness of obtaining complete seizureevaluation information will be demonstrated by esta...

Perfil clínico-epidemiológico de pacientes com neurocisticercose atendidos no Hospital Universitário Regional de Maringá, Paraná, Brasil

“…A realização de TCs como principal forma de diagnóstico em pacientes com NCC é importante uma vez que TCs consecutivas permitem observar a morte e calcificação de cistos viáveis 29 . O diagnóstico da NCC tem sido efetuado por um conjunto de técnicas de imagem e méto-dos imunológicos, pois a utilização de um só método diagnóstico pode fornecer resultados falso-negativos 16,30,31 ou apresentar dados nem sempre proporcionais à severidade da doença 32 . Além disto, a presença de um só cisticerco pode não ser diagnosticada pela TC 33,34 .…”

Epilepsy in the developing world

“…Studies of highly selected patients with seizures in neurologic services of hospital settings from some DCs reported NC to be the main cause of epilepsy, accounting for 30% to 50% of cases [11,13]. It is likely that most people with NC have acute symptomatic seizures that do not necessarily evolve into epilepsy.…”

Epidemiología y control de la cisticercosis en el Perú

“…Rajkoitia et al estimaron el costo usual en 54% de un salario mínimo anual (16) . Ya en el 2005, los datos de los estudios en Tumbes llevaron a la conclusión de que la NCC contribuye en un 30% de los síndromes epilépticos en esta región, dato que es compatible con estudios en Honduras y Ecuador publicados por las mismas fechas (13,17,18) .…”