The prevalence of epilepsy amongst school children in Izmir, Turkey

An estimation of global volume of surgically treatable epilepsy based on a systematic review and meta-analysis of epilepsy

OBJECTIVE

Epilepsy is one of the most common neurological disorders, yet its global surgical burden has yet to be characterized. The authors sought to compile the most current epidemiological data to quantify global prevalence and incidence, and estimate global surgically treatable epilepsy. Understanding regional and global epilepsy trends and potential surgical volume is crucial for future policy efforts and resource allocation.

METHODS

The authors performed a systematic literature review and meta-analysis to determine the global incidence, lifetime prevalence, and active prevalence of epilepsy; to estimate surgically treatable epilepsy volume; and to evaluate regional trends by WHO regions and World Bank income levels. Data were extracted from all population-based studies with prespecified methodological quality across all countries and demographics, performed between 1990 and 2016 and indexed on PubMed, EMBASE, and Cochrane. The current and annual new case volumes for surgically treatable epilepsy were derived from global epilepsy prevalence and incidence.

RESULTS

This systematic review yielded 167 articles, across all WHO regions and income levels. Meta-analysis showed a raw global prevalence of lifetime epilepsy of 1099 per 100,000 people, whereas active epilepsy prevalence is slightly lower at 690 per 100,000 people. Global incidence was found to be 62 cases per 100,000 person-years. The meta-analysis predicted 4.6 million new cases of epilepsy annually worldwide, a prevalence of 51.7 million active epilepsy cases, and 82.3 million people with any lifetime epilepsy diagnosis. Differences across WHO regions and country incomes were significant. The authors estimate that currently 10.1 million patients with epilepsy may be surgical treatment candidates, and 1.4 million new surgically treatable epilepsy cases arise annually. The highest prevalences are found in Africa and Latin America, although the highest incidences are reported in the Middle East and Latin America. These regions are primarily low- and middle-income countries; as expected, the highest disease burden falls disproportionately on regions with the fewest healthcare resources.

CONCLUSIONS

Understanding of the global epilepsy burden has evolved as more regions have been studied. This up-to-date worldwide analysis provides the first estimate of surgical epilepsy volume and an updated comprehensive overview of current epidemiological trends. The disproportionate burden of epilepsy on low- and middle-income countries will require targeted diagnostic and treatment efforts to reduce the global disparities in care and cost. Quantifying global epilepsy provides the first step toward restructuring the allocation of healthcare resources as part of global healthcare system strengthening.

Sociodemographic risk factors for febrile seizures: A school-based study from Izmir, Turkey

PURPOSE

Despite the fact that socioeconomic and environmental factors of a population are changing over time, there are few studies focusing on the effects of sociodemographic factors on the prevalence of febrile seizures (FS). This study was designed to find out the prevalence of FS and to investigate the effect of socio-cultural and economic factors on this prevalence among the Turkish school children.

METHODS

A school-based, cross-sectional study was conducted in first and second-class children. Data were collected through a questionnaire from the parents who agreed to be involved in the study. The survey had questions about some socioeconomic and demographic features of the children and febrile seizure episodes.

RESULTS

3806 children and parent pairs accepted to participate in the survey. Febrile seizure prevalence was 4.8%. It was found that the prevalence of FS was significantly associated with the chronic illnesses of a child that requires continuous medication, developmental delay of a child, NICU history, gestational hypertension history of a mother, and lower educational level of a mother. Recurrence of FS was observed in 32.9% of children. Children whose first FS was seen below the 39 °C had 1.9 times more recurrence risk.

CONCLUSION

FS prevalence rate has declined from 9.7% to 4.3% in our study population within ten years. It was thought that advancing healthcare systems in our country might be decreased the prevalence. Our study enabled us to find out sociodemographic risk factors of FS, but further studies are needed in order to confirm the effect of sociodemographic factors on FS prevalence.

Prevalence and risk factors of epilepsy among school children in Kayseri City Center, an urban area in Central Anatolia, Turkey

PURPOSE

To investigate the prevalence of epilepsy in schoolchildren aged 7-17 in the province of Kayseri together with the accompanying risk factors.

METHODS

Ten thousand individuals selected using the "stratified cluster sampling method" from a total population of 259,428 students within the borders of Kayseri city center constituted the study sample. A questionnaire was prepared in line with the epidemiological studies protocol recommended by the International Epilepsy Union Epidemiology and Prognosis Committee in 1993. Data were analyzed on IBM SPSS Statistics 20. Significance was set at p<0.05.

RESULTS

Of the 15,000 questionnaires distributed, 72% (n=10,742) were returned fully completed. Eighty-three students had been or were still being monitored with a diagnosis of epilepsy. The raw prevalence of epilepsy was 6/1000 in females, 9/1000 in males and 8/1000 in both groups together. Prevalence of active epilepsy was 4/1000 in females, 7/1000 in males and 6/1000 in both groups together. Premature birth increased the risk of epilepsy 2.6 times, and average and poor family income levels increased the risk of epilepsy 3.3 and 1.6 times, respectively. A history of febrile convulsion increased the risk of epilepsy 15.1 times.

CONCLUSION

The prevalence of epilepsy in the 7-17 age group in Kayseri is closer to that in developed rather than developing countries. We conclude that the risk factors for epilepsy, and particularly febrile convulsion, and the true prevalence rates need to be determined through studies involving wide socioeconomic strata.

Prevalence and risk factors of epilepsy among school children in eastern Turkey

Epilepsy is a serious chronic brain disorder of childhood. We performed a cross-sectional prevalence study, determined the prevalence of childhood epilepsy, and identified the significance of certain risk factors for epilepsy among 1625 primary-school students aged 6-14 years, living in the center of Kars province. A questionnaire was prepared according to the definitions and principles of the Commission on Epidemiology and Prognosis, International League Against Epilepsy. Twenty-two children were diagnosed as epileptic. The point prevalence of active epilepsy in males was 4.9/1000, and in females 12.4/1000, representing a total of 8.6/1000. The cumulative prevalence in males was 11.0/1000, and 16.1/1000 in females, representing a total of 13.5/1000. Febrile convulsions, family history of epilepsy, serious maternal illness during pregnancy, a history of head trauma, antenatal/postnatal problems, and a history of neonatal jaundice were statistically significantly related to the development of epilepsy.

Perceptions of epilepsy of three different groups in Turkey

OBJECTIVE

Our aim was to investigate epilepsy-related knowledge, behavior, perceptions, and attitudes of people with epilepsy, their relatives, and a control group (390 participants in total) at the State Hospital Neurology Clinic, Yuksekova City, Turkey.

METHODS

The Survey of Epileptic Patient Relatives on the Knowledge, Attitudes, and Behavior Regarding the Disorder was used and included questions about descriptive characteristics, familiarity with epilepsy, attitudes toward epilepsy, and understanding of epilepsy. Data on SPSS 15.0 software were analyzed with the χ(2) test.

RESULTS

Patients (95.3%), their relatives (89.2%), and controls (63.3%) felt primarily fear when they heard the diagnosis of epilepsy. Most participants would not let their child marry a person with epilepsy, with no statistically significant difference between groups (P>0.05). Patients (66.7%) and relatives (70%) saw no problem in people with epilepsy having children; there was a statistically significant difference between groups on this point because of the control group's response (31.5%) (P<0.05).

CONCLUSION

Patients and relatives showed similar attitudes and behaviors, perhaps because they had common information and experience regarding the disorder.

Effects of sociodemographic factors on febrile convulsion prevalence

BACKGROUND

The aim of the present study was to determine the lifetime risk (LTR) of febrile convulsion and the effects of socioeconomic factors affecting this risk among school children in Izmir province, Turkey.

METHODS

Information was collected from school children aged 7-17 years in a school-based cross-sectional study. Stratified cluster sampling technique was used to define the study population, which represents the schools located in the metropolitan area of Izmir. Data were collected through a standard questionnaire from the parents.

RESULTS

LTR was 9.7% (girls, 9.3%; boys, 10.1%, P > 0.05). The risk of febrile convulsion for children whose fathers' education level was equal to or less than primary school was 2.13 (95% confidence interval [CI]: 1.1-4.0) and, for children whose fathers were blue collar workers it was 1.4 (95%CI: 1.0-1.8).

CONCLUSION

LTR for febrile convulsion was relatively high in this population, consistent with studies from other developing countries. Lower socioeconomic status and lack of knowledge about febrile convulsions were main factors related to this risk.

A substance in broad beans (Vicia faba) is protective against experimentally induced convulsions in mice

Vicia faba (VF, broad beans) constitutes a major food item for the River Nile populations. Contrary to tropical Africa, the prevalence rate of epilepsy (0.9-1 per 1000) among schoolchildren of Khartoum Province, Sudan, is lower compared with the rates in Europe and North America. To explore whether broad beans contain any anticonvulsant that can explain this observation, Balb/c mice were either treated with VF extract (0.01 mL/g) or kept as a control. Various doses of strychnine and picrotoxin were used to explore the effect of VF extract on strychnine-sensitive glycine receptors and GABA(A) receptors. Diazepam (DIZ) was used as anticonvulsant. Thin-layer chromatography was run for the extract against phenobarbital, DIZ, and/or glycine. VF extract demonstrated a clear protective effect against strychnine-induced convulsions and death in Balb/c mice. Diazepam (20 mg/kg, intraperitoneally), administered 20 minutes prior to strychnine (0.112 mg/kg, intraperitoneally), increased the survival rate to 66.7% and, when given with VF extract (0.01 mL/g), to 100%. Various doses of DIZ protected against picrotoxin-induced convulsions (40 mg/kg, intraperitoneally) and deaths. Pretreatment of mice with VF extract was not protective. On chromatography, VF extract separated in a manner similar to the glycine spot, and revealed one peak coinciding with, but not identical to that of glycine. The extract of broad beans (VF) protects against convulsions probably through the inhibitory glycine receptors, and may contain a substance that is intimately related to glycine. Further research is needed to substantiate this by directly assessing the binding of the VF extract to the glycine receptors or a change in receptor physiology.

Public awareness of, attitudes toward, and understanding of epilepsy in Isparta, Turkey

The social stigma attached to epilepsy very often constitutes a considerable problem and much private grief for patients and their relatives. This study was aimed at investigating "perceivers"' awareness of, attitudes toward, and understanding of epilepsy in Isparta, Turkey. Using a questionnaire survey, we interviewed, face-to-face, a random sample of 582 persons older than 18, excluding persons with epilepsy or those with relatives who had epilepsy. Eighty-one percent of respondents had heard of epilepsy, 47% knew a person with epilepsy, and 54% had seen an epileptic seizure. Somewhat less knowledgable were the elderly and less educated individuals. Attitudes toward social acceptance and employment of persons with epilepsy were generally negative, especially to children's associations and marriage. Twelve percent considered epilepsy as a form of insanity. Although understanding of epilepsy was favorable, the results indicate that there exists significant discrimination against persons with epilepsy, and there is a need to implement public education campaigns.