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Nguyen VD, Pham DT, Le MAT, Shen GM. Effect on Satisfactory Seizure Control and Heart Rate Variability of Thread-Embedding Acupuncture for Drug-Resistant Epilepsy: A Patient-Assessor Blinded, Randomized Controlled Trial. Behav Neurol 2023; 2023:5871991. [PMID: 37767181 PMCID: PMC10522444 DOI: 10.1155/2023/5871991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/28/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
This randomized controlled trial investigates the efficacy of thread-embedding acupuncture (TEA) compared to sham TEA in treating drug-resistant epilepsy (DRE). Fifty-four DRE outpatients were randomly divided into two groups: TEA (27 patients) and sham TEA (27 patients). Both groups received four sessions of TEA or sham TEA, spaced four weeks apart, targeting GV20, GV14, BL15, BL18, ST40, and GB34 acupoints. Antiseizure medications were maintained at consistent doses throughout the study. Outcome measures included satisfactory seizure control, seizure freedom, and heart rate (HR) and heart rate variability (HRV) measurements. TEA demonstrated a significantly higher rate of satisfactory seizure control at follow-up compared to the sham TEA group (37% vs. 3.7%, p = 0.003). While no significant intergroup differences were observed in HR, HRV, and HRV components at each stage, the TEA group experienced a significant decrease in HR and a significant increase in HRV posttreatment. This study demonstrates TEA's effectiveness in managing DRE and suggests its impact may relate to heightened parasympathetic nerve activity. Further research with extended follow-up periods is necessary to validate these findings.
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Affiliation(s)
- Van-Dan Nguyen
- School of Integrated Chinese and Western Medicine, Anhui University of Chinese Medicine, Hefei, 230012 Anhui Province, China
- Faculty of Traditional Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 100000, Vietnam
| | - Duc-Thang Pham
- Faculty of Traditional Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 100000, Vietnam
| | - Minh-An Thuy Le
- Department of Neurology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 100000, Vietnam
| | - Guo-Ming Shen
- School of Integrated Chinese and Western Medicine, Anhui University of Chinese Medicine, Hefei, 230012 Anhui Province, China
- Institute of Integrated Chinese and Western Medicine, Anhui University of Chinese Medicine, Hefei, 230012 Anhui Province, China
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2
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Beghi E, Giussani G, Costa C, DiFrancesco JC, Dhakar M, Leppik I, Kwan P, Akamatsu N, Cretin B, O'Dwyer R, Kraemer G, Piccenna L, Faught E. The epidemiology of epilepsy in older adults: A narrative review by the ILAE Task Force on Epilepsy in the Elderly. Epilepsia 2023; 64:586-601. [PMID: 36625133 DOI: 10.1111/epi.17494] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/21/2022] [Accepted: 12/15/2022] [Indexed: 01/11/2023]
Abstract
In an aging world, it is important to know the burden of epilepsy affecting populations of older persons. We performed a selective review of epidemiological studies that we considered to be most informative, trying to include data from all parts of the world. We emphasized primary reports rather than review articles. We reviewed studies reporting the incidence and prevalence of epilepsy that focused on an older population as well as studies that included a wider age range if older persons were tabulated as a subgroup. There is strong evidence that persons older than approximately 60 years incur an increasing risk of both acute symptomatic seizures and epilepsy. In wealthier countries, the incidence of epilepsy increases sharply after age 60 or 65 years. This phenomenon was not always observed among reports from populations with lower socioeconomic status. This discrepancy may reflect differences in etiologies, methods of ascertainment, or distribution of ages; this is an area for more research. We identified other areas for which there are inadequate data. Incidence data are scarcer than prevalence data and are missing for large areas of the world. Prevalence is lower than would be expected from cumulative incidence, possibly because of remissions, excess mortality, or misdiagnosis of acute symptomatic seizures as epilepsy. Segmentation by age, frailty, and comorbidities is desirable, because "epilepsy in the elderly" is otherwise too broad a concept. Data are needed on rates of status epilepticus and drug-resistant epilepsy using the newer definitions. Many more data are needed from low-income populations and from developing countries. Greater awareness of the high rates of seizures among older adults should lead to more focused diagnostic efforts for individuals. Accurate data on epilepsy among older adults should drive proper allocation of treatments for individuals and resources for societies.
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Affiliation(s)
- Ettore Beghi
- Laboratory of Neurological Disorders, Department of Neuroscience, Mario Negri Institute of Pharmacological Research, Scientific Institute for Research and Health Care, Milan, Italy
| | - Giorgia Giussani
- Laboratory of Neurological Disorders, Department of Neuroscience, Mario Negri Institute of Pharmacological Research, Scientific Institute for Research and Health Care, Milan, Italy
| | - Cinzia Costa
- Section of Neurology, Santa Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Jacopo C DiFrancesco
- Department of Neurology, Istituto di Ricovero e Cura a Caraterre Scientifico, San Gerardo Foundation, University of Milan-Bicocca, Monza, Italy
| | - Monica Dhakar
- Department of Neurology, Brown University, Providence, Rhode Island, USA
| | - Ilo Leppik
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Naoki Akamatsu
- Division of Neurology, Neuroscience Center, Fukuoka Samo Hospital, International University of Health and Welfare, Fukuoka, Japan
| | - Benjamin Cretin
- Neuropsychology Unit, Department of Neurology of the University Hospitals of Strasbourg, Strasbourg, France
| | - Rebecca O'Dwyer
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | | | - Loretta Piccenna
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Edward Faught
- Department of Neurology, Emory University, Atlanta, Georgia, USA
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3
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Fong SL, Lim KS, Tan L, Zainuddin NH, Ho JH, Chia ZJ, Choo WY, Puvanarajah SD, Chinnasami S, Tee SK, Raymond AA, Law WC, Tan CT. Prevalence study of epilepsy in Malaysia. Epilepsy Res 2021; 170:106551. [PMID: 33440303 DOI: 10.1016/j.eplepsyres.2021.106551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/26/2020] [Accepted: 01/01/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The lifetime prevalence of epilepsy varies greatly from 1.5-14.0 per 1000 persons among the Asian countries. We aim to study the prevalence of epilepsy in Malaysia to have a better insight into the burden of disease in the country. METHODS A population-based door-to-door survey was carried out throughout the country, using questionnaire for brief screening in ascertainment of epilepsy, using a questionnaire and its validated multilingual versions. Respondents who were screened positive underwent second-stage diagnostic phone interview by neurologists/ research assistants. RESULTS A total 16, 686 respondents participated in the survey and 646 (3.8 %) respondents were screened positive during the first stage interview. A total of 185 consented for second stage diagnostic interview and 118 (63.8 %) respondents were contacted successfully for the second stage diagnostic phone interview, of which 17 (14.4 %) respondents were diagnosed to have epilepsy. An additional 68 (57.6 %) respondents had febrile seizures only. After applying a weighting factor to each respondent to adjust for non-response and for the varying probabilities of selection, the adjusted lifetime epilepsy prevalence was 7.8 in 1000 population, and the adjusted prevalence for active epilepsy was 4.2 in 1000 population in Malaysia. CONCLUSION The prevalence of lifetime epilepsy in Malaysia is 7.8 per 1000 persons.
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Affiliation(s)
- Si-Lei Fong
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia
| | - Kheng-Seang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia.
| | - LeeAnn Tan
- Institute for Public Health, National Institutes of Health, Ministry of Health, Malaysia
| | - Nabilah Hanis Zainuddin
- Biostatistics and Data Repository Sector, National Institutes of Health, Ministry of Health, Malaysia
| | - Jun-Hui Ho
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia
| | - Zhi-Jien Chia
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia
| | - Wan-Yuen Choo
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Malaysia
| | | | | | - Sow-Kuan Tee
- Department of Neurology, Hospital Kuala Lumpur, Malaysia
| | - Azman Ali Raymond
- Department of Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Malaysia
| | - Wan-Chung Law
- Division of Neurology, Borneo Medical Centre, Malaysia
| | - Chong-Tin Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia
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4
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van Nguyen D, Chu HC, Vidal C, Fulton RB, Nguyen NN, Quynh Do NT, Tran TL, Nguyen TN, Thu Nguyen HT, Chu HH, Thanh Thuc HT, Minh Le HT, van Nunen S, Anderson J, Fernando SL. Genetic susceptibilities and prediction modeling of carbamazepine and allopurinol-induced severe cutaneous adverse reactions in Vietnamese. Pharmacogenomics 2020; 22:1-12. [PMID: 33356553 DOI: 10.2217/pgs-2019-0146] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Aims: To determine genetic susceptibility markers for carbamazepine (CBZ) and allopurinol-induced severe cutaneous adverse reactions (SCARs) in Vietnamese. Methods: A case-control study was performed involving 122 patients with CBZ or allopurinol-induced SCARs and 120 drug tolerant controls. Results: HLA-B*58:01 was strongly associated with allopurinol-induced SCARs and strongly correlated with SNP rs9263726. HLA-B*15:02 was associated with CBZ-induced Stevens-Johnson syndrome/toxic epidermal necrolysis but not with drug-induced hypersensitivity syndrome/drug rash with eosinophilia and systemic symptoms. No association was found between HLA-A*31:01 and CBZ-induced SCARs. HLA-B*58:01 and rs3909184 allele A with renal insufficiency were shown to increase the risk of allopurinol-induced SCARs. Conclusion: HLA-B*58:01 and HLA-B*15:02 confer susceptibility to allopurinol-induced SCARs and CBZ-induced SJS/TEN in Vietnamese. SNP rs9263726 can be used as a surrogate marker in identifying HLA-B*58:01.
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Affiliation(s)
- Dinh van Nguyen
- Vinmec Healthcare System, Hanoi, 100000, Vietnam.,College of Health Science, VinUniversity, Hanoi, 100000, Vietnam.,Sydney Medical School - Northern, The University of Sydney, Sydney, 2065, Australia.,ImmunoRheumatology Laboratory, NSW Health Pathology-North, Royal North Shore Hospital, Sydney, 2065, Australia
| | - Hieu Chi Chu
- Center of Allergology & Clinical Immunology, Bach Mai Hospital, Hanoi, 115000, Vietnam
| | - Christopher Vidal
- Sydney Medical School - Northern, The University of Sydney, Sydney, 2065, Australia
| | - Richard B Fulton
- ImmunoRheumatology Laboratory, NSW Health Pathology-North, Royal North Shore Hospital, Sydney, 2065, Australia
| | - Nguyet Nhu Nguyen
- Center of Allergology & Clinical Immunology, Bach Mai Hospital, Hanoi, 115000, Vietnam
| | - Nga Thi Quynh Do
- Department of Immunology & Molecular Biology, National Institute of Hygiene & Epidemiology, Hanoi, 100000, Vietnam
| | | | | | - Ha Thi Thu Nguyen
- Department of Allergy & Clinical Immunology, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Hanh Hong Chu
- Department of Allergy, Immunology & Rheumatology, National Hospital of Pediatrics, Hanoi, 100000, Vietnam
| | - Huyen Thi Thanh Thuc
- Department of Allergy, Immunology & Rheumatology, National Hospital of Pediatrics, Hanoi, 100000, Vietnam
| | - Huong Thi Minh Le
- Department of Allergy, Immunology & Rheumatology, National Hospital of Pediatrics, Hanoi, 100000, Vietnam
| | - Sheryl van Nunen
- Sydney Medical School - Northern, The University of Sydney, Sydney, 2065, Australia.,Department of Clinical immunology & Allergy, Royal North Shore Hospital, Sydney, 2065, Australia
| | - Janet Anderson
- ImmunoRheumatology Laboratory, NSW Health Pathology-North, Royal North Shore Hospital, Sydney, 2065, Australia
| | - Suran L Fernando
- Sydney Medical School - Northern, The University of Sydney, Sydney, 2065, Australia.,ImmunoRheumatology Laboratory, NSW Health Pathology-North, Royal North Shore Hospital, Sydney, 2065, Australia.,Department of Clinical immunology & Allergy, Royal North Shore Hospital, Sydney, 2065, Australia
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5
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Lam NN, Duc NM, Nam L. Epilepsy related burn injuries in developing country: An experience in National Burn Hospital. BURNS OPEN 2019. [DOI: 10.1016/j.burnso.2019.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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6
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Nguyen DV, Vidal C, Chu HC, van Nunen S. Developing pharmacogenetic screening methods for an emergent country: Vietnam. World Allergy Organ J 2019; 12:100037. [PMID: 31198488 PMCID: PMC6558218 DOI: 10.1016/j.waojou.2019.100037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/24/2019] [Accepted: 05/01/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The finding of strong associations between certain human leukocyte antigen (HLA) genotypes and the development of severe cutaneous adverse drug reactions (SCARs), [for example, HLA-B*57:01 and abacavir (ABC), HLA-B*15:02 and carbamazepine (CBZ) and HLA-B*58:01 and allopurinol], has led to HLA screening being used to prevent SCARs. Screening has been shown to be of great benefit in a number of studies. Clinical translation from bench to bedside, however, depends upon the development of simple, rapid and cost-effective assays to detect these risk alleles. In highly populated developing countries such as Vietnam, where there is a high prevalence of HLA-B*15:02 and HLA-B*58:01 correlating with a high incidence of CBZ- and allopurinol-induced SCARs, the crucial factor in the implementation of comprehensive screening programs to detect these major risk HLA alleles is the availability of suitable assays. BODY We have summarized the role and economic benefits of HLA screening, reviewed published HLA screening methods used currently in pharmacogenetic screening and examined the advantages and disadvantages of assays developed specifically for use in screening for risk alleles in the prevention of HLA-associated SCARs in Vietnam. CONCLUSION The optimal approach we propose may serve as a template for the development of screening programs in other emergent countries.
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Affiliation(s)
- Dinh Van Nguyen
- Respiratory, Allergy and Clinical Immunology, Vinmec International Hospital, Times City and Vin University, Hanoi, Viet Nam
- Northern Clinical School, The University of Sydney, Sydney, Australia
- Department of Allergy and Clinical Immunology, Hanoi Medical University, Hanoi, Viet Nam
| | - Christopher Vidal
- Northern Clinical School, The University of Sydney, Sydney, Australia
| | - Hieu Chi Chu
- Center of Allergology and Clinical Immunology, Bach Mai Hospital, Hanoi, Viet Nam
| | - Sheryl van Nunen
- Northern Clinical School, The University of Sydney, Sydney, Australia
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia
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7
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Vaughan KA, Lopez Ramos C, Buch VP, Mekary RA, Amundson JR, Shah M, Rattani A, Dewan MC, Park KB. An estimation of global volume of surgically treatable epilepsy based on a systematic review and meta-analysis of epilepsy. J Neurosurg 2018:1-15. [PMID: 30215556 DOI: 10.3171/2018.3.jns171722] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 03/12/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEEpilepsy 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.METHODSThe 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.RESULTSThis 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.CONCLUSIONSUnderstanding 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.
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Affiliation(s)
- Kerry A Vaughan
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.,5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Christian Lopez Ramos
- 2University of California San Diego School of Medicine, La Jolla, California.,5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Vivek P Buch
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rania A Mekary
- 3Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS University, Boston.,4Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School
| | - Julia R Amundson
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,6Miller School of Medicine, University of Miami, Florida
| | - Meghal Shah
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,7Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Abbas Rattani
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,8Meharry Medical College, School of Medicine, Nashville; and
| | - Michael C Dewan
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,9Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kee B Park
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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8
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Trinka E, Kwan P, Lee B, Dash A. Epilepsy in Asia: Disease burden, management barriers, and challenges. Epilepsia 2018; 60 Suppl 1:7-21. [PMID: 29953579 DOI: 10.1111/epi.14458] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 12/26/2022]
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.
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Affiliation(s)
- Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, University Hospital Paracelsus Medical University, Salzburg, Austria.,Institute of Public Health, Medical Decision Making, and Health Technology Assessment, University for Health Sciences, Medical Informatics, and Technology, Hall in Tyrol, Austria
| | - Patrick Kwan
- Departments of Medicine and Neurology, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - ByungIn Lee
- Department of Neurology, Inje University School of Medicine, Haeundae Paik Hospital, Busan, South Korea
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9
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Yu Z, Dong K, Chang H, Huang X, Ren Y, Fan C, Ma Q, Song H, Zhang Q, Zhang J, Huang L. The epidemiological and clinical characteristics study on epilepsy in 8 ethnic groups of China. Epilepsy Res 2017; 138:110-115. [PMID: 29126018 DOI: 10.1016/j.eplepsyres.2017.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/20/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
Abstract
To survey the epidemiological characteristics and clinical features on epilepsy in eight ethnic groups in Yunnan province of China. METHODES The investigation was based on the WHO questionnaire and ICBERG screening questionnaire. This study was performed through random cluster sampling and door-to-door survey. RESULTS A total of 76,302 individuals from eight ethnic groups were surveyed. The crude prevalence of epilepsy ranged from 1.2/1000 to 6.5/1000 in the eight ethnic groups, and the age-adjusted prevalence of epilepsy was from 2.1/1000 to 7.3/1000. The prevalence of active epilepsy varied from 1.0/1000 to 5.2/1000 in the eight ethnic groups, and the age-adjusted prevalence of active epilepsy was from 1.8/1000 to 6.7/1000. The age peak for seizures was below twenty, the patients of 61.1%-95.0% suffered from generalized seizures and 5%-21.2% had partial seizures. More than 60% of the cases in five ethnic groups, and the frequency of seizures were more than 10 events per year. More than 50% in other three ethnic groups, and the seizures had occurred less than 10 events per year. The treatment gap for active epilepsy ranged from 43.7% to 100.0% among the eight ethnic groups, while the natural remission rate varied from 5.6% to 21.0%. CONCLUSION There were both disparity and similarity in the epidemiological and clinical features of epilepsy in different ethnic group communities.
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Affiliation(s)
- ZhiPeng Yu
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100191, PR China.
| | - Kai Dong
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100191, PR China.
| | - Hong Chang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100191, PR China.
| | - XiaoQin Huang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100191, PR China.
| | - Yi Ren
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100191, PR China.
| | - ChunQiu Fan
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100191, PR China.
| | - QingFeng Ma
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100191, PR China.
| | - HaiQing Song
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100191, PR China.
| | - Qian Zhang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100191, PR China.
| | - Jing Zhang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100191, PR China.
| | - LiYuan Huang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100191, PR China.
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10
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Lee SY, Chung SE, Kim DW, Eun SH, Kang HC, Cho YW, Yi SD, Kim HD, Jung KY, Cheong HK. Estimating the Prevalence of Treated Epilepsy Using Administrative Health Data and Its Validity: ESSENCE Study. J Clin Neurol 2016; 12:434-440. [PMID: 27273925 PMCID: PMC5063869 DOI: 10.3988/jcn.2016.12.4.434] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 02/27/2016] [Accepted: 02/29/2016] [Indexed: 12/03/2022] Open
Abstract
Background and Purpose Few of the epidemiologic studies of epilepsy have utilized well-validated nationwide databases. We estimated the nationwide prevalence of treated epilepsy based on a comprehensive medical payment database along with diagnostic validation. Methods We collected data on patients prescribed of antiepileptic drugs (AEDs) from the Health Insurance Review and Assessment service, which covers the entire population of Korea. To assess the diagnostic validity, a medical records survey was conducted involving 6,774 patients prescribed AEDs from 43 institutions based on regional clusters and referral levels across the country. The prevalence of treated epilepsy was estimated by projecting the diagnostic validity on the number of patients prescribed AEDs. Results The mean positive predictive value (PPV) for epilepsy was 0.810 for those prescribed AEDs with diagnostic codes that indicate epilepsy or seizure (Diagnosis-E), while it was 0.066 for those without Diagnosis-E. The PPV tended to decrease with age in both groups, with lower values seen in females. The prevalence was 3.84 per 1,000, and it was higher among males, children, and the elderly. Conclusions The prevalence of epilepsy in Korea was comparable to that in other East Asian countries. The diagnostic validity of administrative health data varies depending on the method of case ascertainment, age, and sex. The prescriptions of AEDs even without relevant diagnostic codes should be considered as a tracer for epilepsy.
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Affiliation(s)
- Seo Young Lee
- Department of Neurology, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Soo Eun Chung
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Dong Wook Kim
- Department of Neurology, Konkuk University, School of Medicine, Seoul, Korea
| | - So Hee Eun
- Department of Pediatrics, Korea University College of Medicine, Ansan, Korea
| | - Hoon Chul Kang
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Won Cho
- Department of Neurology, Keimyung University School of Medicine, Daegu, Korea
| | | | - Heung Dong Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Young Jung
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.
| | - Hae Kwan Cheong
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea.
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11
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Beghi E, Hesdorffer D. Prevalence of epilepsy--an unknown quantity. Epilepsia 2014; 55:963-7. [PMID: 24966095 DOI: 10.1111/epi.12579] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2014] [Indexed: 11/27/2022]
Abstract
The incidence, prevalence, and mortality of epilepsy vary across countries with different economies. Differences can be explained by methodological problems, premature mortality, seizure remission, socioeconomic factors, and stigma. Diagnostic misclassification-one possible explanation-may result from inclusion of patients with acute symptomatic or isolated unprovoked seizures. Other sources of bias include age and ethnic origin of the target population, definitions of epilepsy, retrospective versus prospective ascertainment, sources of cases, and experienced and perceived stigma. Premature mortality is an issue in low-income countries (LICs), where treatment gap, brain infections, and traumatic brain injuries are more common than in high-income countries (HICs). Death rates may reflect untreated continued seizures or inclusion of acute symptomatic seizures. Lack of compliance with antiepileptic drugs has been associated with increased risk for death, increased hospital admissions, motor vehicle accidents, and fractures in poor communities. Epilepsy is a self-remitting clinical condition in up to 50% of cases. Studies in untreated individuals from LICs have shown that the proportion of remissions overlaps that of countries where patients receive treatment. When the identification of patients is based on spontaneous reports (e.g., door-to-door surveys), patients in remission may be less likely to disclose the disease for fear of stigmatization with no concurrent benefits. This might lead to underascertainment of cases when assessing the lifetime prevalence of epilepsy. In LICs, the proportion of people living in poverty is greater than in HICs. Poverty is associated with risk factors for epilepsy, risk for developing epilepsy, and increased mortality. The high incidence and prevalence of epilepsy found in LICs is also observed in low income individuals from HICs. Epileptogenic conditions are associated with an increased mortality. This may partly explain the difference between incidence and lifetime prevalence of epilepsy in LICs. Poverty within LICs and HICs could be a preventable cause of mortality in epilepsy.
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Affiliation(s)
- Ettore Beghi
- Department of Neurosciences, IRCCS Mario Negri Institute for Pharmacological Research, Milano, Italy
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Prevalence and clinical characteristics of active epilepsy in southern Han Chinese. Seizure 2014; 23:636-40. [PMID: 24895053 DOI: 10.1016/j.seizure.2014.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 04/30/2014] [Accepted: 05/04/2014] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate the prevalence and clinical characteristics of active epilepsy in southern Han Chinese. METHOD A door-to-door survey about epilepsy was conducted in communities identified by random cluster sampling among 20 villages and 3 communities of Yueyang city. A questionnaire for epilepsy based on the World Health Organization screening questionnaire was used. A final diagnosis of epilepsy was made by neurology specialists with the support of head magnetic resonance imaging (MRI), computed tomography (CT), and electroencephalography (EEG) if available. The prevalence, clinical characteristics, and treatment gap were analyzed in patients with active epilepsy within the past year and the past 5 years. RESULTS Active epilepsy was identified in 91 patients within the past year and 117 patients within the past 5 years. The one-year prevalence was 2.8‰, and the five-year prevalence was 3.7‰. The prevalence for epilepsy active within the last year and the last five years was significantly higher in rural areas than in urban areas (P<0.05). Secondary generalized tonic-clonic seizures (53.8%) were the most common seizure type in patients whose epilepsy had been active in the last year. 34.1% of patients were diagnosed with structural or metabolic epilepsy. The most common cause for epilepsy was cerebrovascular disease (32.3%), followed by traumatic brain injury (29.0%). The treatment gap was 93.4%. CONCLUSION The prevalence of epilepsy active within the last one and five years was higher in rural areas than in urban areas of Yueyang city. A large treatment gap exists in this area and a rational intervention strategy is needed.
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Ablah E, Hesdorffer DC, Liu Y, Paschal AM, Hawley S, Thurman D, Hauser WA. Prevalence of epilepsy in rural Kansas. Epilepsy Res 2014; 108:792-801. [DOI: 10.1016/j.eplepsyres.2014.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 12/09/2013] [Accepted: 01/16/2014] [Indexed: 10/25/2022]
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Lee SY, Jung KY, Lee IK, Yi SD, Cho YW, Kim DW, Hwang SS, Kim S. Prevalence of treated epilepsy in Korea based on national health insurance data. J Korean Med Sci 2012; 27:285-90. [PMID: 22379340 PMCID: PMC3286776 DOI: 10.3346/jkms.2012.27.3.285] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 12/21/2011] [Indexed: 12/03/2022] Open
Abstract
The Korean national health security system covers the entire population and all medical facilities. We aimed to estimate epilepsy prevalence, anticonvulsant utilization pattern and the cost. We identified prevalent epilepsy patients by the prescription of anticonvulsants under the diagnostic codes suggesting seizure or epilepsy from 2007 Korean National Health Insurance databases. The information of demography, residential area, the kind of medical security service reflecting economic status, anticonvulsants, and the costs was extracted. The overall prevalence of treated epilepsy patients was 2.41/1,000, and higher for men than women. The age-specific prevalence was the lowest in those in their thirties and forties. Epilepsy was more prevalent among lower-income individuals receiving medical aid. The regional prevalence was the highest in Jeju Island and lowest in Ulsan city. New anticonvulsants were more frequently used than old anticonvulsants in the younger age group. The total annual cost of epilepsy or seizure reached 0.46% of total medical expenditure and 0.27% of total expenditure on health. This is the first nationwide epidemiological report issued on epilepsy in Korea. Epilepsy prevalence in Korea is comparable to those in developed countries. Economic status and geography affect the prevalence of epilepsy.
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Affiliation(s)
- Seo-Young Lee
- Department of Neurology, Kangwon National University, Chuncheon, Korea
| | - Ki-Young Jung
- Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | | | - Sang Do Yi
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Yong Won Cho
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Dong Wook Kim
- Department of Neurology, Konkuk University Medical Center, Seoul, Korea
| | - Seung-Sik Hwang
- Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea
| | - Sejin Kim
- Department of Research and Statistics, Health Insurance Review & Assessment Service, Seoul, Korea
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Neligan A, Hauser WA, Sander JW. The epidemiology of the epilepsies. HANDBOOK OF CLINICAL NEUROLOGY 2012; 107:113-133. [PMID: 22938966 DOI: 10.1016/b978-0-444-52898-8.00006-9] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Aidan Neligan
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
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Vuong DA, Van Ginneken E, Morris J, Ha ST, Busse R. Mental health in Vietnam: Burden of disease and availability of services. Asian J Psychiatr 2011; 4:65-70. [PMID: 23050918 DOI: 10.1016/j.ajp.2011.01.005] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 12/29/2010] [Accepted: 01/18/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE Despite the accomplishments, the economic and social reform program of Vietnam has had negative effects, such as limited access to health care services for those disadvantaged in the new market economy. Among this group are persons with mental disorders. This paper aims to understand the burden of mental disorders and availability of mental health services (MHS) in Vietnam. METHODS We reviewed both national as well as the international literature about the burden of mental disorders and MHS in Vietnam. This included academic literature (Medline, Pubmed), national (government) reports, World Health Organization (WHO) reports, and grey literature. RESULTS The burden of mental disorders in Vietnam is similar to that of other Asian countries and occurs across all population groups. MHS have been made one of the national health priorities and more efforts are being made to promote equity of access by integrating MHS into other health care programs and by increasing MHS capacity. However, it is not yet sufficient to meet the care demand of persons with mental disorders. Challenges remain in various areas of MHS, including: lack of mental health legislation, human resources, hospital beds, shortage and diversification of MHS. CONCLUSION Although MHS in Vietnam have considerably improved over the last decade, mainly in terms of accessibility, the care demand and the illness burden remain high. Therefore, more emphasis should be put on increasing MHS capacity and on human resource development. In that process, more representative epidemiological data and intervention research is needed.
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Affiliation(s)
- Duong Anh Vuong
- Department of Health Care Management, Berlin University of Technology, Berlin, Germany; Department of Medical Service Administration, Ministry of Health of Vietnam, Vietnam
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Tuan NA, Cuong LQ, Allebeck P, Chuc NTK, Persson HE, Tomson T. The incidence of epilepsy in a rural district of Vietnam: A community-based epidemiologic study. Epilepsia 2010; 51:2377-83. [DOI: 10.1111/j.1528-1167.2010.02699.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Aydemir N, Trung DV, Snape D, Baker GA, Jacoby A. Multiple impacts of epilepsy and contributing factors: findings from an ethnographic study in Vietnam. Epilepsy Behav 2009; 16:512-20. [PMID: 19800851 PMCID: PMC2811872 DOI: 10.1016/j.yebeh.2009.09.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 09/04/2009] [Accepted: 09/06/2009] [Indexed: 11/19/2022]
Abstract
We investigated issues related to treatment, impact of epilepsy, attitudes toward epilepsy, and disclosure in Vietnam through in-depth interviews with people with epilepsy (PWE) and their family members. We found that although participants prefer Western to traditional treatment, they experience problems in accessing different kinds of antiepileptic drugs and higher-level treatment facilities and with respect to treatment expenses. The impact of epilepsy can be observed in a wide range of daily living activities which include working, education, marriage, and family formation. Although both families and society at large do not hold negative attitudes toward epilepsy, most PWE reported a sense of burden to others. Both PWE and family members generally prefer disclosing epilepsy rather than concealing it from others. Our findings strongly suggest a need in Vietnam for different types of antiepileptic drugs and epilepsy support information for PWE, family members, and the general public.
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Affiliation(s)
- Nuran Aydemir
- Department of Psychology, Izmir University of Economics, Turkey
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Tuan NA, Tomson T, Allebeck P, Chuc NTK, Cuong LQ. The treatment gap of epilepsy in a rural district of Vietnam: A study from the EPIBAVI project. Epilepsia 2009; 50:2320-3. [DOI: 10.1111/j.1528-1167.2009.02298.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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