Placencia M, Suarez J, Crespo F, Sander J W, Shorvon S D, Ellison R H, Cascante S M
Community Management of Epilepsy Project, Quito, Ecuador.
Neuroepidemiology. 1992;11(2):74-84. doi: 10.1159/000110915.
The methodology is presented of a large-scale study of epilepsy carried out in a highland area in northern Ecuador, South America, covering a population of 72,121 people; The study was carried out in two phases, the first, a cross-sectional phase, consisted of a house-to-house survey of all persons in this population, screening for epileptic seizures using a specially designed questionnaire. Possible cases identified in screening were assessed in a cascade diagnostic procedure applied by general doctors and neurologists. Its objectives were: to establish a comprehensive epidemiological profile of epileptic seizures; to describe the clinical phenomenology of this condition in the community; to validate methods for diagnosis and classification of epileptic seizures by a non-specialised team; and to ascertain the community's knowledge, attitudes and practices regarding epilepsy. A sample was selected in this phase in order to study the social aspects of epilepsy in this community. The second phase, which was longitudinal, assessed the ability of non-specialist care in the treatment of epilepsy. It consisted of a prospective clinical trial of antiepileptic therapy in untreated patients using two standard anti-epileptic drugs. Patients were followed for 12 months by a multidisciplinary team consisting of a primary health worker, rural doctor, neurologist, anthropologist, and psychologist. Standardised, reproducible instruments and methods were used. This study was carried out through co-operation between the medical profession, political agencies and the pharmaceutical industry, at an international level. We consider this a model for further large-scale studies of this type.
本文介绍了在南美洲厄瓜多尔北部一个高地地区开展的一项大规模癫痫研究的方法；该研究覆盖了72121人。研究分两个阶段进行，第一阶段为横断面研究，对该地区所有人进行逐户调查，使用专门设计的问卷筛查癫痫发作情况。筛查出的可能病例由全科医生和神经科医生采用分级诊断程序进行评估。其目标是：建立癫痫发作的综合流行病学概况；描述该疾病在社区中的临床现象学；验证非专业团队对癫痫发作的诊断和分类方法；确定社区对癫痫的认知、态度和行为。在这一阶段选取了一个样本，以研究该社区癫痫的社会层面。第二阶段为纵向研究，评估非专科护理在癫痫治疗中的能力。该阶段包括一项针对未治疗患者使用两种标准抗癫痫药物进行抗癫痫治疗的前瞻性临床试验。由一名初级卫生工作者、乡村医生、神经科医生、人类学家和心理学家组成的多学科团队对患者进行了12个月的随访。使用了标准化、可重复的工具和方法。这项研究是在国际层面通过医学专业人士、政治机构和制药行业的合作开展的。我们认为这是此类进一步大规模研究的一个典范。
