Edwards Tansy, Scott Anthony G, Munyoki Gilbert, Odera Victor Mung'ala, Chengo Edward, Bauni Evasius, Kwasa Thomas, Sander Ley W, Neville Brian G, Newton Charles R
Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, UK.
Lancet Neurol. 2008 Jan;7(1):50-6. doi: 10.1016/S1474-4422(07)70292-2.
Few large-scale studies of epilepsy have been done in sub-Saharan Africa. We aimed to estimate the prevalence of, treatment gap in, and possible risk factors for active convulsive epilepsy in Kenyan people aged 6 years or older living in a rural area.
We undertook a three-phase screening survey of 151,408 individuals followed by a nested community case-control study. Treatment gap was defined as the proportion of cases of active convulsive epilepsy without detectable amounts of antiepileptic drugs in blood.
Overall prevalence of active convulsive epilepsy was 2.9 per 1000 (95% CI 2.6-3.2); after adjustment for non-response and sensitivity, prevalence was 4.5 per 1000 (4.1-4.9). Substantial heterogeneity was noted in prevalence, with evidence of clustering. Treatment gap was 70.3% (65.9-74.5), with weak evidence of a difference by sex and area. Adjusted odds of active convulsive epilepsy for all individuals were increased with a family history of non-febrile convulsions (odds ratio 3.3, 95% CI 2.4-4.7; p<0.0001), family history of febrile convulsions (14.6, 6.3-34.1; p<0.0001), history of both seizure types (7.3, 3.3-16.4; p<0.0001), and previous head injury (4.1, 2.1-8.1; p<0.0001). Findings of multivariable analyses in children showed that adverse perinatal events (5.7, 2.6-12.7; p<0.0001) and the child's mother being a widow (5.1, 2.4-11.0; p<0.0001) raised the odds of active convulsive epilepsy.
Substantial heterogeneity exists in prevalence of active convulsive epilepsy in this rural area in Kenya. Assessment of prevalence, treatment use, and demographic variation in screening response helped to identify groups for targeted interventions. Adverse perinatal events, febrile illness, and head injury are potentially preventable associated factors for epilepsy in this region.
撒哈拉以南非洲地区针对癫痫的大规模研究较少。我们旨在估算肯尼亚农村地区6岁及以上人群中活动性惊厥性癫痫的患病率、治疗缺口及可能的风险因素。
我们对151408人进行了三个阶段的筛查调查，随后开展了一项嵌套式社区病例对照研究。治疗缺口定义为血液中未检测到抗癫痫药物的活动性惊厥性癫痫病例的比例。
活动性惊厥性癫痫的总体患病率为每1000人中有2.9例（95%置信区间2.6 - 3.2）；在对无应答和敏感性进行调整后，患病率为每1000人中有4.5例（4.1 - 4.9）。患病率存在显著异质性，并有聚集现象的证据。治疗缺口为70.3%（65.9 - 74.5），性别和地区差异的证据较弱。所有个体活动性惊厥性癫痫的校正比值在有非热性惊厥家族史时升高（比值比3.3，95%置信区间2.4 - 4.7；p<0.0001），有热性惊厥家族史时升高（14.6，6.3 - 34.1；p<0.0001），有两种发作类型病史时升高（7.3，3.3 - 16.4；p<0.0001），以及有既往头部损伤时升高（4.1，2.1 - 8.1；p<0.0001）。儿童多变量分析结果显示，围产期不良事件（5.7，2.6 - 12.7；p<0.0001）以及儿童母亲为寡妇（5.1，2.4 - 11.0；p<0.0001）会增加活动性惊厥性癫痫的几率。
肯尼亚这个农村地区活动性惊厥性癫痫的患病率存在显著异质性。对患病率、治疗使用情况以及筛查应答中的人口统计学差异进行评估有助于确定需要进行针对性干预的群体。围产期不良事件、热性疾病和头部损伤是该地区癫痫潜在的可预防相关因素。
