Shorvon S D, Farmer P J
Institute of Neurology, National Hospital, London, England.
Epilepsia. 1988;29 Suppl 1:S36-54. doi: 10.1111/j.1528-1157.1988.tb05790.x.
In this report, aspects of epilepsy that differ in developing and in developed countries are reviewed. This is inevitably an incomplete and impressionistic survey, because data on many aspects in developing countries are scarce, and because it is difficult to generalise meaningfully about the enormous diversity of countries and populations that make up the developing world. Epidemiological studies of prevalence and incidence are reviewed with an emphasis on the problems inherent in work in this area in developing countries. Data concerning seizure type, aetiology, and severity of seizures in the Third World are contrasted with those from developed countries. Sociocultural aspects of epilepsy have been poorly studied, and yet are fundamental to effective medical management. The social effects of epilepsy and the local perceptions of cause and of treatment are discussed from work in Africa, Asia, and South America. The principles and success of treatment in the Third World may differ considerably in developing and developed countries. In the Third World, medical manpower is scarce, and epilepsy is managed essentially by primary care resources, without specialised investigations or personnel. The principles of drug therapy may not be understood by patients, and the supply of drugs is often erratic; and these are major reasons for poor compliance with treatment. World Health Organisation (WHO) initiatives have stressed the extensive use of paramedical personnel and of an essential drugs list, but this emphasis may be misdirected, and in practice neither proposal has achieved much success. The recommendation that phenobarbital be extensively used in the Third World, because of its cheapness and efficacy, is also of doubtful merit, as there are well-known and major drawbacks to the widespread use of this drug. Computations of treatment gap figures in three developing countries suggest that between 80-94% of patients with active epilepsy are not receiving anticonvulsant therapy, and cost is only one of a number of reasons for this. The key to improvements in medical treatment lie with a better understanding of the patients' cultural concepts of epilepsy and its treatment, improved drug supply and availability, and efforts to improve education amongst general practitioners and other primary care medical personnel.
本报告回顾了发展中国家和发达国家在癫痫方面存在差异的各个方面。这不可避免地是一项不完整且带有主观印象的调查，原因在于发展中国家许多方面的数据匮乏，而且要对构成发展中世界的众多国家和人口的巨大多样性进行有意义的概括也很困难。本文回顾了患病率和发病率的流行病学研究，重点关注发展中国家该领域研究中固有的问题。将第三世界癫痫发作类型、病因及严重程度的数据与发达国家的数据进行了对比。癫痫的社会文化方面研究较少，但却是有效医疗管理的基础。文中依据非洲、亚洲和南美洲的研究探讨了癫痫的社会影响以及当地对病因和治疗的看法。第三世界的治疗原则和成效在发展中国家和发达国家可能有很大差异。在第三世界，医疗人力稀缺，癫痫主要由基层医疗资源进行管理，缺乏专门的检查或人员。患者可能不理解药物治疗原则，药品供应也常常不稳定；这些是治疗依从性差的主要原因。世界卫生组织（WHO）的举措强调广泛使用辅助医疗人员和基本药物清单，但这种强调可能存在偏差，实际上这两项提议都未取得太大成功。由于苯巴比妥价格低廉且疗效显著，因此有人建议在第三世界广泛使用该药，但鉴于广泛使用此药存在众所周知的重大弊端，这一建议的价值也值得怀疑。对三个发展中国家治疗缺口数据的计算表明，80%至94%的活动性癫痫患者未接受抗惊厥治疗，成本只是造成这种情况的诸多原因之一。改善医疗治疗的关键在于更好地理解患者对癫痫及其治疗的文化观念，改善药品供应和可及性，并努力提高全科医生和其他基层医疗人员的教育水平。
