Singh Gagandeep, Singhal Sachi, Sharma Suman, Paul Birinder S, Bansal Namita, Chaudhary Anurag, Sharma Sarit, Bansal Rajnder K, Goraya Jatinder S, Setia Raj K, Sander Josemir W
Research & Development Unit Dayanand Medical College Ludhiana India.
Department of Neurology Dayanand Medical College Ludhiana India.
Epilepsia Open. 2020 Nov 1;5(4):582-595. doi: 10.1002/epi4.12439. eCollection 2020 Dec.
To describe clinical characteristics of a community-based epilepsy cohort from resource-limited communities in Punjab, Northwest India.
The cohort was gathered following a two-stage screening survey. We cross-sectionally examined and followed up the cohort for one year. A panel of neurologists assigned seizure types, syndromes, and putative etiologies and categorized drug responsiveness.
The cohort of 240 included 161 (67.1%) men, 109 (45.4%) illiterates and 149 (62.1%) unemployed. Current age was >18 years in 155 (64.6%) but age at epilepsy onset was <18 years in 173 (72.1%). Epilepsies due to structural and metabolic causes were diagnosed in 99 (41.3%), but syndromic assignments were not possible in 97 (40.4%). After one year, drug-resistant epilepsy was established in 74 (30.8%). Perinatal events (n = 35; 14.6%) followed by CNS infections (n = 32; 13.3%) and traumatic brain injury (n = 12; 5.0%) were common risk factors. Most of those with CNS infections (n = 19; 63.3%), perinatal antecedents (n = 23; 76.7%), and other acquired risk factors (n = 27; 90.0%) presented with epilepsy due to structural and metabolic causes. Perinatal events were the putative etiology for nearly 40.7% of generalized epilepsies due to structural and metabolic causes and 28.2% of all epilepsies with onset <10 years.
Existing classifications schemes should be better suited to field conditions in resource-limited communities in low- and middle-income countries. The finding of drug-resistant epilepsy in nearly at least a third in a community-based sample underscores an unmet need for enhancing services for this segment within healthcare systems. Perinatal events, CNS infections, and head injury account for a third of all epilepsies and hence preventative interventions focusing on these epilepsy risk factors should be stepped up.
描述来自印度西北部旁遮普邦资源有限社区的社区癫痫队列的临床特征。
该队列是在两阶段筛查调查后收集的。我们对该队列进行了横断面检查并随访了一年。一组神经科医生对癫痫发作类型、综合征和假定病因进行了分类，并对药物反应性进行了分级。
该队列共240人，其中男性161人（67.1%），文盲109人（45.4%），失业者149人（62.1%）。155人（64.6%）当前年龄大于18岁，但173人（72.1%）癫痫发作起始年龄小于18岁。99人（41.3%）被诊断为结构性和代谢性病因所致癫痫，但97人（40.4%）无法进行综合征分类。一年后，74人（30.8%）被确定为药物难治性癫痫。围产期事件（n = 35；14.6%），其次是中枢神经系统感染（n = 32；13.3%）和创伤性脑损伤（n = 12；5.0%）是常见的危险因素。大多数中枢神经系统感染患者（n = 19；63.3%）、围产期病史患者（n = 23；76.7%）和其他后天危险因素患者（n = 27；90.0%）表现为结构性和代谢性病因所致癫痫。围产期事件是近40.7%的结构性和代谢性病因所致全身性癫痫以及28.2%的所有起始年龄小于10岁癫痫的假定病因。
现有的分类方案应更适合低收入和中等收入国家资源有限社区的现场情况。在基于社区的样本中近至少三分之一的患者被发现患有药物难治性癫痫，这突出表明医疗保健系统中这一群体的服务需求未得到满足。围产期事件、中枢神经系统感染和头部损伤占所有癫痫的三分之一，因此应加强针对这些癫痫危险因素的预防干预措施。
