Department of Psychiatry and Psychotherapy, Section for personality disorder and posttraumatic stress disorder, Campus Benjamin Franklin, Charité-Universitätsmedizin, Berlin, Hindenburgdamm 30, Berlin 12203, Germany; Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health. Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Berlin, Germany.
Oxford Epilepsy Research Group, NIHR Oxford Biomedical Research Centre, Nuffield Department of Clinical Neuroscience, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom.
Seizure. 2021 Nov;92:128-148. doi: 10.1016/j.seizure.2021.08.004. Epub 2021 Aug 13.
With a growing number of forcibly displaced people (FDP) globally, the focus on their medical needs has necessarily increased. Studies about the prevalence and incidence of epilepsy and psychogenic non-epileptic seizures (PNES) in this population are, though, sparse. This Review highlights the importance of exploring and managing both conditions in these vulnerable people to promote global health. We performed an exhaustive review of 10 databases, as well as a manual search of relevant websites related to global health and refugee-related organizations. We analyzed data related to the prevalence and incidence of epilepsy and PNES; health visits; costs of medical care and challenges faced by healthcare workers in relation to FDP with these conditions. Fifty six papers met our inclusion criteria. Of these, 53 reported directly or indirectly on the prevalence of epilepsy and its costs in FDP. Two articles reported on the prevalence of PNES in forcibly displaced people. The reported prevalence of epilepsy in FDP varied from 0.2% to 39.13%, being highest in people with pre-existing neurological or psychiatric comorbidities. Only one study reported on the incidence of epilepsy in internally displaced children. Data from the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) have identified a tendency to higher incidence of epilepsy in children following wars. While within displaced women without a history of sexual violence the rate of PNES was 16.7%, in FDP women with such a history the rate of PNES was 43.7% (p=0.02). The healthcare costs for epilepsy can be high, with recurrent health visits related to seizures being the most common cause of health encounters in refugee camps. Increasing awareness and further studies of multicultural aspects to improve shared understanding of seizure phenomenon in vulnerable displaced populations would seem crucial.
随着全球被迫流离失所者（FDP）人数的不断增加，对他们医疗需求的关注必然会增加。然而，关于这一人群中癫痫和心因性非癫痫性发作（PNES）的患病率和发病率的研究却很少。这篇综述强调了在这些弱势群体中探索和管理这两种疾病的重要性，以促进全球健康。我们对 10 个数据库进行了全面审查，并对与全球健康和难民相关组织相关的相关网站进行了手动搜索。我们分析了与 FDP 中癫痫和 PNES的患病率和发病率、就诊情况、医疗保健费用以及医疗保健工作者面临的挑战相关的数据。有 56 篇论文符合我们的纳入标准。其中，有 53 篇论文直接或间接报告了 FDP 中癫痫及其费用的患病率。有两篇文章报告了被迫流离失所者中 PNES 的患病率。FDP 中癫痫的报告患病率从 0.2%到 39.13%不等，在存在先前存在的神经或精神合并症的人群中患病率最高。只有一项研究报告了内部流离失所儿童癫痫的发病率。联合国近东巴勒斯坦难民救济和工程处（近东救济工程处）的数据表明，战争后儿童癫痫发病率有上升趋势。在没有性暴力史的流离失所妇女中，PNES 的发生率为 16.7%，而有这种病史的 FDP 妇女中，PNES 的发生率为 43.7%（p=0.02）。癫痫的医疗保健费用可能很高，与癫痫发作相关的反复就诊是难民营中最常见的就诊原因。似乎需要提高对癫痫发作现象的多文化方面的认识，并进一步研究，以改善对弱势流离失所人群中癫痫发作现象的共同理解。
