Division of Neurology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
Clinical Research Centre, Seberang Jaya Hospital, Penang, Malaysia.
J Clin Neurosci. 2022 Aug;102:60-64. doi: 10.1016/j.jocn.2022.05.028. Epub 2022 Jun 18.
Seizure remission rates of 60% with antiseizure medications were reported in developed countries, but might be lower in resource-limited countries. The challenges in epilepsy care in resource-limited regions were highlighted 10 years ago, and still remain an ongoing issue. This study aimed to determine the seizure freedom rates in level-2 epilepsy care centres (centres with general neurologists) compared to level-3/4 centres (centres with epileptologists providing epilepsy surgery evaluation) in Malaysia. This is a retrospective study of 1,347 adult epilepsy patients from two level-2 (n = 290) and two level-3/4 epilepsy care centres (n = 1,057). The seizure remission rates were significantly lower in level-2 centres (42.5%) compared to the level 3/4 centres (61.9%, p < 0.05). Level-2 centres had significantly more patients with undetermined seizure types compared to level-3/4 centres (6.6% vs 3.1%, p < 0.05). Level-3/4 centres had significantly more patients with epilepsy of structural and genetic origins, whereas more patients in level-2 centres had unknown aetiology (46.2% vs. 34.0% in level-3/4, p < 0.05). Level-2 centres had a lower neurologist-to-patient ratio (1:97 vs. 1:50 in level-3/4 centres, p < 0.05). Level-2 centres also had fewer patients, who underwent investigations such as EEG (74.1% vs. 89.6%) and brain MRI (54.1% vs. 72.4%, p < 0.05) in comparison with level-3/4 centres. Our study emphasized the existing challenges in epilepsy care in a resource-limited country to achieve the ideal 60% seizure remission rate.
在发达国家，抗癫痫药物的癫痫发作缓解率为 60%，但在资源有限的国家可能较低。10 年前就强调了资源有限地区癫痫护理的挑战，这仍然是一个持续存在的问题。本研究旨在确定马来西亚 2 级（n=290）和 3/4 级（n=1,057）癫痫护理中心（有普通神经科医生）的癫痫发作无发作率。这是一项回顾性研究，共纳入了来自两个 2 级（n=290）和两个 3/4 级癫痫护理中心的 1347 例成年癫痫患者。2 级中心的癫痫发作缓解率明显低于 3/4 级中心（42.5%比 61.9%，p<0.05）。2 级中心有更多未确定的癫痫发作类型的患者，而 3/4 级中心则有更多有结构性和遗传性起源的癫痫患者（6.6%比 3.1%，p<0.05）。3/4 级中心有更多病因不明的患者，而 2 级中心则有更多病因不明的患者（46.2%比 34.0%，p<0.05）。2 级中心的神经科医生与患者的比例较低（1：97 比 1：50 在 3/4 级中心，p<0.05）。与 3/4 级中心相比，2 级中心进行脑电图（74.1%比 89.6%）和脑 MRI（54.1%比 72.4%）等检查的患者较少（p<0.05）。我们的研究强调了资源有限的国家在实现理想的 60%癫痫发作缓解率方面存在的挑战。
