Past and Personal History

Family history of epilepsy, past neurological and medical history must be documented in detail and may give clue to the underlying mechanisms of the disease. In developing countries, some studies reported low incidence of family history of epi-lepsy,10-12 whereas others reported a high incidence.13-18 One study in Tanzania reported an extremely high incidence of 75 .13 Studies carried out in 9 different African countries, between 1996 and 1999, using the Questionnaire for Investigation of...

Drug Withdrawal and Seizure Relapse

Of the patients on AED treatment, 70-80 will eventually become seizure free.1 Because of the possibility of long-term side effects of drugs, it is good practice to consider drug withdrawal after a substantial remission period. There are risks of relapse, however, in doing so and several studies have addressed this issue.13-17 The probability of relapse has varied between 11 and 41 . Most studies in children have reported figures at the lower end of the spectrum while studies in adults tend...

Epilepsy in the Tropics

The Institute of Neurological Sciences CARE Hospital Hyderabad, India Nimal Senanayake, M.D., Ph.D., D.Sc. Faculty of Medicine University of Peradeniya Peradeniya, Sri Lanka VADEMECUM Epilepsy in the Tropics LANDES BIOSCIENCE Georgetown, Texas U.S.A. Copyright 2006 Landes Bioscience All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system,...

Prenatal and Perinatal Pathology

Poor prenatal or perinatal care resulting in brain damage of the child is often claimed to be a reason for the high prevalence of epilepsy in the tropics.3,31 Unfortunately, very few studies in the tropics define inclusion criteria for this category. In studies in developed countries the presence of prenatal and perinatal events do not appear to be associated with the occurrence of childhood epilepsy when children with cerebral palsy and mental retardation are excluded.32 The USA Collaborative...

Table 1 Common sources of misinterpretation of scalp EEGs

Electrode artifacts Myogenic artifacts ECG and pulse artifacts Benign epileptiform variants Benign sporadic sleep spikes Wicket waves 14 and 6 Hz positive spikes 6 Hz spike-waves Rhythmic temporal theta burst of drowsiness Subclinical rhythmic electroencephalographs discharge of adults Atypical responses to photic stimulation Bifrontal delta activity on hyperventilation Posterior slow waves of youth Breach activity tropical world. In India, there are no defined minimum standards for EEG...

Special Issues in Developing Countries

Thomas Introduction Epilepsy is one of the most common chronic disorders affecting women of child-bearing age and 3 to 5 of every 1000 births are to mothers with epilepsy.1 Women with epilepsy (WWE) in developing countries have many concerns and face many social and cultural taboos related to the diversity in ethnic, racial, religious, economic, educational, and cultural spheres. In addition, in developing countries child-bearing for WWE has not always been acceptable...

Hasan Aziz and Zarin Mogal

Epilepsy is a worldwide problem with a major impact on the personal, family, and social life of the affected individual and also on the society. The reported prevalence rates of epilepsy in various epidemiological studies vary from 1.5 to 19.5 per 1,000 population with higher prevalence rates in developing countries.1-5 The average accepted prevalence rate is 5 per 1000.2 Stigmatization, low literacy, sub-optimal employment, and social and economical marginalization are the commonly faced...

Screening Questionnaire

Diagnosis of epilepsy is fundamentally a clinical judgment. Clinical history should elicit details of seizure semiology, seizure provoking factors, and seizure frequency in the preceding five years.7 At times there can be discrepancy in the diagnosis of epilepsy when it is based only on a screening questionnaire. In a recent epidemiological survey in Togo of the 9,155 subjects screened by a screening questionnaire, 285 subjects (3.1 ) reported loss of consciousness, 263 (2.9 ) had seizures and...

Status Epilepticus in Developing Countries An Account

Pierre-Marie Preux, Mouhamadou Diagana and Michel Druet-Cabanac Status epilepticus is a common neurological emergency and is associated with a significant mortality. It may occur in association with epilepsy and in the context of acute central nervous system insults and the systemic illness.1 There is very few published data about status epilepticus in developing countries. Generalized tonic-clonic status epilepticus is readily recognized. But other forms of status epilepticus may not be...

Inspection

Inspection is the key step in the diagnostic evaluation as certain findings burn scars and amputations can give a clue to the epileptic nature of seizures. In developing countries due to high usage of unattended open fires, patients with epilepsy are at a higher risk of burns. Burns from falling into domestic fires are very common. When a patient with epilepsy falls into a fire or on a hot object he may be deserted by the entourage (Fig. 1). In India forehead of a child with febrile seizures is...

Developing Countries Perspective

Febrile seizure is the most common seizure disorder in childhood. Often the terms febrile convulsion and febrile seizure are used synonymously or interchangeably. In the newly proposed classification this seizure disorder has been recognized as a special syndrome and the term febrile seizures (FS) has been proposed.1,2 Epidemiological studies of FS are very few from the developing countries and show some differences not only in the incidence and prevalence rates but also in the clinical...

And Etiological Profile in Developing Countries

Acute symptomatic seizures are those caused or provoked by an acute medical or neurological insult1 and, in the aggregate are almost as common as febrile seizures or epilepsy.2 They make up 40 of all the newly diagnosed seizure disorders.3 Acute symptomatic seizures show clearly differentiated characteristics with regard to true epileptic seizures (1) a clearly identified causal association, (2) generally tend not to recur, (3) usually long-term antiepileptic drug (AED) treatment is not...

Neonatal Seizures Developing Countries Perspective

Seizures in the newborn period are a frequent clinical problem and represent the most distinctive signal of neurological disease. Neonatal seizures are usually related to specific illness requiring prompt therapy. Early diagnosis of underlying cause is important, as some of the risk factors are associated with high mortality or adverse neurological sequelae. Neonatal seizures show clearly differentiated characteristics from seizures in older children. Several unique characteristics of neonatal...

Traditional Therapeutic Scarification on Patients with Epilepsy

A major problem of epilepsy in developing countries is its social implications. Prejudice against the disease is common and patients with epilepsy are marginalized and discriminated. Epilepsy is often concealed. The very pronunciation of the word falling disease as epilepsy is called is a taboo. Many regard epilepsy as supernatural. This negative attitude will have considerable biases in hospital and population-based studies. Patients often consult traditional doctors. Traditional scarification...

Nimal Senanayake

Its high waves fluttering like hands, Magha, the great Sanskrit poet of the seventh century A.D., in his famous epic-'Sisupalavadha, giving a vivid description of the island, Dwarakapuri on the Western coast of Gujarat in India, compared the ocean with a patient having an epileptic seizure. Epilepsy, or the falling sickness, not only has a much older history than any of the other individual nervous or mental disorders, but it has also occupied people's minds to a much larger extent than the...