Blog #47: Epilepsy in Developed vs. Underdeveloped Nations

(This blog was originally posted on June 25, 2014)

 

Premature death is more likely to occur in underdeveloped, low-income countries, than in the developed world. Significant causes of these early deaths include deficiencies in education, nutrition, sanitary conditions, perinatal care and access to medical services. More than 85 percent of people who have epilepsy—approximately 70 million people worldwide—reside in areas of the world with limited health-related resources (1). Epilepsy-related deaths in these countries seem to be associated with falls, burns, drowning and status epilepticus, or uncontrolled continuous seizures lasting many minutes to hours to days without stopping. 

The data is staggering. Ngugi, et al, published a study in Kenya, Africa. It showed that the death rate of those with active convulsive epilepsy is more than six times that of a comparison group without active convulsive epilepsy (2). Important factors contributing to this high mortality associated with epilepsy include lack of appropriate anticonvulsant medications and nonadherence to their anticonvulsant medication regimen (commonly associated with long distances from medical providers, traditional animistic beliefs about epilepsy and cognitive impairment). More than half of all deaths in this study were directly related to epilepsy with a high incidence of prolonged seizures and status epilepticus. The researchers concluded that access to basic medical management of seizures would have saved lives.

Conversely, death due to epilepsy is far less common in the developed world. Sudden Unexplained Death in Epilepsy (SUDEP) is a known cause occurring in approximately one out of one thousand people who have epilepsy (see my Blog # 13, November 14, 2011: Sudden Unexpected Death in Seizures). It is imperative that people with epilepsy: follow medical treatment advice; prevent drowning—do not swim alone and don’t bathe or shower unless the bathroom door is open and someone is at home, if at all possible; and don’t drive unless epilepsy is controlled.

The underdeveloped world’s tremendous challenge is to serve their populations by improving the quality of life for all of their people and to prioritize healthcare.

 

1.      Newton CR, Garcia HH. Epilepsy in poor regions of the world. The Lancet 2012; 380: 1193-1201.

2.      Ngugi AK, Bottemly C, et. al. Premature mortality in active convulsive epilepsy in rural Kenya. Neurology 2014; 82: 582-589.

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. DINGS is his first novel. It is a mother’s dramatic story that teaches epilepsy.