Prevalence and Clinical Features of Epilepsy in a Biracial United States Population

A need for prevalence information emphasizing racial differences prompted a door-to-door survey of all residents of Copiah County, Mississippi. The fieldwork involved a complete census and an extensive screening questionnaire inquiring about diagnoses, signs, and symptoms of neurologic disease. Residents who lived in institutions or had screening responses suggestive of epilepsy were requested to have an examination by neurologists who used defined diagnostic criteria. Prevalence day was 1 January 1978, and the survey yielded prevalence ratios of 1,043/100,000 inhabitants for epilepsy and 678/100,000 inhabitants for active epilepsy. Age-adjusted prevalence ratios were somewhat higher for males and for blacks. Of the 246 identified cases of epilepsy, 37% were judged symptomatic. The leading (putative) cause was head trauma, especially among white males. About 57% of the 246 cases had been evaluated previously by a neurologist or neurosurgeon, while 7% had never been evaluated medically before the survey.     

Prevalence and Pattern of Epilepsy (Lath/Mirgi/Laran) in Rural Kashmir, India

The rural population of 63,645 living in the mountainous Kuthar Valley of South Kashmir, Northwest India was surveyed to determine the prevalence of major neurologic disorders, including epilepsy (called Lath/Mirgi/Laran in the local language). The survey was done according to a World Health Organization protocol (1981). House-to-house screening was done by Anganwadi workers to identify people with possible epilepsy. The screening questionnaire was translated into local vernacular. Persons who had some indication of a history of seizures or other neurologic disease were subsequently examined by a neurologic team. The diagnostic criteria of Hauser and Kurland (1975) were used to define cases of active epilepsy and seizure classification (ILAE, 1981) was done only with clinical data. One hundred fifty-seven cases of active epilepsy were detected, giving a crude prevalence rate of 2.47/1,000 general population. In those aged less than 14 years, prevalence was 3.18/1,000. Ninety-five (60.5%) of all cases were male; 91% of active epilepsy cases had onset of seizures before age 30 years. Mean age of onset in males was 5.3 years, and in females it was 7.1 years. Mean duration of seizures was 6 years; 78.9% cases had generalized seizures, 74.5% cases were receiving no specific treatment, 99.4% cases were born of home delivery, and 8.9% cases had a positive family history of seizures. Mental retardation was the most common associated abnormality in 22.9% of cases.     

Prevalence of Epilepsy in the Parsi Community of Bombay

A door-to-door survey was carried out to screen a community of 14,010 people (Parsis living in colonies in Bombay, India) for possible neurologic diseases. High school graduates, social workers, and medical students administered a screening questionnaire that in a pilot survey had a sensitivity of 100% for identifying persons with epilepsy. Neurologists used defined diagnostic criteria to evaluate individuals positive on the screening survey. Sixty-six persons (43 males, 23 females) suffered from epilepsy (4.7 cases/1,000). Of those, 50 (34 males, 16 females) had active epilepsy (3.6 cases/1,000). The age-specific prevalence ratios remained fairly constant for each age group except for a small peak in the group aged 20-39 years for all epilepsy cases combined. Age-adjusted prevalence ratios were higher for males. The most common seizure type was partial (36 cases). The most frequently associated conditions were cerebral palsy and mental retardation. The majority of individuals were receiving medication as of prevalence day (47 cases).     

Pilot study to detect neurologic disease in Ecuador among a population with a high prevalence of endemic goiter

A census, uniform screening questionnaire, and simple screening neurologic examination were administered in a door-to-door survey to residents of Quiroga, Ecuador, a rural community in the Andes Mountains. The screening procedures had been pretested to assure a high level of sensitivity for detecting children and adults with major neurologic disease. A total of 1,113 participated in the study. Of these, 399 had responses or findings suggesting the presence of neurologic disease. These individuals were then examined by a neurologist, who used fixed diagnostic criteria. The prevalence ratios (per 1,000) for the most common neurologic conditions identified in this survey are: recurrent/persistent severe headache = 68.3, and epilepsy = 17.1.     

Prevalence of Epilepsy in Silivri, a Rural Area of Turkey

PURPOSE: To learn the prevalence of epilepsy in Silivri, a western town of Turkey, a randomized door-to-door survey was conducted using a standard questionnaire. The method of the study was adopted from the suggestions of the World Health Organization (WHO) for prevalence studies in developing countries, and the criteria were derived from Guidelines for Epidemiologic Studies on Epilepsy proposed by the Commission on Epidemiology and Prognosis, the International League Against Epilepsy (ILAE) 1993. METHODS: From June 1 to October 1, 1994, 4,803 people out of a total population of 70,394 were surveyed. The questionnaire, which was administered by practitioners and intern doctors, consisted of 15 questions, with a sensitivity of 99.9% and a specificity of 76%. After the survey, neurologists examined all of the 415 people suspected of having epilepsy and classified the seizures of the active cases. RESULTS: Of the 415 suspected cases, 49 people (24 women, 25 men) were determined as having epilepsy on the assessment day of October 1, 1994. The crude point prevalence of active epilepsy was 10.2 of 1,000 for the region. The prevalence of active epilepsy among women was 10.01 of 1,000 and among men was 10.39 of 1,000. Of the 49 cases, 40.8% had generalized seizures, 53.1% had partial onset seizures, and 6.1% could not be classified. Only 7.7% of the cases with partial onset seizures were defined as probable symptomatic cases. CONCLUSIONS: Onset of the disease peaked at the first decade of life. On the assessment day, 44.9% of those with epilepsy were receiving treatment, and 65.1% had visited religious figures at the onset or during the course of the disease, a figure that reveals the high prevalence of mystical beliefs about the disease in the study area.     

Prevalence of epilepsy in rural Bolivia: a door-to-door survey

OBJECTIVE: To carry out a door-to-door survey in rural areas of the Cordillera Province, Santa Cruz Department, Bolivia, to determine the prevalence of neurologic diseases (epilepsy, stroke, parkinsonism, and peripheral neuropathy) in a sample of approximately 10,000 inhabitants. METHODS: A team of nondoctor health workers administered a standard screening instrument for neurologic diseases-a slightly modified version of the World Health Organization protocol. All subjects found positive during the screening underwent a neurologic examination. RESULTS: On screening, the authors found 1,130 positive subjects, of whom 1,027 were then investigated by neurologists. On the basis of the definition proposed by the International League Against Epilepsy, we detected 124 epileptic patients (prevalence, 12.3/1,000), 112 of whom had active epilepsy (prevalence, 11.1/1,000) on the prevalence day (November 1, 1994). Peak age-specific prevalence occurred in the 15 to 24-year age group (20.4/1,000). Sex-specific prevalence was higher in women (13.1/1,000) than men (11.4/1,000). Eighty-nine patients (71.8%) underwent a standard EEG recording. Considering both EEG and clinical data, partial seizures were the most common type (53.2%) based on the classification of the International League Against Epilepsy. The mean age at onset was 20.7 years for partial seizures and 13.6 years for generalized seizures. Only 10.5% of patients had received specific treatment for more than 2 months of their life. CONCLUSION: This report on epilepsy prevalence in Bolivia confirms that epilepsy is a major health problem in rural areas of developing countries.     

Prevalence of Parkinson's disease in the Parsi community of Bombay, India

A door-to-door survey was carried out to screen a community of 14010 people (Parsis living in colonies in Bombay, India) for possible neurologic diseases. High school graduates, social workers, and medical students administered a screening questionnaire that had been shown in a pilot survey to have a sensitivity of 100% for identifying those with Parkinson's disease. Neurologists used defined diagnostic criteria to evaluate individuals positive on the screening survey. There were 46 people (25 men, 21 women) who suffered from Parkinson's disease (328.3 cases per 1000 population). The age-specific prevalence ratios increased consistently with age. Age-adjusted prevalence ratios were slightly higher for men.     

Prevalence of epilepsy in a rural district of central Lao PDR

PURPOSE: To assess the prevalence of epilepsy in a rural district of Lao PDR and to describe the clinical and epidemiological profile of the disease. METHODS: Door-to-door screening was performed on the entire population of 8 randomly selected villages in the Hinheub district, using an internationally validated and standardized questionnaire. Additional passive case detection was performed through village key informants. Suspected epilepsy patients identified by the questionnaire were revisited and examined by an experienced neurologist on two follow-up visits. The confirmation of epilepsy was based only on an in-depth clinical examination. Electroencephalograms were performed at the district health care center. RESULTS: In the 8 villages, 277 suspected cases of epilepsy were identified among 4,310 interviewed subjects; 194 of whom (70%) underwent a clinical examination by a neurologist during the first visit while 65 of 83 remaining suspected cases were seen on the second confirmation visit. Twenty-seven persons with epilepsy were identified. Six additional patients were diagnosed in 219 self-referred subjects. An overall prevalence of 7.7 cases of epilepsy per thousand inhabitants was calculated (95% CI 5.3-10.7). Generalized epilepsy (21 cases, 63.6%) was commoner than partial epilepsy (9 cases, 27.3%). The remaining 3 cases (9.1%) were not-classifiable as either generalized or partial. EEG abnormal findings were found in 12 of the 24 patients (50.0%) who had an EEG registration. CONCLUSIONS: This is the first study in Lao PDR to estimate the prevalence of epilepsy. Compared to Western countries it shows a pattern towards a higher prevalence.     

The importance of people compliance (social desirability bias) in the assessment of epilepsy prevalence in rural areas of developing countries. Results of the Atahualpa Project

Epilepsy is a major health issue in rural areas of developing countries. However, heterogeneity of epilepsy prevalence in different studies precludes assessment of the magnitude of the problem. Using similar protocols, two population‐based surveys were conducted 12 years apart (2003 and 2015) in a rural Ecuadorian village (Atahualpa). The only difference was a higher people compliance with interviewers during the second survey. Epilepsy prevalence in the 2003 survey was 13.5 per 1,000 (18/1,332) in villagers aged ≥20 years. This rate increased to 26.8 per 1,000 (41/1,530) in the 2015 survey. Thirty‐three persons with epilepsy detected during the second survey lived in the village in 2003; six of them had seizures starting after 2003. Of the remaining 27 cases, 13 (48%) denied their problem during the first survey. Further interview revealed that denial was related to lack of confidence with unacquainted field personnel. Social Desirability Scale‐17 scores were lower in those who admitted having epilepsy than in those who denied their condition (p = 0.048). Lack of confidence with interviewers and a social desirability bias account for a sizable proportion of epilepsy denial in the study population, and may explain heterogeneity of epilepsy prevalence reported in studies conducted in poor rural settings.     

The prevalence of epilepsy in a rural district of Vietnam: a population-based study from the EPIBAVI project

SUMMARY: A field survey was carried out to determine the prevalence of active epilepsy in northern Vietnam between January and December 2005, when members of approximately 13,000 households were screened for seizure disorders. A clinical examination of all screened positive was performed by a neurologist to verify the epilepsy diagnosis, and all epilepsy cases were offered an EEG. Out of 47,269 screened, 1,338 (2.8%) had a positive response to the questionnaire. Of these, 206 fulfilled the criteria for active epilepsy, yielding a prevalence of 4.4 per 1,000 (95% CI 3.8-5.0), higher among males (5.1) than females (3.7), among those with lower compared with higher education and among single compared with those married. Only 20.6% were seizure-free the year before the examination. The prevalence of active epilepsy in Vietnam is similar to some other Asian countries but lower than in developing countries from Africa and South America.