Prevalence of epilepsy-An unknown quantity
Prevalence of epilepsy-An unknown quantity
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DOI：
10.1111/epi.12579
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发表时间：
2014-07-01
期刊：
影响因子：
5.6
通讯作者：
Hesdorffer, Dale
中科院分区：
文献类型：
--
作者：
Beghi, Ettore;Hesdorffer, Dale
癫痫的发病率、患病率和死亡率在不同经济体的国家各不相同。差异可以通过方法学问题、过早死亡、癫痫缓解、社会经济因素和耻辱来解释。诊断错误分类-一种可能的解释-可能是由于纳入急性症状性或孤立的无端癫痫发作的患者。其他偏倚来源包括目标人群的年龄和种族、癫痫的定义、回顾性与前瞻性确定、病例来源以及经历和感知的耻辱。过早死亡是低收入国家（LIC）的一个问题，治疗差距，脑感染和创伤性脑损伤比高收入国家（HIC）更常见。死亡率可能反映了未经治疗的持续癫痫发作或包括急性症状性癫痫发作。缺乏抗癫痫药物依从性与贫困社区的死亡风险增加、住院人数增加、机动车事故和骨折有关。癫痫是一种自我缓解的临床疾病，高达50%的病例。对低收入国家未经治疗的个人进行的研究表明，缓解率与患者接受治疗的国家的缓解率重叠。当患者的识别基于自发报告时（例如，例如，在一个实施例中，挨家挨户的调查），缓解期患者可能不太可能透露疾病，因为担心受到侮辱，同时没有好处。这可能导致在评估癫痫终生患病率时对病例的不确定性。在低收入国家，生活贫困的人口比例高于高收入国家。贫困与癫痫的风险因素、癫痫的发病风险和死亡率增加有关。在低收入国家中发现的癫痫的高发病率和患病率在高收入国家的低收入者中也观察到。癫痫病与死亡率增加有关。这可能部分解释了低收入国家癫痫发病率和终生患病率之间的差异。低收入国家和高收入国家的贫困可能是癫痫死亡的一个可预防的原因。
The incidence, prevalence, and mortality of epilepsy vary across countries with different economies. Differences can be explained by methodological problems, premature mortality, seizure remission, socioeconomic factors, and stigma. Diagnostic misclassification-one possible explanation-may result from inclusion of patients with acute symptomatic or isolated unprovoked seizures. Other sources of bias include age and ethnic origin of the target population, definitions of epilepsy, retrospective versus prospective ascertainment, sources of cases, and experienced and perceived stigma. Premature mortality is an issue in low-income countries (LICs), where treatment gap, brain infections, and traumatic brain injuries are more common than in high-income countries (HICs). Death rates may reflect untreated continued seizures or inclusion of acute symptomatic seizures. Lack of compliance with antiepileptic drugs has been associated with increased risk for death, increased hospital admissions, motor vehicle accidents, and fractures in poor communities. Epilepsy is a self-remitting clinical condition in up to 50% of cases. Studies in untreated individuals from LICs have shown that the proportion of remissions overlaps that of countries where patients receive treatment. When the identification of patients is based on spontaneous reports (e. g., door-to-door surveys), patients in remission may be less likely to disclose the disease for fear of stigmatization with no concurrent benefits. This might lead to underascertainment of cases when assessing the lifetime prevalence of epilepsy. In LICs, the proportion of people living in poverty is greater than in HICs. Poverty is associated with risk factors for epilepsy, risk for developing epilepsy, and increased mortality. The high incidence and prevalence of epilepsy found in LICs is also observed in low income individuals from HICs. Epileptogenic conditions are associated with an increased mortality. This may partly explain the difference between incidence and lifetime prevalence of epilepsy in LICs. Poverty within LICs and HICs could be a preventable cause of mortality in epilepsy.