Epilepsy in a wider world.
Epilepsy in a wider world.
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更广阔的世界中的癫痫。
DOI：
10.1097/00019052-200004000-00007
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发表时间：
2000
影响因子：
4.8
通讯作者：
Theodore,WH
中科院分区：
文献类型：
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作者：
Theodore,WH
本次研讨会的论文反映了癫痫病患者诊断和治疗方法的前沿，包括影像学、新型抗癫痫药物和非药物治疗以及神经生理学。这些技术先进的治疗方式和昂贵的疗法在“发达”世界（即使不是统一的）也被广泛使用，并且是最先进国家的患者的需求，他们通过大众媒体了解了它们。例如，在美国，国家电视网络上曾多次播出专门讲述因癫痫不受控制而接受颞叶切除术甚至大脑半球切除术的患者的故事。 《纽约时报》最近报道了“伽马刀”在癫痫手术中的潜在作用。相比之下，地球上绝大多数癫痫患者无法获得手术、正电子发射断层扫描、磁共振成像、“现代”抗癫痫药物，甚至在许多情况下根本无法获得抗癫痫药物。 1995年，巴基斯坦只有24个脑电图实验室、20台计算机断层扫描仪和3台磁共振成像扫描仪，服务于超过1.2亿人[1]。令问题更加严重的是，发展中国家的癫痫患病率可能更高，特别是在治疗手段可能更少的农村地区[1]。例如，埃塞俄比亚农村地区的一项研究[2]表明，只有 13% 的患者接受了抗癫痫药物治疗。总体而言，发展中国家 80-98% 的患者未得到治疗[3]。由于缺乏治疗，癫痫病的死亡率可能高于发达地区。癫痫患者的年粗死亡率（31.6/1000）几乎是对照死亡率的两倍[2]。此外，居住在乡村社区的癫痫患者经常因掉入明火中而被烧伤。即使包含在政府药房的官方处方中，药物供应也可能并不总是可靠，并导致间歇性、无效的治疗[4]。由于营销劣势，即使是“中产阶级”患者也难以获得药物，因此在发展中国家，尤其是新型抗癫痫药物的成本可能要高得多[5]。对于居住在较偏远地区的患者来说，光是去诊所的交通费用就可能令人望而却步。
The papers in this symposium reflect the leading edge of diagnostic and therapeutic approaches to patients with seizure disorders, including imaging, new antiepileptic drugs and non-pharmacological treatments, and neurophysiology. These technologically advanced modalities and expensive therapies are widely, if not uniformly, available in the ‘developed’world, and are demanded by patients in the most advanced countries, who have been made aware of them via the popular media. In the United States, for example, there have been several broadcasts on national television networks devoted to the sagas of patients who have undergone temporal lobectomy, even hemispherectomy, for uncontrolled epilepsy. The potential role of the ‘gamma knife’for epilepsy surgery was featured recently in the New York Times.In contrast, the vast majority of patients with epilepsy on our planet have no access to surgery, positron emission tomography, magnetic resonance imaging,‘modern’antiepileptic drugs, or even, in many cases, antiepileptic drugs at all. In 1995, Pakistan had only 24 electroencephalograph laboratories, 20 computed tomography scanners and three magnetic resonance imaging scanners for more than 120 million people [1]. Exacerbating the problem, the prevalence rates for epilepsy may be higher in developing countries, particularly in rural areas where treatment may be even less available [1]. A study in rural Ethiopia [2], for example, showed that only 13% of patients were treated with antiepileptic drugs. Overall, 80-98% of patients in developing countries go untreated [3]. Death rates from seizure disorders may be higher than in developed areas, as a result of this lack of treatment. The annual crude death rate for people with epilepsy (31.6/1000) was nearly twice the control rate [2]. Moreover, patients with epilepsy living in village communities often suffer burns from falling into open cooking fires. Even when included in official formularies for government dispensaries, drug supplies may not always be reliable, and lead to intermittent, ineffective treatment [4]. Costs, particularly for new antiepileptic medications, can be much higher in developing countries, because of marketing disadvantages, limiting access even for ‘middle class’ patients [5]. For patients who live in more remote areas, the cost just of transportation to a clinic can be prohibitive.