Population-Based Study of Epilepsy in Cambodia Associated Factors, Measures of Impact, Stigma, Quality of Life, Knowledge-Attitude-Practice, and Treatment Gap
Purpose Identify epilepsy-associated factors and calculate measures of impact, stigma, quality of life (QOL), knowledge-attitude-practice (KAP) and treatment gap in Prey Veng, Cambodia. Methods This first Cambodian population-based case-control study had 96 epileptologist-confirmed epilepsy cases and 192 randomly selected matched healthy controls. Standard questionnaires, which have been used in similar settings, were used for collecting data on various parameters. Univariate and multivariate regression was done to determine odds ratios. Jacoby stigma, 31-item QOL, KAP etc were determined and so were the factors associated with them using STATA software. Treatment gap was measured using direct method. Key findings Multivariate analyses yielded family history of epilepsy, difficult or long delivery, other problems beside seizures (mainly mental retardation, hyperthermia), and eventful pregnancy of the subject's mother as factors associated with epilepsy. There was high frequency of seizure precipitants esp. those related to sleep. Population attributable risk (%) was: family history (15.0), eventful pregnancy of subject's mother (14.5), long/difficult birth (6.5), and other problem beside seizures (20.0). Mean stigma (1.9±1.1, on a scale of 3) was mainly related to treatment efficacy. Mean QOL (5.0±1.4 on a scale of 10) was mainly related to treatment regularity. Cause or risk factor could be determined in 56% of cases. Treatment gap was 65.8%. Significance Factors in pre- and perinatal period were found to be most crucial for epilepsy risk in Cambodia which inturn provides major prevention opportunities. A global action plan for treatment, stigma reduction and improvement of QOL should be set-up in this country.
References
[1]
Preux PM, Chea K, Chamroeun H, Bhalla D, Vannareth M, et al. (2011) First-ever, door-to-door cross-sectional representative study in Prey Veng province (Cambodia). Epilepsia 52: 1382–1387.
[2]
Mac TL, Tran DS, Quet F, Odermatt P, Preux PM, et al. (2007) Epidemiology, aetiology, and clinical management of epilepsy in Asia: a systematic review. Lancet Neurol 6: 533–543.
[3]
Nyame PK, Biritwum RB (1997) Epilepsy: knowledge, attitude and practice in literate urban population, Accra, Ghana. West Afr J Med 16: 139–145.
[4]
Weiss MG, Ramakrishna J, Somma D (2006) Health-related stigma: rethinking concepts and interventions. Psychol Health Med 11: 277–287.
[5]
CDHS (2005) Cambodian Demographic and Health Survey. Phnom Penh: National Institute of Public Health and National Institute of Statistics.
[6]
Jacoby A (1994) Felt versus enacted stigma: a concept revisited. Evidence from a study of people with epilepsy in remission. Soc Sci Med 38: 269–274.
[7]
Cramer JA, Perrine K, Devinsky O, Bryant-Comstock L, Meador K, et al. (1998) Development and cross-cultural translations of a 31-item quality of life in epilepsy inventory. Epilepsia 39: 81–88.
[8]
ILAE (1981) Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the Commission on Classification and Terminology of the International League Against Epilepsy. Epilepsia 22: 489–501.
[9]
ILAE (1993) Guidelines for epidemiologic studies on epilepsy. Commission on Epidemiology and Prognosis, International League Against Epilepsy. Epilepsia 34: 592–596.
[10]
Cruz I, Bossano F, Cruz ME (1989) Population-based case control study of epilepsy in an Andean community (abstract). Proceedings of the Annual Scientific Meeting of the WFN Research Committee on Neuroepidemiology, Chicago.
[11]
D'Amelio M, Shinnar S, Hauser WA (2001) Epilepsy in children with mental retardation and cerebral palsy. In: Devinsky O, Westbrook LE, editors. Epilepsy and Developmental Disabilities. Boston: Butterworth-Heinemann. pp. 3–16.
[12]
Moshe SL, Sharpless NS, Kaplan J (1981) Kindling in developing rats: variability of afterdischarge thresholds with age. Brain Res 211: 190–195.
[13]
Ullal GR, Satishchandra P, Shankar SK (1996) Hyperthermic seizures: an animal model for hot-water epilepsy. Seizure 5: 221–228.
[14]
Sun Y, Vestergaard M, Christensen J, Olsen J (2011) Prenatal exposure to elevated maternal body temperature and risk of epilepsy in childhood: a population-based pregnancy cohort study. Paediatr Perinat Epidemiol 25: 53–59.
[15]
Lundgren J, Smith ML, Blennow G, Siesjo BK (1994) Hyperthermia aggravates and hypothermia ameliorates epileptic brain damage. Exp Brain Res 99: 43–55.
[16]
Kuruba R, Hattiangady B, Shetty AK (2009) Hippocampal neurogenesis and neural stem cells in temporal lobe epilepsy. Epilepsy Behav 14 Suppl 1: 65–73.
[17]
Lilienfeld AM, Pasamanick B (1954) Association of maternal and fetal factors with the development of epilepsy. I. Abnormalities in the prenatal and paranatal periods. J Am Med Assoc 155: 719–724.
[18]
Hackett RJ, Hackett L, Bhakta P (1997) The prevalence and associated factors of epilepsy in children in Calicut District, Kerala, India. Acta Paediatr 86: 1257–1260.
[19]
Sidenvall R, Heijbel J, Blomquist HK, Nystrom L, Forsgren L (2001) An incident case-control study of first unprovoked afebrile seizures in children: a population-based study of pre- and perinatal risk factors. Epilepsia 42: 1261–1265.
[20]
Edwards T, Scott AG, Munyoki G, Odera VM, Chengo E, et al. (2008) Active convulsive epilepsy in a rural district of Kenya: a study of prevalence and possible risk factors. Lancet Neurol 7: 50–56.
[21]
Lilienfeld AM, Benjamin P, Rogers M (1955) Relationship between pregnancy experience and the development of certain neuropsychiatric disorders in childhood. Am J Public Health 45: 637–643.
[22]
Anderson VE, Hauser WA, Rich SS (1986) Genetic heterogeneity in the epilepsies. Adv Neurol 44: 59–75.
[23]
Anderson VE, Hauser WA (1985) The genetics of epilepsy. Prog Med Genet 6: 9–52.
[24]
Salazar AM, Jabbari B, Vance SC, Grafman J, Amin D, et al. (1985) Epilepsy after penetrating head injury. I. Clinical correlates: a report of the Vietnam Head Injury Study. Neurology 35: 1406–1414.
[25]
Hiyoshi T, Yagi K (2000) Epilepsy in the elderly. Epilepsia 41 Suppl 9: 31–35.
[26]
Ottman R, Annegers JF, Risch N, Hauser WA, Susser M (1996) Relations of genetic and environmental factors in the etiology of epilepsy. Ann Neurol 39: 442–449.
[27]
Nakken KO, Solaas MH, Kjeldsen MJ, Friis ML, Pellock JM, et al. (2005) Which seizure-precipitating factors do patients with epilepsy most frequently report? Epilepsy Behav 6: 85–89.
[28]
Aird RB (1983) The importance of seizure-inducing factors in the control of refractory forms of epilepsy. Epilepsia 24: 567–583.
[29]
Rafael F, Houinato D, Nubukpo P, Dubreuil CM, Tran DS, et al. (2010) Sociocultural and psychological features of perceived stigma reported by people with epilepsy in Benin. Epilepsia 51: 1061–1068.
[30]
Kamgno J, Pion SD, Boussinesq M (2003) Demographic impact of epilepsy in Africa: results of a 10-year cohort study in a rural area of Cameroon. Epilepsia 44: 956–963.
[31]
Youssef FF, Dial S, Jaggernauth N, Jagdeo CL, Pascall A, et al. (2009) Knowledge of, attitudes toward, and perceptions of epilepsy among college students in Trinidad and Tobago. Epilepsy Behav 15: 160–165.
[32]
Tran DS, Odermatt P, Singphuoangphet S, Druet-Cabanac M, Preux PM, et al. (2007) Epilepsy in Laos: knowledge, attitudes, and practices in the community. Epilepsy Behav 10: 565–570.
[33]
Jacoby A, Wang W, Vu TD, Wu J, Snape D, et al. (2008) Meanings of epilepsy in its sociocultural context and implications for stigma: findings from ethnographic studies in local communities in China and Vietnam. Epilepsy Behav 12: 286–297.
[34]
Baker GA, Brooks J, Buck D, Jacoby A (2000) The stigma of epilepsy: a European perspective. Epilepsia 41: 98–104.
[35]
Varley J, Delanty N, Normand C, Coyne I, McQuaid L, et al. (2010) Epilepsy in Ireland: towards the primary-tertiary care continuum. Seizure 19: 47–52.
[36]
Moore PM, Baker GA (2002) The neuropsychological and emotional consequences of living with intractable temporal lobe epilepsy: implications for clinical management. Seizure 11: 224–230.
[37]
Wolfe WR, Weiser SD, Leiter K, Steward WT, Percy-de Korte F, et al. (2008) The impact of universal access to antiretroviral therapy on HIV stigma in Botswana. Am J Public Health 98: 1865–1871.
[38]
Santosh D, Kumar TS, Sarma PS, Radhakrishnan K (2007) Women with onset of epilepsy prior to marriage: disclose or conceal? Epilepsia 48: 1007–1010.
[39]
Smeets VM, van Lierop BA, Vanhoutvin JP, Aldenkamp AP, Nijhuis FJ (2007) Epilepsy and employment: literature review. Epilepsy Behav 10: 354–362.
[40]
Dalrymple J, Appleby J (2000) Cross sectional study of reporting of epileptic seizures to general practitioners. BMJ 320: 94–97.
[41]
Jacoby A, Austin JK (2007) Social stigma for adults and children with epilepsy. Epilepsia 48 Suppl 9: 6–9.
[42]
Baker GA (2002) People with epilepsy: what do they know and understand, and how does this contribute to their perceived level of stigma? Epilepsy Behav 3: 26–32.
[43]
Troster H (1998) Coping with the stigma of epilepsy. Psychology, Health & Medicine 3: 149–161.
[44]
Jackson MJ, Turkington D (2005) Depression and anxiety in epilepsy. J Neurol Neurosurg Psychiatry 76 Suppl 1: i45–47.
Ni Eidhin MN, Mc Leavey B (2001) The relationship between perceived acceptance, stigma and severity in a population with epilepsy. Ir J Psychol 22: 213–222.
[47]
Rwiza HT, Matuja WB, Kilonzo GP, Haule J, Mbena P, et al. (1993) Knowledge, attitude, and practice toward epilepsy among rural Tanzanian residents. Epilepsia 34: 1017–1023.
[48]
Jilek-Aall L (1965) Epilepsy in the Wapagoro tribe in Tanganyika. Acta Psychiatr Neurol Scand 41: 57–86.
[49]
Nubukpo P, Preux PM, Clement JP, Houinato D, Tuillas M, et al. (2003) Etude comparée des représentations socioculturelles des épilepsies en France (Limousin) et en Afrique (Togo et Bénin). Med Trop (Mars) 63: 143–150.
[50]
Zhao Y, Zhang Q, Tsering T, Sangwan , Hu X, et al. (2008) Prevalence of convulsive epilepsy and health-related quality of life of the population with convulsive epilepsy in rural areas of Tibet Autonomous Region in China: an initial survey. Epilepsy Behav 12: 373–381.
[51]
Guekht AB, Mitrokhina TV, Lebedeva AV, Dzugaeva FK, Milchakova LE, et al. (2007) Factors influencing on quality of life in people with epilepsy. Seizure 16: 128–133.
[52]
Picot MC, Crespel A, Daures JP, Baldy-Moulinier M, El Hasnaoui A (2004) Psychometric validation of the French version of the quality of life in epilepsy inventory (QOLIE-31): comparison with a generic health-related quality of life questionnaire. Epileptic Disord 6: 275–285.
[53]
Mrabet H, Mrabet A, Zouari B, Ghachem R (2004) Health-related quality of life of people with epilepsy compared with a general reference population: a Tunisian study. Epilepsia 45: 838–843.
[54]
Piperidou C, Karlovasitou A, Triantafyllou N, Dimitrakoudi E, Terzoudi A, et al. (2008) Association of demographic, clinical and treatment variables with quality of life of patients with epilepsy in Greece. Qual Life Res 17: 987–996.
[55]
Heo K, Lee BI, Yi SD, Cho YW, Shin DJ, et al. (2012) Short-term efficacy and safety of zonisamide as adjunctive treatment for refractory partial seizures: a multicenter open-label single-arm trial in Korean patients. Seizure 21: 188–193.
[56]
Dodrill CB (2002) Progressive cognitive decline in adolescents and adults with epilepsy. Prog Brain Res 135: 399–407.
[57]
Park SP, Kwon SH (2008) Cognitive effects of antiepileptic drugs. J Clin Neurol 4: 99–106.
[58]
Akinsulore A, Adewuya A (2010) Psychosocial aspects of epilepsy in Nigeria: a review. Afr J Psychiatry (Johannesbg) 13: 351–356.
