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Molecular & Cellular Epilepsy 2015; 2: e524. doi: 10.14800/mce.524; © 2015 by Abhik Sinha, et al. http://www.smartscitech.com/index.php/mce

RESEARCH ARTICLE

Neuroepidemiology of epileptic seizures: A study from a tertiary care setting of Eastern India Abhik Sinha1, Dibakar Haldar2, Sarmila Mallik3, Debasish Sanyal4, Samir Dasgupta5, Mohana Sinha6, Amiya K.Dwari7 1

Department of Community Medicine, RGKar Medical College Kolkata, India Department of Community Medicine, Bankura Sammilani Medical College, India 3 Department of Community Medicine, Murshidabad Medical College, India 4 Department of Psychiatry, KPC Medical College, Kolka ,India 5 Department of Community Medicine, Burdwan Medical College, India 6 Department of Ophthalmology, Calcutta National Medical College, India 7 Department of Chest Medicine, Bankura Sammilani Medical College, India 2

Correspondence: Abhik Sinha E-mail: [email protected] or [email protected] Received: January 09, 2015 Published online: May 10, 2015

Neurological diseases occupy a major chunk of the burden of Non Communicable disease all over the world. Epilepsy is one of the most important Neurological diseases in India. It has complex etiology and is characterized by recurrent seizures. The study was conducted to To study the clinicosocialprofile of the epilepsy patients under study and to find out the predictors of seizure free status in them. A descriptive cross sectional study carried out in Neuromedicine OPD involving 315 diagnosed epilepsy patients selected by systematic random sampling. The selected patients and their caregivers were interviewed with the predesigned, pretested semistructuredproforma. Data were compiled and analysed using SPSS software. Most of the study subjects was in the age group of 16-30 years with completed primary education and were unskilled labours and belonged to class IV and V of Prasad’s economic status scale. Almost twenty four percent (23.8per cent) had their onset of epileptic fits between 11 to 15 years. Mean duration of epilepsy was 7.93 ± 6.44 years for males and 9.84 ± 7.96 years for females and the difference was not statistically significant ( p= 0.99). Family history of epilepsy was present in 14.3per cent cases. Almost 35.0 per cent had complex partial seizure, 30.2per cent simple partial seizure and 26per cent had experienced generalized tonic-clonic seizure. About 15.0per cent of the total participants reported to have some precipitating or provocating factors. Regarding the treatment received by the study subjects, 55.2per cent were on monotherapy and 44.8per cent on polytherapy.Family history of epilepsy and presence of addiction were found to be significant predictors of seizure free status in the study population. Keywords: epilepsy; sociodemographic; types of seizure; polytherapy; addiction; precipitating factors To cite this article: Abhik Sinha et al. Neuroepidemiology of epileptic seizures: A study from a tertiary care setting of Eastern India. Mol Cell Epilepsy 2015; 2: e524. doi: 10.14800/mce.524.

Introduction Non-communicable diseases (NCDs) are gaining more importance in the developing countries like India in recent times. They have presently drawn attention to the policy makers.

Neurological diseases are important causes of long term morbidity. Epilepsy is one of the most important neurological disorders. It poses a substantial social and economic burden to the country.Epilepsy as ‘recurrent unprovoked seizures’ is known for its because of its episodic unpredictable and varied manifestations [1].

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Molecular & Cellular Epilepsy 2015; 2: e524. doi: 10.14800/mce.524; © 2015 by Abhik Sinha, et al. http://www.smartscitech.com/index.php/mce Table 1. Distribution of study subjects as per few demographics (N=315) Variables

Age group (yrs)

Age of onset of seizure (yrs)

Number

Percent

≤ 15

20

6.3

16-30

172

54.6

72

22.9

46-60

43

13.7

≥ 60

2

0.6

≤ 15

122

38.6

16-30

125

39.6

31-45

57

18.0

4

1.3

>50

8

2.5

Educational Status

Occupation

Population based neuroepidemiologic studies [2] in different regions of India have shown that epilepsy constitutes nearly a third to a fifth of all neurological disorders. It has been estimated that India with 6-10 million people with epilepsy accounts for nearly 1/5th of the global burden of the dreaded disease. Studies have shown the prevalence of epilepsy in India varies from 2.5 to 11.9 per 1000 population. In a survey in south India [2], the prevalence in the rural community was found to be twice that of the urban community. But study conducted by Sridharan R and Murthy BN [3] had shown a prevalence rate of 5.59 per 1000 with no statistical difference between men and women in urban and rural areas. Studies have shown that developing countries used to carry 90 per cent of the financial burden of epilepsy as 85per cent of world’s 40 million people with epilepsy live in developing countries[4]. Health is an important economic resource and ill health leads to economic burden. In a landmark multicentric study4 to study the cost of epilepsy in India the total annual cost per patient amounted to INR 13,755 (USD 344). The total economic burden of epilepsy in India was found to be INR 68.75 billion (1.72 billion USD) which constituted 0.5per cent GNP of India. Out of pocket expenditure is an important area of concern in resource poor country like India. It has been seen that out of pocket expenditure in health have forced many APL families to become BPL families. In this scenario when the burden of epilepsy in India is becoming an area of concern this study was planned. AIMS AND OBJECTIVES

Variables

Number

Precent

45

14.3

Below Primary

56

17.8

Primary completed

140

44.5

Secondary

39

12.4

Higher Secondary

20

6.3

≥Graduate

15

4.8

Unemployed

81

25.7

Home Maker

24

7.6

Student

42

13.3

Unskilled labour

95

30.2

Skilled labour

40

12.7

Service/self-employed

33

10.5

Never Married

204

64.8

Currently Married

107

34.0

Widow / widower

02

0.6

Divorced / separated

02

0.6

Class I

10

3.2

Class II

26

8.3

Class III

49

15.5

Class IV

150

47.6

Class V

80

25.4

Illiterate

31-45

46-50

Table 2. Distribution of study subjects as per few socioeconomic attributes (N=315)

Marital Status

Socio-econom ic status

To study the clinicosocial profile of the epilepsy patients under study and to find out the predictors of seizure free status in them. MATERIALS AND METHODS This was a descriptive hospital based study with cross sectional design conducted at the Out Patient Department (OPD) of Department of Neuromedicine of Medical College involving the diagnosed epilepsy patients. Inclusion Criteria of the study sample were: age of the epilepsy patient ≥ 12 years, willingness to participate in the study and presence of informant / spouse / parent / near relative with the patient. Ethical clearance was taken from the concerned authority of Medical College, Kolkata. Informed consent of patients was taken before the study. Refusal was obtained from none. From the last five years’ hospital records, the average yearly attendance in the Neuromedicine OPD of Medical College was calculated to be 840 with negligible yearly variation. As the data collection period was 9 months, the expected attendance in that period came to be 630. As per feasibility, sample size was determined to be 50per cent of the

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Molecular & Cellular Epilepsy 2015; 2: e524. doi: 10.14800/mce.524; © 2015 by Abhik Sinha, et al. http://www.smartscitech.com/index.php/mce Table-3. Distribution of the study subjects according to their addiction (N=315)* Addiction Alcohol Smoking Guthka Others No addiction

Male (n1=208) No. per cent 57 18.1 78 24.8 62 19.7 2 0.6 98 31.1

Female (n2=107) No. per cent 1 0.9 2 1.9 0 0.0 1 0.9 104 97.2

No. 58 80 62 3 202

Total per cent 18.4 25.4 19.7 1.0 64.1

* Multiple response

Table-4. Distribution of study subjects as per the type of seizure (N=315) Types of Seizure Simple Partial Seizure Complex Partial Seizure Generalized Tonic-Clonic Seizure Absence Seizure Myoclonic Seizure Total

Male (n1=208) No. per cent 61 29.3 78 37.5 55 26.4

Female (n2=107) No. per cent 34 31.8 32 29.9 27 25.3

No. 95 110 82

8 6 208

7 7 107

15 13 315

3.9 2.9 100

study population i.e. 315 and the study sample was selected by systematic random sampling technique. Entry of study subject was doneupto the total desired sample size of 315 was arrived. Study duration was three years of which nine months were devoted to data collection. Response to treatment with AED (Anti Epileptic Drug) was considered if there was 50per cent or greater reduction in the frequency of seizure with 12 weeks of treatment with AED. Considering the type of drugs used for treatment of epilepsy the conventional AED included phenobarbitone, phenytoin, carbamazepine etc and newer AEDs included the drugs other than conventional AEDs e.g. Lamotrigine,Levotiracitam. Interview of the patients and attending caregiver with a predesigned, pretested, semi-structured proforma was done and analysis of records available with the patients.

6.5 6.5 100

Total per cent 30.2 34.9 26.0 4.8 4.1 100

cent illiterate. Majority (30.2 per cent) were unskilled labour, followed by unemployed (23.2 per cent), students (13.3 per cent), skilled labourer (12.7 per cent) and homemaker (7.6 per cent). Evaluation of economic status revealed that 47.6 per cent. 25.4 per cent and 15.5 per cent of the participants belonged to class IV, V and III of Prasad’s scale, respectively. As per marital status- 64.8 per cent were never married; 34 per cent currently married and 0.6 per cent each were widow / widower and divorced or separated. (Table 2) Overall average per capita income was found to be INR 678.70 ± 915.8 (mean±sd). Average per capita incomes of the rural and urban patients were INR 482.01 ± 371.33 and 743±1026.6, respectively. According to the per capita income a statistically significant difference was found between the rural and urban groups (p = 0.001).

RESULTS

Majority (23.8 per cent) had their onset of fits between 11 to 15 years. Comparing mean age of onset of seizure no statistically robust difference was observed across the gender.(z=0.01,p=0.99). Mean duration of epilepsy was 7.93 ± 6.44 years for males and 9.84 ± 7.96 years for females and the difference was not statistically significant ( p= 0.99).

Most (54.6 per cent) of the study subjects was in the age group of 16-30 years.(Table 1) .Study population had a mean age of the was 29.98 years with a standard deviation of 12.70 years. Two third (66.03 per cent) of the participants were male. (Table 2)

Almost thirty six percent (35.9 per cent) had some form of addiction of which 97.3 per cent were males. Smoking (25.4 per cent) was the commonest mode of addiction, followed by Guthka (19.7 per cent) and Alcohol (18.4 per cent). Others included Cannabis, Heroin and other drugs. (Table 3)

Three fourth i.e. 75.2 per cent of the participants were from urban areas.

Family history of epilepsy was present in 14.3 per cent cases. History of pork intake was present only in 6.3 per cent.

So far the educational level- majority i.e. 102 (32.4 per cent) had completed primary education, followed by 56 (17.8 per cent) who did not complete primary education and 14.3per

In the present study 34.9 per cent had complex partial seizure. (Table 4)

Analysis was doneusing SPSS 18.0 software.

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Molecular & Cellular Epilepsy 2015; 2: e524. doi: 10.14800/mce.524; © 2015 by Abhik Sinha, et al. http://www.smartscitech.com/index.php/mce Table 5. Distribution of the study subjects as per their seizure free status and few pertinent socioclinical variables Variable

Seizure free group (n1=198), No. (%)

Nonseizurefree (n2=117), No. (%)

group

Total (N=315), No. (%)

Illiterate

30 (15.2%)

15(12.8%)

45(14.3%)

Others

168(84.8%)

102(87.2%)

270(85.7%)

Present

81(40.9%)

32 (27.4%)

113(35.9%)

Absent

117(59.1%)

85(72.6%)

202(64.1%)

Male

134(67.7%)

74(63.2%)

208(66%)

Female

64(32.3%)

43(36.8%)

107(34%)

χ2, p

Literacy status 0.326,0.568

Addiction 5.88,0.015 Gender 0.643,0.423

Family history of epilepsy Present

40(20.2%)

5(4.3%)

45(14.3%)

Absent

158(79.8%)

112(95.7%)

270(85.7%)

Unmarried

128(64.6%)

76(65%)

204(64.8%)

Others

70(35.4%)

41(35%)

111(32.2%)

Residence Rural

44(22.2%)

34(29.1%)

78(24.8%)

Urban

154(77.8%)

83(70.9%)

237(75.2%)

15.24,