Prevalence, Incidence, and Etiology of Epilepsies in Rural Honduras: The Salamá Study

• Published in: Epilepsia (Copenhagen) 2005-01, Vol.46 (1), p.124-131
• Main Authors: Medina, Marco T., Durón, Reyna M., Martínez, Lisandro, Osorio, Juan Ramón, Estrada, Ana L., Zúniga, Concepción, Cartagena, Dora, Collins, Julianne S., Holden, Kenton R.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anticonvulsants. Antiepileptics. Antiparkinson agents; Biological and medical sciences; Child; Child, Preschool; Drug toxicity and drugs side effects treatment; Electroencephalography; Epidemiology; Epilepsy; Epilepsy - diagnosis; Epilepsy - epidemiology; Epilepsy - etiology; Etiology; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Honduras; Honduras - epidemiology; Humans; Incidence; Infant; Infant, Newborn; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurocysticercosis; Neurocysticercosis - complications; Neurocysticercosis - diagnosis; Neurocysticercosis - epidemiology; Neurology; Neuropharmacology; Pharmacology. Drug treatments; Prevalence; Rural Population - statistics & numerical data; Tomography, X-Ray Computed; Toxicity: urogenital system; Videotape Recording
• ISSN: 0013-9580; 1528-1167
• DOI: 10.1111/j.0013-9580.2005.11704.x

Purpose: Determination of epilepsy etiology in population‐based studies is difficult because of the high cost of diagnostic tests. However, cost‐effectiveness may be proven if preventive public‐health strategies can be established from the test results. We report an epilepsy population‐based study using clinical and laboratory techniques. Methods: A medical team administered an epilepsy survey to 88% of the residents by census in the rural county of Salamá, Honduras. Ninety of 100 participants identified with active epilepsy underwent a neurologic examination, video‐electroencephalography (video‐EEG), brain computed tomography (CT) scan, and serum enzyme‐linked immunoelectrotransfer blot (EITB) for cysticercosis. Final diagnoses were based on the International League Against Epilepsy classifications for seizures and epilepsy syndromes. Combined epidemiologic, clinical, video‐EEG, neuroimaging, and serum EITB assays were used for the diagnosis of epilepsy etiologies. Results: Among 6,473 residents surveyed, 151 persons with epilepsy (prevalence rate, 23.3/1,000) were identified, 100 of whom had active epilepsy (15.4/1,000) on the prevalence day. Incidence was determined to be 92.7/100,000. Partial seizures with or without secondary generalization were common (92.2%). Symptomatic epilepsy (62%) was primarily due to neurocysticercosis (37%), perinatal brain damage (8%), post‐traumatic (3%), and poststroke (2%). Eight percent were idiopathic, and 30% were cryptogenic (unknown cause). Conclusions: Symptomatic epilepsies primarily explained the high prevalence and incidence of epilepsy in Salamá. Integration of video‐EEG and brain CT scan with clinical‐epidemiologic evaluation was critical for determination of epilepsy etiology. Establishment of specific programs for continuation of epidemiologic surveillance, education, intervention, and long‐term follow‐up will benefit the Salamá region.