Abstracts

Rationale: There are about 50 million diagnosed cases of epilepsy worldwide, of which 40 million live in low- and middle-income countries (LMICs). Nearly a quarter to a third of these might be expected to have drug resistant epilepsy, a condition associated with heavy economic burden. Even otherwise, epilepsy is associated with enormous consequences on quality of life, morbidity and premature mortality. An understanding of the population-based characteristics of epilepsy, its socio-demographic features, etiologies, the scale of drug resistance and spectrum of comorbidities is required to develop strategies to control epilepsy at national levels in the LMICs. The characteristics of epilepsy as well as drug resistance in epilepsy is poorly described in low- and middle-income countries. We undertook a population-based survey to identify people with epilepsy in a resource-limited, impoverished community in India. Here, we report the characteristics of epilepsy in this sample. We also surveyed to assess the proportion of patient with drug resistant epilepsy, as well as existing medical and/or psychiatric co morbidities in this population. Methods: Community Interventions For Epilepsy (CIFE) is a population-based initiative to provide care for people with epilepsy through primary and community health workers. A cluster-randomized controlled trial is currently underway with support from the Indian Council of Medical Research. A population-based survey was conducted to identify subjects for this trial. This was done in a two-step method: (1) by door to door screening for epilepsy (n = 55,953). People screened positive in the first step (n=556) underwent evaluation by a neurologist and also Electroencephalograms and Magnetic Resonance Imaging (n= 234,125). People, who screened negative for true epilepsy (e.g. Non epileptic attacks, single seizures, syncope) were excluded (n = 96). Of the remainder, people who did not show up for step 2 of evaluation were also excluded (n = 67). The community was divided into 9 zones, with 2-3 clusters per zone, and the total eligible patients (n = 254) from 24 clusters were enrolled in the cluster randomized trial. These subjects have now been followed up for 12-19 months. We undertook to describe the socio-demographic features of this cohort, to characterize the seizure types and epilepsy syndromes according to 2017 International League Against Epilepsy (ILAE) classification schemes. We also used current ILAE criteria (2010) to label among this cohort, those with drug-resistant epilepsy. Finally, we used a previously used inventory to associate various medical and psychiatric comorbidities with each of the cases (2009). Those with febrile seizures, neonatal seizures, single seizures not fulfilling the current operational definition for epilepsy and acute symptomatic seizures associated with head injury, stroke, toxic, metabolic and infective conditions – excluded. Results: A total of 254 people with epilepsy out of the 55,953 surveyed population were included. Mean age – 25.78 (+/- 15.21) years, 84 were females and 170 males. The duration of epilepsy varied between 16 and 742 months (median: 132 months). The seizure types, syndromes and etiological conditions will be described. Epilepsy was labelled as controlled in n=97 patients (38.18%) and fulfilled criteria for drug-resistance in n=79 patients (31.10%). Drug-resistance or control could not be determined in n=78 patients (30.70%).Psychiatric co morbities were fairly common: developmental delay of varying degrees –n=20 (7.87%), depression (n=13; 5.11%), alcohol abuse (n=7; 2.75%), other drug abuse (n=7; 2.75%; tobacco use (n=4; 1.5%). and 4(1.5%) people had suicidal ideations. Amongst other psychiatric conditions found in this population were dementia, ADHD, behavioral disorders, interictal psychosis, and sleep disturbances. Neurological disorders were also fairly common: perinatal insult (n=25; 9.84%), neurocysticercosis (n=24; 9.44%),traumatic brain injury sequelae (n= 19; 7.4%), hemiplegia (n=6,2.36%) and migraine (n=2,0.78%).Others also seen in this population –dermatological conditions(n=8,3.54%), GIT infections (n=7,2.75%), tuberculosis (n=5,1.96%), menstrual problems (n=4,1.57%), dengue(n=3,1.8%), and chest infections (n= 0.78%) amongst others. Six people in the cohort experienced status epilepticus during the follow-up period. Conclusions: A large proportion of people in this this cohort had drug-resistant epilepsy. This could be due to under ascertainment as epilepsy is a profoundly stigmatizing condition or due to peculiar treatment-seeking characteristics of the population. The large numbers with various psychiatric, neurological and medical comorbidities mean that these conditions must be included in any programs directed towards control of epilepsy in LMICs. Funding: No funding