Abstracts

Rationale: The World Health Organization (WHO), International League Against Epilepsy (ILAE), and International Bureau for Epilepsy have called epilepsy a public health imperative, with appropriate emphasis on low-to-middle income countries (LMIC). Although Canada is a high-income country (HIC), health resources are not distributed uniformly and the Arctic may be overlooked. Therefore we examined the incidence of status epilepticus (SE) in a well-defined Canadian Arctic region.

Methods: This study takes epidemiologic advantage of the Kivalliq Region’s geographical isolation, which is accessible only by air. All SE patients requiring emergency care are consistently flown 1,200-1,900 kilometres to a single designated hospital in a distinct southern part of Canada for further management and electroencephalography (EEG). We conducted a retrospective database and chart review at this “bottleneck” hospital to identify patients with seizure(s) severe enough to justify emergency airborne medical evacuation over a 11.25 year period from 2009-2020.

Results: Screening 40,392 EEGs yielded 117 distinct medical evacuations for “operational SE” from 99 patients to derive SE incidences of 99.9 evacuations per 100,000/year, and 84.5 patients per 100,000/year. Average time from seizure onset to EEG was 3.2 days. Only 16.2% of SE patients had known epilepsy. Considering only “confirmed SE” cases meeting ILAE criteria, or with persistently epileptiform EEG despite days of empiric treatment, incidence was 77.7 evacuations per 100,000/year and 64.9 patients per 100,000/year.

Conclusions: The Kivalliq Region has among the highest known SE incidence rates in the world, but only a fraction of SE patients had a known history of epilepsy. Our findings are consistent with a very high Arctic burden of epilepsy amidst clinical under-recognition of epilepsy and systemic under-resourcing of epilepsy care.

Funding: Please list any funding that was received in support of this abstract.: None.