Abstracts

The worldwide prevalence of epilepsy has been estimated to be around 10/1,000; however, the access to treatment is quite variable. Many people go untreated, particularly in resource poor countries, which may add to the cumulative prevalence of epilepsy in these countries. This study had an objective to estimate the prevalence of epilepsy and the proportion of people not receiving adequate treatment in different socio-economic classes in Brazil, a resource poor country. We conducted a door-to-door community survey to assess the prevalence and treatment gap of epilepsy (corrected for socio-economic status) in three areas of two cities (Campinas and S[atilde]o José do Rio Preto[SJRP]) in the southeast of Brazil. The total population studied in these three areas was 96,300 people. We applied a validated epidemiological questionnaire with sensitivity 95.8% and specificity 97.8% for epilepsy screening, and a neurologist further ascertained the positive cases. We applied a validated questionnaire based on household possessions inventory for socio-economic classification that ranges from Class A (highest) to E (lowest). We defined adequate epilepsy treatment as regular use of antiepileptic drugs (AEDs) at standard dosage. The cumulative prevalence was 9.1/1,000 people. The estimated prevalence of active epilepsy was 5.3/1,000 people. The prevalence of active epilepsy was higher in the more deprived social classes in Campinas (Class D+E = 8.1/1,000 [95%CI = 4.4-11.9] vs. Class A = 1.6/1,000 [0.4-2.9]) and in SJRP (Class D+E = 7.3/1,000 [5.7-8.9] vs. Class B = 3.1/1,000 [1.5-4.7]). Thirty-seven percent of patients with active epilepsy had inadequate treatment, including 19% who were not on any medication; the figures were similar in the different socio-economic groups. The prevalence of epilepsy in Brazil is similar to other resource-poor countries, and the treatment gap is high. We studied the differences in the social classes for prevalence and treatment gap, and the poorer classes had higher prevalence than the richest ones, while treatment gap is similar. Commitment of the health system towards improvement of the quality of health management for people with epilepsy and consistent and regular AED supply is needed. (Supported by FAPESP.)