Bulletin of the World Health Organization

Global disparities in the epilepsy treatment gap: a systematic review

Ana-Claire Meyer, Tarun Dua, Juliana Ma, Shekhar Saxena & Gretchen Birbeck

Volume 88, Number 4, April 2010, 260-266

Table 1. Studies used for estimating epilepsy treatment gap based on the prevalence of active epilepsy, by country

Country Location Year No. of cases % treatment gap Setting/population Study
Argentina Junin 1991 64 22 Town Kochen S, Melcon MO. Prognosis of epilepsy in a community-based study: 8 years of follow-up in an Argentine community. Acta Neurol Scand 2005;112:370-4. doi:10.1111/j.1600-0404.2005.00519.x PMID:16281918
Argentina Buenos Aires 1991 84 7 Urban, primary school Somoza MJ, Forlenza RH, Brussino M, Licciardi L. Epidemiological survey of epilepsy in the primary school population in Buenos Aires. Neuroepidemiology 2005;25:62-8. doi:10.1159/000086285 PMID:15947492
Brazil Mato Grosso state 2000 9 67 Rural, Bakairi indians Borges MA, Barros EP, Zanetta DM, Borges AP. Prevalence of epilepsy in Bakairi indians from Mato Grosso State, Brazil. Arq Neuropsiquiatr 2002;60:80-5 [Portuguese.]. PMID:11965413
Brazil Rio de Janeiro 2000 5 0 Urban, low-income Gomes M, Zeitoune R, Kropf L, Van Beeck E. A house-to-house survey of epileptic seizures in an urban community of Rio de Janeiro, Brazil. Arq Neuropsiquiatr 2002;60:708-11. PMID:12364934
Brazil Barao Geraldo, Campinas; Jaguare and Santo Antonio, Sao Jose do Rio Preto, south-eastern Brazil 2002 290 38 Mixed Noronha AL, Borges M, Marques L, Zanetta D, Fernandes P, De Boer H, et al. Prevalence and pattern of epilepsy treatment in different socioeconomic classes in Brazil. Epilepsia 2007;48:880-885. doi:10.1111/j.1528-1167.2006.00974.x PMID:17326788
China 5 provinces: Heilongjiang, Ningxia, Henan, Shanxi, Jiangsu 2003a 257 63 Mixed Wang WZ, Wu JZ, Wang DS, Dai XY, Yang B, Wang TP, et al. The prevalence and treatment gap in epilepsy in China: an ILAE/IBE/WHO study. Neurology 2003;60:1544-5. PMID:12743252
China, Province of Taiwan 20 districts and townships in Ilan County, NE Taiwan 1993–95 25 4 Mixed, adults > 40 yrs old Su CL, Chang SF, Chen ZY, Lee CS, Chen RC. Neuroepidemiological survey in Ilan, Taiwan (NESIT): Prevalence of epilepsy. Acta Neurol Taiwan 1998;7:75-84.
China Tibet Autonomous Region 2006 35 97 Rural Zhao Y, Zhang Q, Tsering T, Sangwan, Hu X, Liu L, et al. Prevalence of convulsive epilepsy and health-related quality of life of the population with convulsive epilepsy in rural areas of Tibet Autonomous Region in China: An initial survey during a verbal episodic memory task. Epilepsy Behav 2008;12:373-81. doi:10.1016/j.yebeh.2007.10.012 PMID:18180204
Ecuador Atahualpa 2003 18 28 Rural Del Brutto OH, Santibanez R, Idrovo L, Rodriguez S, Diaz-Calderon E, Navas C, et al. Epilepsy and neurocysticercosis in Atahualpa: a door-to-door survey in rural coastal Ecuador. Epilepsia 2005;46:583-7. doi:10.1111/j.0013-9580.2005.36504.x PMID:15816956
Ecuador El Carchi and Imbabura regions, northern Ecuador 1992a 575 79 Rural Placencia M, Shorvon SD, Paredes V, Bimos C, Sander JW, Suarez J, et al. Epileptic seizures in an Andean region of Ecuador. Incidence and prevalence and regional variation. Brain 1992;115:771-82. doi:10.1093/brain/115.3.771 PMID:1628201Placencia M, Sander J, Roman M, Madera A, Crespo F, Cascante S, et al. The characteristics of epilepsy in a largely untreated population in rural Ecuador. J Neurol Neurosurg Psychiatry 1994;57:320-5. doi:10.1136/jnnp.57.3.320 PMID:8158180
Ethiopia Zay society 2006a 34 53 Rural Almu S, Tadesse Z, Cooper P, Hackett R. The prevalence of epilepsy in the Zay Society, Ethiopia – an area of high prevalence. Seizure 2006;15:211-3. doi:10.1016/j.seizure.2006.01.004 PMID:16488161
Ethiopia Meskan and Mareko sub-district, Haykoch and Butajira district 1986–1988 306 98 Rural Tekle-Haimanot R, Forsgren L, Abebe M, Gebre-Mariam A, Heijbel J, Holmgren G, et al. Clinical and electroencephalographic characteristics of epilepsy in rural Ethiopia: a community based study. Epilepsy Res 1990;7:230-9. doi:10.1016/0920-1211(90)90020-V PMID:2289482
Ethiopia Meskan and Mareko sub-district, Haykoch and Butajira district 1990 139 87 Rural Tekle-Haimanot R, Forsgren L, Ekstedt J. Incidence of epilepsy in rural central Ethiopia. Epilepsia 1997;38:541-6. doi:10.1111/j.1528-1157.1997.tb01138.x PMID:9184599
France Paris, Seine et Marne, Seine Saint-Denis, Val de Marne 1987–1988 149 7 Urban Jallon P. Evaluation of epilepsy prevalence rate in young recruits in a military selection centre. Rev Neurol 1991;147:319-22. PMID:2063084
Gambia Farafenni 1997, 1999 69 100 Rural Coleman R, Loppy L, Walraven G. The treatment gap and primary health care for people with epilepsy in rural Gambia. Bull World Health Organ 2002;80:378-83. PMID:12077613
Honduras Salama County 1997 100 58 Rural Medina MT, Duron RM, Martinez L, Osorio JR, Estrada AL, Zuniga C, et al. Prevalence, incidence, and etiology of epilepsies in rural Honduras: the Salama Study. Epilepsia 2005;46:124-31. doi:10.1111/j.0013-9580.2005.11704.x PMID:15660778
India Parsi community of Bombay 1985 50 22 Urban Bharucha NE, Bharucha E, Bharucha A, Bhise A, Schoenberg B. Prevalence of epilepsy in the Parsi community of Bombay. Epilepsia 1988;29:111-5. doi:10.1111/j.1528-1157.1988.tb04405.x PMID:3258234
India Calicut district, Kerala 1997a 26 50 Mixed Hackett RJ, Hackett L, Bhakta P. The prevalence and associated factors of epilepsy in children in Calicut District, Kerala, India. Acta Paediatr 1997;86:1257-60. doi:10.1111/j.1651-2227.1997.tb14857.x PMID:9401524
India Kuthar Valley, Anantnag district, South Kashmir 1986 157 75 Rural Koul R, Razdan S, Motta A. Prevalence and pattern of epilepsy (Lath/Mirgi/Laran) in Rural Kashmir, India. Epilepsia 1988;29:116-22. doi:10.1111/j.1528-1157.1988.tb04406.x PMID:3258235Razdan S, Kaul R, Motta A, Kaul S, Bhatt R. Prevalence and pattern of major neurological disorders in rural Kashmir (India) in 1986. Neuroepidemiology 1994;13:113-9. doi:10.1159/000110368 PMID:8015664
India Yelandur, Karnataka, south India 1990–1991 457 78 Rural Mani KS, Rangan G, Srinivas HV, Kalyanasundaram S, Narendran S, Reddy AK. The Yelandur study: a community-based approach to epilepsy in rural South India – epidemiological aspects. Seizure 1998;7:281-8. doi:10.1016/S1059-1311(98)80019-8 PMID:9733402
India West Bengal 1995–1996 90 90 Rural Pal DK, Das T, Sengupta S. Comparison of key informant and survey methods for ascertainment of childhood epilepsy in West Bengal, India. Int J Epidemiol 1998;27:672-6. doi:10.1093/ije/27.4.672 PMID:9758124
India Thrissur, Palakkad, Malappuram districts, Kerala, south India; High literacy and health awareness 1996 1175 38 Semi-urban Radhakrishnan K, Pandian JD, Santhoshkumar T, Thomas SV, Deetha TD, Sarma PS, et al. Prevalence, knowledge, attitude, and practice of epilepsy in Kerala, South India. Epilepsia 2000;41:1027-35. doi:10.1111/j.1528-1157.2000.tb00289.x PMID:10961631
India Baruipur block, west Bengal, east India 1992–1993 75 65 Rural Saha SP, Bhattacharya S, Das SK, Maity B, Roy T, Raut DK. Epidemiological study of neurological disorders in a rural population of Eastern India. J Indian Med Assoc 2003;101:299-300. PMID:14575218
India Churu Tehsil, Rajasthan 2005 517 40 Rural Sureka RK, Sureka R. Prevalence of epilepsy in rural Rajasthan – a door-to-door survey. J Assoc Physicians India 2007;55:741-2. PMID:18173034
Kenya Kilifi district 2003 408 85 Rural Edwards T, Scott AG, Munyoki G, Odera VM, Chengo E, Bauni E, et al. Active convulsive epilepsy in a rural district of Kenya: a study of prevalence and possible risk factors. Lancet Neurol 2008;7:50-6. doi:10.1016/S1474-4422(07)70292-2 PMID:18068520
Lao People's Democratic Republic District Hinheub 2003–2004 33 97 Rural Tran DS, Odermatt P, Le TO, Huc P, Druet-Cabanac M, Barennes H, et al. Prevalence of epilepsy in a rural district of central Lao People's Democratic Republic PDR. Neuroepidemiology 2006;26:199-206. doi:10.1159/000092407 PMID:16569936
Madagascar Grand Antananarivo 2001 25 32 Urban Andriantseheno L, Ralaizandriny D. Prevalence communautaire de l'epilepsie chez les Malgaches. Epilepsies 2004;16:83-6.
Mali 18 villages in Tyenfala, Baguineda 2000 70 65 Rural Farnarier G, Diop S, Coulibaly B, Arborio S, Dabo A, Diakite M, et al. [Onchocerciasis and epilepsy. Epidemiological survey in Mali]. Med Trop (Mars) 2000;60:151-5. PMID:11100441
Mali Comune IV and Comune VI, Bamako district 1998 46 76 Urban Traore M, Tahny R, Sacko M. Prevalence de l'epilepsie chez les enfants de 3 a 15 ans dans 2 communes du district de Bamako. Rev Neurol (Paris) 2000;156: Suppl 1:S18.
Nigeria Igbo-Ora 1982 101 96 Town Osuntokun BO, Adeuja A, Nottidge V, Bademosi O, Olumide A, Ige O, et al. Prevalence of the epilepsies in Nigerian Africans: a community based study. Epilepsia 1987;28:272-9. doi:10.1111/j.1528-1157.1987.tb04218.x PMID:3582291
Norway Vaga community, southern Norway 1995–1997 12 0 Rural Brodtkorb E, Sjaastad O. Epilepsy prevalence by individual interview in a Norwegian community. Seizure 2008;17:646-50. doi:10.1016/j.seizure.2008.03.005 PMID:18434213
Norway Oppland county 2001 35 3 Mixed Svendsen T, Lossius M, Nakken KO. Age-specific prevalence of epilepsy in Oppland County, Norway. Acta Neurol Scand 2007;116:307-11. doi:10.1111/j.1600-0404.2007.00909.x PMID:17922724
Pakistan Sind Province, Mirpur Sakro 1987 126 98 Rural Aziz H, Ali S, Frances P, Khan M, Hasan K. Epilepsy in Pakistan: a population-based epidemiologic study. Epilepsia 1994;35:950-8. doi:10.1111/j.1528-1157.1994.tb02539.x PMID:7925166
Pakistan Karachi 1987 115 73 Urban Aziz H, Ali S, Frances P, Khan M, Hasan K. Epilepsy in Pakistan: a population-based epidemiologic study. Epilepsia 1994;35:950-8. doi:10.1111/j.1528-1157.1994.tb02539.x PMID:7925166
Panama Changuinola, Bocas del Toro province 1988 19 100 Small town, Guaymi Indians Gracia F, deLao S, Castillo L, Larreategui M, Archbold C, Brenes M, et al. Epidemiology of epilepsy in Guaymi Indians from Bocas del Toro Province, Republic of Panama. Epilepsia 1990;31:718-23. doi:10.1111/j.1528-1157.1990.tb05512.x PMID:2245802
Senegal Pikine Health District, suburb of Dakar 2005 64 23 Suburban Ndoye NF, Sow AD, Diop AG, Sessouma B, Sene-Diouf F, Boissy L, et al. Prevalence of epilepsy its treatment gap and knowledge, attitude and practice of its population in sub-urban Senegal an ILAE/IBE/WHO study. Seizure 2005;14:106-11. doi:10.1016/j.seizure.2004.11.003 PMID:15694563
South Africa Bushbuckridge, Northern Province 2000 45 51 Rural, children Christianson AL, Zwane ME, Manga P, Rosen E, Venter A, Kromberg JG. Epilepsy in rural South African children – prevalence, associated disability and management. S Afr Med J 2000;90:262-6. PMID:10853404
South Africa Nkalukeni village 2003 38 88 Rural Del Rio-Romero A, Foyaca-Sibat H, Ibanez-Valdes L, Vega-Novoa E. Prevalence of Epilepsy and General Knowledge about Neurocysticercosis at Nkalukeni Village, South Africa. Internet Journal of Neurology 2005;3:1-12.
Spain Madrid 1984 9 56 Urban Cruz Gutierrez-del-Olmo M, Schoenberg BS, Portera-Sanchez A. Prevalence of neurological diseases in Madrid, Spain. Neuroepidemiology 1989;8:43-7. doi:10.1159/000110164 PMID:2643061
Togo 10 of 13 villages in Nadoba, Batamariba district; Batamariba or Tamberma tribe 2002 92 100 Rural Balogou AA, Grunitzky K, Belo M, Sankaredja M, Djagba D, Tatagan-Agbi K, et al. Managment of Epilepsy Patients in Batamariba District, Togo. Acta Neurol Scand 2007;116:211-6. doi:10.1111/j.1600-0404.2007.00871.x PMID:17824896
Togo Tone 1995 170 78 Mixed Balogou AA, Doh A, Grunitzky K. Affections neurologiques et endemie goitreuse: analyse comparative de deux provinces du Togo. Bull Soc Pathol Exot 2001;94:406-10. PMID:11889943
Turkey Central Anatolia (Elmadag township and Kutludugun village) and Demirlirbahce district of Anakara city 1987 59 70 Mixed Aziz H, Guvener A, Akhtar SW, Hasan KZ. Comparative epidemiology of epilepsy in Pakistan and Turkey: population-based studies using identical protocols. Epilepsia 1997;38:716-22. doi:10.1111/j.1528-1157.1997.tb01242.x PMID:9186255
Turkey Sivas 1997 33 76 Urban Topalkara K, Akyuz A, Sumer H, Bekar D, Topaktas S, Dener S, et al. Siva il Merkezinde Tabakali Ornekleme Yontemi ile Gerceklestirilen Epilepsi Prevalans Calismasi. Epilepsia 1999;5:24-9.
Turkey Bursa city center 2004–2005 18 50 Urban Calişir N, Bora I, Irgil E, Boz M. Prevalence of Epilepsy in Bursa City Center, an Urban Area of Turkey. Epilepsia 2006;47:1691-9. doi:10.1111/j.1528-1167.2006.00635.x PMID:17054692
Turkey Silivri 1994 49 45 Mixed Karaagaç N, Yeni SN, Senocak M, Bozluolcay M, Savrun FK, Ozdemir H, et al. Prevalence of epilepsy in Silivri, a rural area of Turkey. Epilepsia 1999;40:637-42. doi:10.1111/j.1528-1157.1999.tb05567.x PMID:10386534
Turkey 47 villages in Ulas town, Sivas city, middle Anatolia region of Turkey 125 78 Mixed Sahin A, Bolayir E, Sumer H, Tas A, Mollaoglu M, Dener S. Epidemiologic evaluation of epileptic and nonepileptic seizures in Sivas region of Middle Anatolia. Neurol Psychiatry Brain Res 2004;11:97-102.
Uganda Kabende parish, Kabarole district 1994 61 100 Rural Kaiser C, Kipp W, Asaba G, Mugisa C, Kabagambe G, Rating D, et al. The prevalence of epilepsy follows the distribution of onchocerciasis in a west Ugandan focus. Bull World Health Organ 1996;74:361-7. PMID:8823957
United Kingdom of Great Britain and Northern Ireland National child survey 1988 124 2 National, children only Kurtz Z, Tookey P, Ross E. Epilepsy in young people: 23 year follow up of the British national child development study. BMJ 1998;316:339-42. PMID:9487166
United Republic of Tanzania Nachingwea district 1999 42 95 Rural Dent W, Helbok R, Matuja WB, Scheunemann S, Schmutzhard E. Prevalence of active epilepsy in a rural area in South United Republic of Tanzania: a door-to-door survey. Epilepsia 2005;46:1963-9. doi:10.1111/j.1528-1167.2005.00338.x PMID:16393163
United Republic of Tanzania Ulanga district 1989–1990 185 100 Rural Rwiza H, Kilonzo G, Haule J, Matuja W, Mteza I, Mbena P, et al. Prevalence and incidence of epilepsy in Ulanga, a rural Tanzanian district: a community-based study. Epilepsia 1992;33:1051-6. doi:10.1111/j.1528-1157.1992.tb01758.x PMID:1464263Rwiza H. The Muhimbili epilepsy project, a three pronged approach. Trop Geogr Med 1994;46 Suppl;22-4.
United States of America Washington Heights, Inwood, New York City 2004–2005 42 7 Urban Kelvin EA, Hesdorffer DC, Bagiella E, Andrews H, Pedley TA, Shih TT, et al. Prevalence of self-reported epilepsy in a multiracial and multiethnic community in New York City. Epilepsy Res 2007;77:141-50. doi:10.1016/j.eplepsyres.2007.09.012 PMID:18023147
United States of America California 2003 322 10 Mixed Kobau R, Zahran H, Grant D, Thurman DJ, Price PH, Zack MM. Prevalence of active epilepsy and health-related quality of life among adults with self-reported epilepsy in California: California Health Interview Survey, 2003. Epilepsia 2007;48:1904-13. doi:10.1111/j.1528-1167.2007.01161.x PMID:17565591
United States of America 19 states 2005 919 7 Mixed Kobau R, Zahran H, Thurman DJ, Zack MM, Henry TR, Schachter SC, et al. Epilepsy surveillance among adults — 19 States, Behavioural Risk Factor Surveillance System, 2005. MMWR Surveill Summ 2008;57:1-20. PMID:18685554
Zambia Chikankata catchment area 2000–2001 799 97 Rural Birbeck GL, Kalichi EM. Epilepsy prevalence in rural Zambia: a door-to-door survey. Trop Med Int Health 2004;9:92-5. doi:10.1046/j.1365-3156.2003.01149.x PMID:14728612


a Prevalence year not reported in manuscript, therefore publication year substituted.

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