Epilepsy : global issues for the practicing neurologist PDF
Preview Epilepsy : global issues for the practicing neurologist
This Page Intentionally Left Blank World Federation of Neurology Seminars in Clinical Neurology EPILEPSY: GLOBAL ISSUES FOR THE PRACTICING NEUROLOGIST This Page Intentionally Left Blank World Federation of Neurology Seminars in Clinical Neurology Epilepsy: Global Issues for the Practicing Neurologist Jerome Engel, Jr., MD, PhD, CHAIR Jonathan Sinay Professor of Neurology and Neurobiology Chief of Epilepsy and Clinical Neurophysiology Director, Seizure Disorder Center David Geffen School of Medicine at UCLA Reed Neurological Research Center Los Angeles, CA Gretchen L. Birbeck, MD, MPH Assistant Professor Departments of Neurology & Epidemiology Michigan State University Core Faculty African Studies Center East Lansing, MI Director Chikanhata Epilepsy Care Center, Chikanhata Health Services Mazabuka, Zambia Amadou Gallo Diop, MD, PhD Professor of Neurology, Epileptology, and Neurobiology Clinique Neurologique C.H.U. Fann Dakar, Senegal Satish Jain, MD, DM Professor Head of Neurology—FORTIS Hospitals Director, Indian Epilepsy Centre Hauz Khas, New Delhi, India André Palmini, MD, PhD Associate Professor of Internal Medicine Division of Neurology Faculty of Medicine Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS) Scientific Director Porto Alegre Epilepsy Surgery Program Hospital São Lucas—PUCRS Porto Alegre, Brazil Series Editor Theodore L. Munsat, MD Professor of Neurology Emeritus Tufts University School of Medicine Boston, Massachusetts New York Demos Medical Publishing, LLC. 386 Park Avenue South New York, NY 10016, USA Visit our website at www.demosmedpub.com © 2005 by World Federation of Neurology. All rights reserved. This work protected under copyright under the World Federation of Neurology and the fol- lowing terms and conditions apply to its use: Photocopying Single photocopies of single chapter, may be made for personal use as allowed by national copyright laws. Multiple or systematic copying is permitted free of charge for educational institutions that wish to make photocopies for non-profit educational classroom use, but not for resale or commercial purposes. Permission of the World Federation of Neurology is required for advertising or promotional purposes, resale and all forms of document delivery. Permissions may be sought directly from the World Federation of Neurology, 12 Chandos Street, London W1G 9DR, UK. Derivative Works Tables of Contents may be reproduced for internal circulation but permission of the World Federation of Neurology is required for resale of such material. Permission of the World Federation of Neurology is required for all other derivative works, including compilations and translations. Notice No responsibility is assumed by the World Federation of Neurology for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use of operation of any methods, products, instructions, or ideas contained in the material herein. Because of the rapid advances in the medical sciences, in particular, inde- pendent verification of diagnoses and drugs dosages should be made. First edition 2005 Library of Congress Cataloging-in-Publication Data Epilepsy : global issues for the practicing neurologist / Jerome Engel ... [et al.]. p. ; cm. Includes bibliographical references and index. ISBN 1-888799-88-9 (pbk. : alk. paper) 1. Epilepsy. 2. Epilepsy—Developing countries. [DNLM: 1. Epilepsy—diagnosis. 2. Epilepsy—therapy. ] I. Engel, Jerome. RC372.E665 2005 616.8'53—dc22 2004030996 Preface Epilepsy is one of the most common serious primary brain disorders, affecting 40 million people worldwide. According to the World Health Organization (WHO), epilepsy accounts for 1% of the Global Burden of Disease, equivalent to lung cancer in men and to breast can- cer in women. It is not surprising, therefore, that 10 to 20 textbooks on epilepsy are pub- lished annually. These texts contain the very latest information on the diagnosis and treat- ment of various aspects of epilepsy; however, approximately 80% of people with epilepsy in the world live in developing countries, where modern diagnostic and treatment approach- es do not exist. Upwards of 90% of people with epilepsy in these areas receive no treatment at all. It is surprising, therefore, that no textbook on epilepsy addresses the issues faced by neurologists who must deliver care with limited resources, often in a setting of tropical dis- eases and malnutrition that characterizes practice in developing countries. This text is specif- ically designed for this purpose. The World Federation of Neurology has recognized the unmet need of neurologists who must practice medicine without many of the advantages that are often taken for granted in the industrialized world, and has undertaken the task of creating a series of textbooks on neuro- logic subspecialty topics, in an effort to address issues important for neurologists in develop- ing countries, but which are not covered in standard textbooks. This is the first in the series specifically intended to achieve this goal. At this point, the book is a work in progress, because the authors’ experience is limited to only a few areas of the extensive developing regions of the world, and undoubtedly, many important problems remain to be identified and addressed. Consequently, we will appreciate feedback from our colleagues who use this text to help us make it more comprehensive in future editions. Although I, as chief editor, practice at the University of California in Los Angeles, with all the advantages available to neurologists in the industrialized world, my familiarity with the prob- lems of people with epilepsy in developing countries has increased since 1993, when I served first as treasurer, then president, of the International League against Epilepsy (ILAE), and most recently as co-chair of the joint ILAE/International Bureau for Epilepsy (IBE)/WHO Global Campaign against Epilepsy. My personal lack of hands-on experience is complemented by the coauthors of this book, all of whom are neurologists practicing in developing countries. Gretchen Birbeck is a neurologist in a general medical clinic in rural Zambia, and she has written a handbook on epilepsy for healthcare workers in similar environments. Amadou Gallo Diop is a member of the neurology department at a medical college in Dakar, Senegal, and has been instrumental in organizing epilepsy programs for the WHO and the ILAE in Sub- Saharan Africa. Satish Jain heads an epilepsy center in New Delhi, India, and has been active in programs of the Southeast Asian region of the WHO. André Palmini is the scientific direc- tor of an epilepsy center at a university hospital in Porto Alegre, Brazil, and was chair of the ILAE Commission on Latin American Affairs. The authors are grateful to Martin Brodie from Glasgow, Scotland, an expert on the clinical pharmacology of antiepileptic drugs, who chaired the ILAE Commission on European Affairs v PREFACE and is currently a vice president of that organization; Olivier Dulac, a pediatric epileptologist in Paris, France, who has worked in various developing countries; J.A.W. Sander of London, who has organized epidemiologic studies throughout the developing world, and is currently treasurer of the ILAE, and C.T. Tan, a general neurologist in Kuala Lumpur, Malaysia, who chairs the ILAE Commission on Asian and Oceanian Affairs, for their review and critical com- ments on the manuscript. Jerome Engel, Jr., MD, PhD Los Angeles, California September 2004 vi Editor’s Preface The mission of the World Federation of Neurology (WFN, wfneurology.org) is to develop international programs for the improvement of neurologic health, with an emphasis on devel- oping countries. A major strategic aim is to develop and promote affordable and effective continuing neurologic education for neurologists and related health care providers. With this continuing education series, the WFN launches a new effort in this direction. The WFN Seminars in Neurology uses an instructional format that has proven to be successful in con- trolled trials of educational techniques. Modeled after the American Academy of Neurology’s highly successful Continuum, we use proven pedagogical techniques to enhance the effec- tiveness of the course. These include case-oriented information, key points, multiple choice questions, annotated references, and abundant use of graphic material. In addition, the course content has a special goal and direction. We live in an economic environment in which even the wealthiest nations have to restrict health care in one form or another. Especially hard pressed are countries where, of necessity, neurologic care is often reduced to the barest essentials or less. There is general agreement that much of this prob- lem is a result of increasing technology. With this in mind, we have asked the faculty to pres- ent the instructional material and patient care guidelines with minimal use of expensive tech- nology. Technology of unproven usefulness has not been recommended. However, at the same time, advice on patient care is given without compromising a goal of achieving the very best available care for the patient with neurologic disease. On occasion, details of certain investigative techniques are pulled out of the main text and presented separately for those interested. This approach should be of particular benefit to health care systems that are attempting to provide the best in neurologic care but with limited resources. These courses are provided to participants by a distribution process unusual for continu- ing education material. The WFN membership consists of 86 individual national neurologic societies. Societies that have expressed an interest in the program and agree to meet certain specific reporting requirements are provided a limited number of courses without charge. Funding for the program is provided by unrestricted educational grants. Preference is given to neurologic societies with limited resources. Each society receiving material agrees to con- vene a discussion group of participants at a convenient location within a few months of receiving the material. This discussion group becomes an important component of the learn- ing experience and has proved to be highly successful. Our second course addresses the important area of epilepsy management. The Chair of this course, Professor Jerome Engel, Jr. a recognized international authority, has selected an outstanding faculty of experts. We very much welcome your comments and advice for future courses. Theodore L. Munsat, M.D. Professor of Neurology Emeritus Tufts University School of Medicine Boston, Massachusetts vii This Page Intentionally Left Blank
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