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Epilepsy in Thailand

Epilepsy in Thailand. Dr.Yotin Chinvarun M.D. Ph.D . The Neurological Society of Thailand. Diversity of the Asia-Pacific Region Population and Economical Development. Population (millions) 12 1,272 7 1,027 209 126 47 5 24 2 5 78 3 61 80. Gross National Income

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Epilepsy in Thailand

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  1. Epilepsy in Thailand Dr.Yotin Chinvarun M.D. Ph.D. The Neurological Society of Thailand

  2. Diversity of the Asia-Pacific RegionPopulation and Economical Development Population (millions) 12 1,272 7 1,027 209 126 47 5 24 2 5 78 3 61 80 Gross National Income per capita (US$) 310 1100 25,430 530 810 34,510 12,030 320 3,780 480 510 1,080 21,230 2,190 480 Cambodia China Hong Kong India Indonesia Japan Korea Rep Lao Malaysia Mongolia Papua New Guinea Philippines Singapore Thailand Vietnam World Bank, 2003

  3. Epilepsy in Asia and ThailandScale of the problem • Epilepsy sufferers • Worldwide 50 million • Asia 30 million • Thailand 700,000 cases • Refractory Epilepsy • Overall A bout 20 – 30% • Asia up to 10 million • Thailand up to 30,000 cases

  4. Epilepsy Program in Thailand • Thailand Epilepsy Society (since 1995) • One chapter in the ILAE • Comprehensive epilepsy program • Basic CEP: 5 centers • Advance CEP: 2 centers • Epilepsy fellowship program • Two training centers

  5. Epilepsy clinic Non invasive tests Routine EEG 24 hrs video-EEG monitoring MRI brain Ictal and interictal SPECT PET Neuropsychological testing Invasive tests Intracranial monitoring ECoG EEG monitoring 64, 128 channels Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No Yes Yes Yes Yes Yes No CEP in Thailand Basic CEP Advance CEP

  6. Epilepsy surgery Temporal lobectomy Extratemporal lobe surgery Corpus callosotomy Hemispherectomy Subpial resection Vagal nerve stimulation Ketogenic diet No No No Yes Yes Yes No No No No Yes No Yes Yes CEP in Thailand Basic CEP Advance CEP

  7. Traditional AEDs Phenytoin Cabarmazepine Sodium valproate Phenobarbital Benzodiazepine Acetazolamide 2nd line AEDs Lamotrigine Oxcarbazepine Vigabatrin Gabapentin Topiramate Levetiracetam Zonisamide Pregabalin AEDs in Thailand

  8. Pramongkutklao Comprehensive epilepsy program • Secondary/Tertiary hospital, Bangkok • CEP program created since 2001 • Epilepsy and 1st seizure clinic • Presurgical evaluations both basic and advance tests • Epilepsy fellowship training program (2 yrs training)

  9. Refractory epilepsy in PMK hospital • 523 cases with epilepsy from Jan 2001-June 2005 • Male 46% (241 cases) • Female 54% (282 cases) • Age between 10-75 years old (mean 31 years) • 3,220 visited within Jan 2001-June 2005

  10. Seizure diagnosis • Epileptic seizures (507 cases) • Generalized seizures 33 cases (IGE 4, JME 10, JAE 1, ? Primary or secondary generalized seizures 18) • Partial seizures 474 cases (93%) • Non epileptic seizure 16 cases (3%)- e.g. NPSE, Syncope etc.

  11. Monotherapy vs Polytherapy • 46% (235 cases) – Monotherapy • 54 % (272 cases) - Polytherapy

  12. Refractory cases • 250 cases (49%) are refractory cases • 243 cases- localization related epilepsy • TLE 72 cases • FLE 17 cases • PLE 4 cases • OLE 2 cases • Unidentified lobe 148 cases • 198 cases (79%) on duotherapy or polytherapy

  13. MRI brain Total MRI brain 228 cases Normal 38 Hippocampal sclerosis 66 (35%) -(bilateral HS 6) Developmetal anomalies 32 (17%) Dual pathology 12 Tumor 24 (13%) (Astocytoma 21, gangloglioma 7, DNET 2) Vascular abnormalities 9 (Carvenoma 3, veneous angioma 1, AVM 5) Hippocampal atrophy only 7 Focal atrophy 6 Infraction 3 Cystic lesion 6 Calcified lesion 5 Hemiatrophy 2 Others 18 cases Chinvarun 2005

  14. MRI brain: Etiology 35% N=228 cases 17% 13% Chinvarun 2005

  15. Presurgical evaluationsPMK hospital • 24 hrs video-EEG monitoring 40-60 cases/years • Interictal and ictal SPECT • Neuropsychological test (WAIS-R test, WADA test) • WADA test • Amobarbital WADA - 55 cases • Propofol WADA - 6 cases • Intracranial monitoring • EcoG • Intracranial plate, grid, EEG with 64/128 channel

  16. Epilepsy surgery of refractory cases PMK hospital (June 2005) • Temporal lobectomy 60 cases • Lesionectomy 22 cases • Hemispherectomy 1 case • Callosotomy 3 cases • Vagal nerve stimulation 5 cases

  17. Epilepsy surgery in Asia: A survey (2004) Population (million) Epilepsy surgery program Countries Prevalence of pts requiring surgery Hong Kong India Indonesia Japan Korea Mongolia Philippines Singapore Taiwan Thailand Vietnam Available Pediatric service No of case/yr 6.8 1,000.0 210.0 120.0 47.0 2.5 82.0 4.2 23.0 67.0 80.0 Y Y Y Y Y N Y Y Y Y N Y N N Y Y N Y Y Y Y N 40 100 10 500 300 - 10 10 60 100 - 4,600 (270/yr) 68,000 (40,000/yr 14,000 (8,400/yr) 8,200 (4,800/yr) 3,200 (1,880/yr) 170 (100/yr) 5,500 (3,200/yr) 300 (170/yr) 1,500 (920/yr) 4,500 (2,180/yr) 5,400 (3,200/yr)

  18. Current status of management in Thailand • A limited of antiepileptic drugs available in the rural area • Surgery is severely underutilized • Lack of expertise personnel and equipment • Only a few basic epilepsy surgery centers

  19. Plan to improve epilepsy management in Thailand • Epilepsy training program / Research • Developing guideline for management of epilepsy • Public education program

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