Epidemiology and care of epilepsy in Vietnam

Abstract: Epilepsy is often considered the most common serious chronic neurological disorder estimated to affect 50 million people globally. Although the majority of these live in developing countries, data on the epidemiology of epilepsy from such countries are scarce. This is true also for Vietnam. The overall objective of this project, Epidemiology and Care of Epilepsy in Ba Vi (EPIBAVI), was therefore to provide essential epidemiological data on epilepsy in Vietnam as a basis for an improved management of people with epilepsy in the country. Four studies were carried out in Ba Vi, a representative rural district in the Ha Tay province, utilizing the epidemiological field laboratory FilaBavi. We first assessed public knowledge, attitudes and practice toward epilepsy by application of a WHO questionnaire to 2,005 persons from Ba Vi. Knowledge of epilepsy among the interviewed was found to be limited compared to in some Western countries and attitudes clearly more negative. As examples, 36% would object to their children playing with someone with seizures and 82% to their children marrying someone with epilepsy. Utilizing a validated screening questionnaire, approximately 50,000 people in the region were questioned in their homes by trained interviewers to identify potential cases of epilepsy. All who were screened positive in these surveys were subsequently examined by a neurologist to confirm or refute the epilepsy diagnosis. In total 40 incident cases (two surveys combined) and 206 prevalent cases of active epilepsy were thus identified. Age-adjusted incidence was 44.8/100,000 (95%CI 30.6-59.0), higher in those under 16 years, among people with lower education, and with lower income. Age-adjusted prevalence was 4.4 per 1,000 (95%CI 3.8-5.0), higher among males, 5.1(4.1-5.9), than females, 3.8(3.0-4.6), and among those with lower compared with higher education and among single compared with those married. CT-scan of the brain revealed the etiology of epilepsy in a very small proportion of the incident cases. Cases with active epilepsy were interviewed about their treatment, and 84.7% (95%CI: 79.5% - 89.8%) were found not to be on adequate drug treatment. The most common reasons for not taking antiepileptic drugs expressed by the patients was the perception that their seizures were too few to justify the trouble and costs associated with treatment. In conclusion, the incidence and prevalence of active epilepsy in Vietnam and the association with socio-economic conditions is similar to the patterns reported from Europe and North America. Only 15% of people with active epilepsy in the present study were on adequate drug treatment despite a national programme providing some drugs free of charge. Patient as well as public education about epilepsy and its treatment is needed.