Spectrum of epilepsy – prevalence, impact, and treatment gap: an epidemiological study from Al-Quseir, Egypt

Figures & data

Table 1 Age-specific lifetime prevalence and incidence rates of epilepsy in Al-Quseir

Age-group (years)	Total population	Lifetime prevalence		Incidence
		Total cases	Prevalence/1,000 (95% CI)	Cases/year	Incidence/100,000 (95% CI)
Birth to <2	1,242	15	12.1 (7.0–20.3)	4	322 (296.2–349.0)
2 to <6	2,975	32	10.8 (7.5–15.3)	3	100.8 (99.8–101.0)
6 to <12	3,862	29	7.5 (5.1–10.9)	2	51.7 (50.1–53.3)
12 to <18	4,014	33	8.2 (5.8–11.7)	1	24.9 (23.6–26.3)
18 to <40	13,009	40	3.1 (2.2–4.2)	1	7.6 (7.15–8.07)
40 to <60	6,077	20	3.3 (2.86–3.78)	2	32.9 (31.72–34.10)
≥60	2,106	13	6.2 (5.20–7.31)	3	142.4 (127.9–158.2)
Total	33,285	182	5.5 (5.23–5.72)	16	48 (47.46–48.54)

Abbreviation: CI, confidence interval.

Table 2 Sex-specific lifetime prevalence rate of epilepsy in Al-Quseir

Age-groups (years)	Total population (n)		Cases
	Male	Female	Male		Female
			No	Prevalence	No	Prevalence
Birth to <2	637	605	9	14.1	6^*	9.9
2 to <6	1,546	1,429	18	11.6	14^*	9.8
6 to <12	2,025	1,837	21	10.4	8^*	4.4
12 to <18	2,065	1,949	18	8.7	15^*	7.7
18 to <40	6,300	6,709	29	4.6	11^*	1.6
40 to <60	3,021	3,056	10	3.3	10^*	3.3
≥60	1,263	843	10	7.9	3^*	3.6
Total	16,857	16,428	115	6.8	67	4.1

Note: The ^* indicates not significant.

Table 3 Rate of different types of epilepsy in Al-Quseir

Type	Etiology
	Presumed genetic	Structural/metabolic	Unknown	Total
	n=114 (%)	n=58 (%)	n=10 (%)	n=182 (%)
Generalized	46 (25.3)	26 (14.3)	3 (1.6)	75 (41.2)
Localization related	68 (37.4)	32 (17.6)	7 (3.8)	107 (58.8)
Total	114 (62.7)	58 (31.9)	10 (5.4)	182 (100.0)

Table 4 Rate and prevalence of probable etiologies of epilepsy in Al-Quseir

Etiology	No of cases	% of PWE (n=182)	Prevalence/1,000 N=33,385
Presumed genetic	114	62.6	3.4
Structural/metabolic	58	31.8	1.75
Perinatal complications	31	17	0.9
Vascular	12	6.6	0.4
Central nervous system infection	8	4.4	0.24
Tumors	4	2.2	0.12
Head trauma	2	1.1	0.06
Congenital malformations	1	0.5	0.03
Unknown	10	5.5	0.3
Total	182	100	5.45

Abbreviation: PWE, patients with epilepsy.

Table 5 Rate of different seizure types among various age-groups

Seizure type, n (%)	Birth to <18 years n=109	≥18 to <40 years n=40	≥4 to <60 years n=20	≥60 years n=13	Total N=182
Generalized	41 (37.6)	22 (55.0)	6 (30.0)	2 (15.4)	71 (38.8)
Generalized tonic-clonic	32 (29.4)	21 (52.5)	6 (30.0)	2 (15.4)	61 (33.5)
Tonic	2 (1.8)	1 (2.5)	0 (0.0)	0 (0.0)	3 (1.6)
Clonic	1 (0.9)	0 (0.0)	0 (0.0)	0 (0.0)	1 (0.5)
Atonic	1 (0.9)	0 (0.0)	0 (0.0)	0 (0.0)	1 (0.5)
Myoclonic	2 (1.8)	0 (0.0)	0 (0.0)	0 (0.0)	2 (1.1)
Absence	3 (2.8)	0 (0.0)	0 (0.0)	0 (0.0)	3 (1.6)
Focal seizures	64 (58.8)	17 (42.5)	14 (70.0)	11 (84.7)	106 (58.3)
Focal seizures	4 (3.7)	3 (7.5)	3 (15.0)	2 (15.4)	12 (6.6)
Focal seizures with impaired consciousness	28 (25.7)	10 (25.0)	6 (30.0)	4 (30.8)	48 (26.4)
Focal with secondary generalization	32 (29.4)	4 (10.0)	5 (25.0)	5 (38.5)	46 (25.3)
Mixed	4 (3.7)	1 (2.5)	0 (0.0)	0 (0.0)	5 (2.7)

Table 6 Comorbid disorders among PWE in Al-Quseir

Type of comorbidity	n	%
Dementia	9	4.9
Mental retardation	51	28
Psychosis	3	1.6
Substance abuse	2	1.1
Cerebral palsy	15	6.6
Stroke	12	8.3
Total	92	50.5

Abbreviation: PWE, patients with epilepsy.

Table 7 Rate of active epilepsy and treatment gap in Al-Quseir

Subject	n	Rate (%)
Patients with active epilepsy	111/182	61.0
Prevalence rate of active epilepsy/1,000 population		3.3/1,000
Patients with active epilepsy on regular AEDs	18	16.2
Patients with active epilepsy never received AEDs	28	25.2
Patients with active epilepsy who are inadequately treated	65	58.6
Treatment gap	93/111	83.8

Abbreviation: AED, anti-epileptic drug.

Table 8 Magnitude of treatment gap worldwide

Location	Studies (n)	Treatment gap (%)	Author
Al-Quseir/present study	1	83.8	El-Tallawy et al^Citation4
Al-Kharga, Egypt	1	58.9	El-Tallawy et al^Citation38
Asia and Africa	65	56	Ngugi et al^Citation39
Rural Vietnam	1	84.7	Tuan et al^Citation40
Brazil	1	56.6	Noronha et al^Citation41
Rural China	1	49.8	Wang et al^Citation42

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