Status epilepticus in the Canadian Arctic: A public health imperative hidden in plain sight

Abstract Objective The World Health Organization, International League Against Epilepsy (ILAE), and International Bureau for Epilepsy have called epilepsy a public health imperative, with appropriate emphasis on low‐to‐middle‐income countries (LMIC). Although Canada is a high‐income country (HIC), i...

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Autores principales:	Marcus C. Ng, Milena Pavlova
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	epilepsy health care inequity Nunavut seizures underserved population Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/9f1e156b40194f31a3a039c9a12d3b11
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spelling	oai:doaj.org-article:9f1e156b40194f31a3a039c9a12d3b112021-12-01T06:09:19ZStatus epilepticus in the Canadian Arctic: A public health imperative hidden in plain sight2470-923910.1002/epi4.12538https://doaj.org/article/9f1e156b40194f31a3a039c9a12d3b112021-12-01T00:00:00Zhttps://doi.org/10.1002/epi4.12538https://doaj.org/toc/2470-9239Abstract Objective The World Health Organization, International League Against Epilepsy (ILAE), and International Bureau for Epilepsy have called epilepsy a public health imperative, with appropriate emphasis on low‐to‐middle‐income countries (LMIC). Although Canada is a high‐income country (HIC), income is not distributed uniformly. Furthermore, epilepsy data from the national statistical agency explicitly overlook the Arctic by excluding these territories. A common neurologic emergency, status epilepticus (SE) is a life‐threatening manifestation of epilepsy that demands prompt treatment to avoid death and long‐term sequelae. Therefore, we examined the rate of SE in a well‐defined Canadian Arctic region. Methods This study takes epidemiologic advantage of the Kivalliq Region's geographical isolation, which is accessible only by air. All SE patients requiring emergency care are consistently flown 1200‐1900 kilometers to a single designated hospital in a distinct southern part of Canada for further management and electroencephalography (EEG). We conducted a retrospective database and chart review at this “bottleneck” hospital to identify patients with seizure(s) severe enough to justify emergency airborne medical evacuation over a 11.25‐year period from 2009 to 2020. Results We screened 40 392 EEGs to yield 117 distinct medical evacuations for “operational SE” from 99 patients to derive estimated SE incidences of 99.9 evacuations per 100 000/year and 84.5 patients per 100 000/year. The average time from seizure onset to EEG was 3.2 days. Only 16.2% of SE patients had known epilepsy. For “confirmed SE” cases meeting ILAE criteria, or cases with persistently epileptiform EEG despite days of empiric treatment, estimated incidence was 77.7 evacuations per 100 000/year and 64.9 patients per 100 000/year. Significance High SE and epilepsy rates in the Canadian Arctic are consistent with LMIC rather than HIC. Our findings demonstrate the paradox of LMIC‐equivalent epilepsy populations camouflaged within HIC. Our findings also highlight the long‐standing plight of these under‐served and overlooked populations hidden in plain sight.Marcus C. NgMilena PavlovaWileyarticleepilepsyhealth care inequityNunavutseizuresunderserved populationNeurology. Diseases of the nervous systemRC346-429ENEpilepsia Open, Vol 6, Iss 4, Pp 703-713 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	epilepsy health care inequity Nunavut seizures underserved population Neurology. Diseases of the nervous system RC346-429
spellingShingle	epilepsy health care inequity Nunavut seizures underserved population Neurology. Diseases of the nervous system RC346-429 Marcus C. Ng Milena Pavlova Status epilepticus in the Canadian Arctic: A public health imperative hidden in plain sight
description	Abstract Objective The World Health Organization, International League Against Epilepsy (ILAE), and International Bureau for Epilepsy have called epilepsy a public health imperative, with appropriate emphasis on low‐to‐middle‐income countries (LMIC). Although Canada is a high‐income country (HIC), income is not distributed uniformly. Furthermore, epilepsy data from the national statistical agency explicitly overlook the Arctic by excluding these territories. A common neurologic emergency, status epilepticus (SE) is a life‐threatening manifestation of epilepsy that demands prompt treatment to avoid death and long‐term sequelae. Therefore, we examined the rate of SE in a well‐defined Canadian Arctic region. Methods This study takes epidemiologic advantage of the Kivalliq Region's geographical isolation, which is accessible only by air. All SE patients requiring emergency care are consistently flown 1200‐1900 kilometers to a single designated hospital in a distinct southern part of Canada for further management and electroencephalography (EEG). We conducted a retrospective database and chart review at this “bottleneck” hospital to identify patients with seizure(s) severe enough to justify emergency airborne medical evacuation over a 11.25‐year period from 2009 to 2020. Results We screened 40 392 EEGs to yield 117 distinct medical evacuations for “operational SE” from 99 patients to derive estimated SE incidences of 99.9 evacuations per 100 000/year and 84.5 patients per 100 000/year. The average time from seizure onset to EEG was 3.2 days. Only 16.2% of SE patients had known epilepsy. For “confirmed SE” cases meeting ILAE criteria, or cases with persistently epileptiform EEG despite days of empiric treatment, estimated incidence was 77.7 evacuations per 100 000/year and 64.9 patients per 100 000/year. Significance High SE and epilepsy rates in the Canadian Arctic are consistent with LMIC rather than HIC. Our findings demonstrate the paradox of LMIC‐equivalent epilepsy populations camouflaged within HIC. Our findings also highlight the long‐standing plight of these under‐served and overlooked populations hidden in plain sight.
format	article
author	Marcus C. Ng Milena Pavlova
author_facet	Marcus C. Ng Milena Pavlova
author_sort	Marcus C. Ng
title	Status epilepticus in the Canadian Arctic: A public health imperative hidden in plain sight
title_short	Status epilepticus in the Canadian Arctic: A public health imperative hidden in plain sight
title_full	Status epilepticus in the Canadian Arctic: A public health imperative hidden in plain sight
title_fullStr	Status epilepticus in the Canadian Arctic: A public health imperative hidden in plain sight
title_full_unstemmed	Status epilepticus in the Canadian Arctic: A public health imperative hidden in plain sight
title_sort	status epilepticus in the canadian arctic: a public health imperative hidden in plain sight
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/9f1e156b40194f31a3a039c9a12d3b11
work_keys_str_mv	AT marcuscng statusepilepticusinthecanadianarcticapublichealthimperativehiddeninplainsight AT milenapavlova statusepilepticusinthecanadianarcticapublichealthimperativehiddeninplainsight
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Status epilepticus in the Canadian Arctic: A public health imperative hidden in plain sight

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