Epilepsy in Cambodia-treatment aspects and policy implications: a population-based representative survey.

<h4>Introduction</h4>We tested two treatment strategies to determine: treatment (a) prognosis (seizure frequency, mortality, suicide, and complications), (b) safety and adherence of treatment, (c) self-reported satisfaction with treatment and self-reported productivity, and policy aspect...

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Autores principales:	Devender Bhalla, Kimly Chea, Chamroeun Hun, Vichea Chan, Pierre Huc, Samleng Chan, Robert Sebbag, Daniel Gérard, Michel Dumas, Sophal Oum, Michel Druet-Cabanac, Pierre-Marie Preux
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/bd26237a53684e139ab18e1b5af7cef1
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spelling	oai:doaj.org-article:bd26237a53684e139ab18e1b5af7cef12021-11-18T08:56:36ZEpilepsy in Cambodia-treatment aspects and policy implications: a population-based representative survey.1932-620310.1371/journal.pone.0074817https://doaj.org/article/bd26237a53684e139ab18e1b5af7cef12013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24040345/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Introduction</h4>We tested two treatment strategies to determine: treatment (a) prognosis (seizure frequency, mortality, suicide, and complications), (b) safety and adherence of treatment, (c) self-reported satisfaction with treatment and self-reported productivity, and policy aspects (a) number of required tablets for universal treatment (NRT), (b) cost of management, (c) manpower-gap and requirements for scaling-up of epilepsy care.<h4>Methods</h4>We performed a random-cluster survey (N = 16510) and identified 96 cases (≥1 year of age) in 24 villages. They were screened by using a validated instrument and diagnosed by the neurologists. International guidelines were used for defining and classifying epilepsy. All were given phenobarbital or valproate (cost-free) in two manners patient's door-steps (March 2009-March 2010, primary-treatment-period, PTP) and treatment through health-centers (March 2010-June 2011, treatment-continuation-period, TCP). The emphasis was to start on a minimum dosage and regime, without any polytherapy, according to the age of the recipients. No titration was done. Seizure-frequency was monthly and self-reported.<h4>Results</h4>The number of seizures reduced from 12.6 (pre-treatment) to 1.2 (end of PTP), following which there was an increase to 3.4 (end of TCP). Between start of PTP and end of TCP, >60.0% became and remained seizure-free. During TCP, ∼26.0% went to health centers to collect their treatment. Complications reduced from 12.5% to 4.2% between start and end of PTP and increased to 17.2% between start and end of TCP. Adverse events reduced from 46.8% to 16.6% between start and end of PTP. Nearly 33 million phenobarbital 100 mg tablets are needed in Cambodia.<h4>Conclusions</h4>Epilepsy responded sufficiently well to the conventional treatment, even when taken at a minimal dosage and a simple daily regimen, without any polytherapy. This is yet another confirmation that it is possible to substantially reduce direct burden of epilepsy through means that are currently available to us.Devender BhallaKimly CheaChamroeun HunVichea ChanPierre HucSamleng ChanRobert SebbagDaniel GérardMichel DumasSophal OumMichel Druet-CabanacPierre-Marie PreuxPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 9, p e74817 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Devender Bhalla Kimly Chea Chamroeun Hun Vichea Chan Pierre Huc Samleng Chan Robert Sebbag Daniel Gérard Michel Dumas Sophal Oum Michel Druet-Cabanac Pierre-Marie Preux Epilepsy in Cambodia-treatment aspects and policy implications: a population-based representative survey.
description	<h4>Introduction</h4>We tested two treatment strategies to determine: treatment (a) prognosis (seizure frequency, mortality, suicide, and complications), (b) safety and adherence of treatment, (c) self-reported satisfaction with treatment and self-reported productivity, and policy aspects (a) number of required tablets for universal treatment (NRT), (b) cost of management, (c) manpower-gap and requirements for scaling-up of epilepsy care.<h4>Methods</h4>We performed a random-cluster survey (N = 16510) and identified 96 cases (≥1 year of age) in 24 villages. They were screened by using a validated instrument and diagnosed by the neurologists. International guidelines were used for defining and classifying epilepsy. All were given phenobarbital or valproate (cost-free) in two manners patient's door-steps (March 2009-March 2010, primary-treatment-period, PTP) and treatment through health-centers (March 2010-June 2011, treatment-continuation-period, TCP). The emphasis was to start on a minimum dosage and regime, without any polytherapy, according to the age of the recipients. No titration was done. Seizure-frequency was monthly and self-reported.<h4>Results</h4>The number of seizures reduced from 12.6 (pre-treatment) to 1.2 (end of PTP), following which there was an increase to 3.4 (end of TCP). Between start of PTP and end of TCP, >60.0% became and remained seizure-free. During TCP, ∼26.0% went to health centers to collect their treatment. Complications reduced from 12.5% to 4.2% between start and end of PTP and increased to 17.2% between start and end of TCP. Adverse events reduced from 46.8% to 16.6% between start and end of PTP. Nearly 33 million phenobarbital 100 mg tablets are needed in Cambodia.<h4>Conclusions</h4>Epilepsy responded sufficiently well to the conventional treatment, even when taken at a minimal dosage and a simple daily regimen, without any polytherapy. This is yet another confirmation that it is possible to substantially reduce direct burden of epilepsy through means that are currently available to us.
format	article
author	Devender Bhalla Kimly Chea Chamroeun Hun Vichea Chan Pierre Huc Samleng Chan Robert Sebbag Daniel Gérard Michel Dumas Sophal Oum Michel Druet-Cabanac Pierre-Marie Preux
author_facet	Devender Bhalla Kimly Chea Chamroeun Hun Vichea Chan Pierre Huc Samleng Chan Robert Sebbag Daniel Gérard Michel Dumas Sophal Oum Michel Druet-Cabanac Pierre-Marie Preux
author_sort	Devender Bhalla
title	Epilepsy in Cambodia-treatment aspects and policy implications: a population-based representative survey.
title_short	Epilepsy in Cambodia-treatment aspects and policy implications: a population-based representative survey.
title_full	Epilepsy in Cambodia-treatment aspects and policy implications: a population-based representative survey.
title_fullStr	Epilepsy in Cambodia-treatment aspects and policy implications: a population-based representative survey.
title_full_unstemmed	Epilepsy in Cambodia-treatment aspects and policy implications: a population-based representative survey.
title_sort	epilepsy in cambodia-treatment aspects and policy implications: a population-based representative survey.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/bd26237a53684e139ab18e1b5af7cef1
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Epilepsy in Cambodia-treatment aspects and policy implications: a population-based representative survey.

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