Transcript Prevalence of Epilepsy in the Philippines

Prevalence of Epilepsy in the Philippines
• Population of 83 million and an estimated
prevalence of 0.9%
• an estimated 750,000 people with epilepsy in
the country
– majority in the productive years of their life (Chua
2007)
Chua, Annabelle. Epilepsy surgery in the Philippines Neurology Asia 2007; 12 (Supplement 2) : 43 – 45
WHO Western Pacific Region
2004 Key data on epilepsy: Epilepsy Professionals
Philippines
Malaysia
Singapore
Australia
Specialist
neurologists
Specialist
Neurologists
Specialist
neurologists
Specialist
Neurologists
Neurosurgeons
Neurosurgeons
Neuropediatricians
Neuropediatricians
Neurosurgeons
Neuropediatricians
Neuropsychologists
Neurophysiologists
Social workers
Social workers
Neurological nurses
Neurological nurses
World Health Organization. "Epilepsy in the Western Pacific Region: A call to action." Global Campaign Against Epilepsy, 2004.
WHO Western Pacific Region
2004 Key data on epilepsy: Epilepsy equipment, facilities, etc
Philippines
Malaysia
Singapore
Australia
•CT
• CT
• CT
• CAT
•MRI
• MRI
• MRI
• MRI
•EEG
• EEG
• EEG
• PET
•Therpeutic Drug
Monitoring
•Therpeutic Drug
Monitoring
• SPECT
• SPECT
•Long-term
video/EEG
monitoring
•Long-term
video/EEG
monitoring
•Long-term
video/EEG
monitoring
•Long-term
video/EEG
monitoring
•Epilepsy surgery
•Epilepsy surgery
•Epilepsy surgery
•Neuropsychological
services
•Neuropsychological
services
•Neuropsychological
services
•Psychiatric
counseling
•Psychiatric
counseling
•Psychiatric
counseling
•Epilepsy surgery
including
intracranial
electrophysiology
•Special education
World Health Organization. "Epilepsy in the Western Pacific Region: A call to action." Global Campaign Against Epilepsy, 2004.
WHO Western Pacific Region
2004 Key data on epilepsy: Major causes of seizures
Philippines
Malaysia
Singapore
Australia
• Cerebrovascular
accidents
• Idiopathic
• Post-traumatic
• Hippocampal
sclerosis
•CNS infection (TB
meningitis, bacterial
meningitis)
• Post-traumatic
• Postcerebrovascular
accident
• Post-traumatic
•Head Injury
• Birth related
injury/insult
• CNS infections
• Stroke
•Brain tumors
• Hippocampal
sclerosis
• Mesial temporal
sclerosis
• Perinatal injury
•Perinatal
insults/injuries
• Brain infection
• Tumors
• Idiopathic
World Health Organization. "Epilepsy in the Western Pacific Region: A call to action." Global Campaign Against Epilepsy, 2004.
WHO Western Pacific Region
2004 Key data on epilepsy: Available AEDs and cost
Philippines
Malaysia
Singapore
•Phenobarbital, Php1.75
($0.03)
Australia
• Acetazolamide
• Phenytoin,Php18.00
($0.32)
• Phenytoin, 4¢ per 100mg
($0.11)
• Phenytoin, 9 ¢ per 100mg
($0.53)
• Clozabam, Diazepam
• Carbamazepine, Php16.00
($0.29)
• Carbamazepine, 20¢ per
200mg ($0.05)
• Carbamazepine, 9¢ per
200mg ($0.53)
• Ethosuximide
• Valproate, Php18.00
($0.32)
• Valproate, 20¢ per 200mg
($0.05)
• Valproate 24¢ per 200mg
($0.14)
• Gabapentin
• Lamotrigine, Php27.00
($0.49)
• Lamotrigine, RM2.52 ($0.66)
•Also available: gabapentin,
topiramate, clonazepam,
diazepam
• Topimarate, RM 2.86 per
50mg
•Gabapentin, RM 2.37 per
300mg
• Phenobarbitone, 2¢ per 30mg
• Clonazepam (22 per 0.5/24¢
prt mg)
• Often price of consultation
includes medication and
investigations
• Lamotrigine
• Phenobarbiton, 3¢ per
30mg
• Diazepam 3¢ per 5mg
• Levitiracetam, Ocarbazepine,
Levitiracam, Nitrazepam,
Oxcarbazepine,
phenobarbitone, phenytoin,
primidone, sulthiame,
tiagabine, topimarate,
valproate, vigabatrin
•Subsidized under a national
Pharmaceutical Benefits
Scheme (PBS) which limits
the cost to AU$ 23 per
month’s supply
World Health Organization. "Epilepsy in the Western Pacific Region: A call to action." Global Campaign Against Epilepsy, 2004.
Awareness and understanding of epilepsy among patients,
families, caregivers and health workers
• Awareness
– 32% of patients and caregivers and 11% of health
workers have not heard or read any information
about epilepsy
• Etiology
– 17% of health workers and 4% of patients and
caregivers believe that epilepsy is contagious and
can be transmitted by either marrying, caring for
or living with a person with epilepsy or even by
witnessing an epileptic attack
Salonga, A.M. et al. 1999, Epilepsy Education Program: It’s Role In the Comprehensive Management of Children with Epilepsy”
Awareness and understanding of epilepsy among patients,
families, caregivers and health workers
• Treatment
– more parents and caregivers (86%) believe
epilepsy can be cured with medications than
health workers (68%)
– 54-72% believe epilepsy can be cured with prayer
Salonga, A.M. et al. 1999, Epilepsy Education Program: It’s Role In the Comprehensive Management of Children with Epilepsy”
Awareness and understanding of epilepsy among patients,
families, caregivers and health workers
• What to do during an attack
– about half of all the respondents will insert a
spoon into the mouth
– 1/3-2/3 will fan the patient
– 1/3-2/3 will do nothing and wait
– A smaller percentage will massage the patient,
blow air on the face, put pressure on the stomach
or even bite the patient.
Salonga, A.M. et al. 1999, Epilepsy Education Program: It’s Role In the Comprehensive Management of Children with Epilepsy”
Public Attitude and Awareness Towards Epilepsy
A Public Pulse in a Tertiary Hospital
• Awareness
– 94.84% have heard or
heard about epilepsy
– 44.52% knows someone
w/ epilepsy
– 69.68% had seen an
epileptic attack
• Understanding epilepsy
– 10.32% did not know
what epilepsy was
– 3.87% did not know
what an epileptic attack
looks like
Piano, Anthony and Joanne Robles. "Public Attitude and Awareness Towards Epilepsy: A Public Pulse in a Tertiary Hospital ." (2008).
Public Attitude and Awareness Towards Epilepsy
A Public Pulse in a Tertiary Hospital
• Attitude
– 83.87% did not have any objections in having their
children interact w/ persons w/ epilepsy
– 31.61% would object to having their children
marry someone w/ seizures
– 76.77% believed that people w/ epilepsy should
be employed
– 8.39% believed that epilepsy is a form of insanity
Piano, Anthony and Joanne Robles. "Public Attitude and Awareness Towards Epilepsy: A Public Pulse in a Tertiary Hospital ." (2008).
Is Epilepsy a Burden?
• Economic
– Medical care is mostly shouldered out-of-pocket
– Cost
• Phenytoin 100mg/cap TID
– P26/tab x 3 = P78/day
• Levetiracetam 500mg/tab BID
– P45/tab x 2 = P90/day
Patient’s Perception Towards Epilepsy
• Personal reaction to having epilepsy
– fear
– worry
– uncertainty
– anger,
– confusion
– self-pity
– neutrality
– heightened emotionality
Cabral-Lim, Leonor. Epilepsy in the Philippines. September 28, 2001. http://www.plae.org.ph/web/epilepsy_information4.php.
Patient’s Perception Towards Epilepsy
• Difficulties encountered
– taunting and irritability from others
– difficulty in accomplishing tasks
– feeling of being abandoned by family members
– inability to pursue work and other activities
– feeling of being a burden to family
Patient’s Perception Towards Epilepsy
• Reaction from others
–
–
–
–
being overprotective and restrictive
making fun of the person and labeling person as crazy
distancing and fear
majority of parents would not want their normal children nor
themselves to marry a person with epilepsy
Cabral-Lim, Leonor. Epilepsy in the Philippines. September 28, 2001. http://www.plae.org.ph/web/epilepsy_information4.php.
Addressing the issues
• Financing and budget
– Increase health budget
– Reduce OOP and increase health insurance
coverage
• Primary Prevention
– Social
• Increase awareness
• Address social stigma
Philippine League Against Epilepsy
Awareness Campaigns
http://www.plae.org.ph/web/plae_archives.php
Philippine League Against Epilepsy
Awareness Campaigns
• Television Advertisement
– "Tsismis" (Gossip)
• Radio Advertisment
– " Romy”
• Raymonde please embed attached wav file
http://www.plae.org.ph/web/plae_archives.php