Transcript Epilepsy in Thailand

Epilepsy in Thailand
Dr.Yotin Chinvarun M.D. Ph.D.
The Neurological Society of
Thailand
Diversity of the Asia-Pacific Region
Population and Economical Development
Cambodia
China
Hong Kong
India
Indonesia
Japan
Korea Rep
Lao
Malaysia
Mongolia
Papua New Guinea
Philippines
Singapore
Thailand
Vietnam
World Bank, 2003
Population
(millions)
12
1,272
7
1,027
209
126
47
5
24
2
5
78
3
61
80
Gross National Income
per capita (US$)
310
1100
25,430
530
810
34,510
12,030
320
3,780
480
510
1,080
21,230
2,190
480
Epilepsy in Asia and Thailand
Scale of the problem


Epilepsy sufferers
•
•
•
Worldwide 50 million
Asia
30 million
Thailand
700,000 cases
Refractory Epilepsy
•
•
•
Overall
A
Asia
Thailand
bout 20 – 30%
up to 10 million
up to 30,000 cases
Epilepsy Program in Thailand



Thailand Epilepsy Society (since 1995)
•
One chapter in the ILAE
Comprehensive epilepsy program
•
•
Basic CEP: 5 centers
Advance CEP: 2 centers
Epilepsy fellowship program
•
Two training centers
CEP in Thailand
Basic CEP
Epilepsy clinic
Advance CEP
Yes
Yes
Yes
Yes
Yes
No
No
No
Yes
Yes
Yes
Yes
No
Yes
No
No
No
Yes
Yes
Yes
Non invasive tests
Routine EEG
24 hrs video-EEG monitoring
MRI brain
Ictal and interictal SPECT
PET
Neuropsychological testing
Invasive tests
Intracranial monitoring
ECoG
EEG monitoring 64, 128 channels
CEP in Thailand
Basic CEP
Advance CEP
Epilepsy surgery
No
No
No
No
No
Yes
Yes
Yes
Yes
No
Vagal nerve stimulation
No
Yes
Ketogenic diet
No
Yes
Temporal lobectomy
Extratemporal lobe surgery
Corpus callosotomy
Hemispherectomy
Subpial resection
AEDs in Thailand

Traditional AEDs
• Phenytoin
• Cabarmazepine
• Sodium valproate
• Phenobarbital
• Benzodiazepine
• Acetazolamide

2nd line AEDs
• Lamotrigine
• Oxcarbazepine
• Vigabatrin
• Gabapentin
• Topiramate
• Levetiracetam
• Zonisamide
• Pregabalin
Pramongkutklao Comprehensive epilepsy program

Secondary/Tertiary hospital, Bangkok

CEP program created since 2001

Epilepsy and 1st seizure clinic
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Presurgical evaluations both basic and advance tests

Epilepsy fellowship training program (2 yrs training)
Refractory epilepsy in PMK hospital
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
523 cases with epilepsy from Jan 2001-June 2005
•
•
•
Male 46% (241 cases)
Female 54% (282 cases)
Age between 10-75 years old (mean 31 years)
3,220 visited within Jan 2001-June 2005
Seizure diagnosis

Epileptic seizures (507 cases)
•
•

Generalized seizures 33 cases (IGE 4, JME 10, JAE 1, ?
Primary or secondary generalized seizures 18)
Partial seizures 474 cases (93%)
Non epileptic seizure 16 cases (3%)- e.g. NPSE,
Syncope etc.
Monotherapy vs Polytherapy

46% (235 cases) – Monotherapy

54 % (272 cases) - Polytherapy
Refractory cases

250 cases (49%) are refractory cases
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•
243 cases- localization related epilepsy
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•
•
•
•
TLE 72 cases
FLE 17 cases
PLE 4 cases
OLE 2 cases
Unidentified lobe 148 cases
198 cases (79%) on duotherapy or polytherapy
MRI brain
Total MRI brain
228 cases
cases
Normal
Hippocampal sclerosis
Developmetal anomalies
Dual pathology
Tumor
Vascular abnormalities
Hippocampal atrophy only
Focal atrophy
Infraction
Cystic lesion
Calcified lesion
Hemiatrophy
Others
Chinvarun 2005
38
66 (35%) -(bilateral HS 6)
32 (17%)
12
24 (13%) (Astocytoma 21, gangloglioma 7, DNET 2)
9 (Carvenoma 3, veneous angioma 1, AVM 5)
7
6
3
6
5
2
18
MRI brain: Etiology
35%
70
N=228 cases
60
50
40
17%
13%
30
20
10
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Chinvarun 2005
Presurgical evaluations
PMK hospital



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24 hrs video-EEG monitoring 40-60 cases/years
Interictal and ictal SPECT
Neuropsychological test (WAIS-R test, WADA test)
•
WADA test
•
•
Amobarbital WADA - 55 cases
Propofol WADA - 6 cases
Intracranial monitoring
•
•
EcoG
Intracranial plate, grid, EEG with 64/128 channel
Epilepsy surgery of refractory cases
PMK hospital (June 2005)

Temporal lobectomy
60 cases

Lesionectomy
22 cases

Hemispherectomy
1 case

Callosotomy
3 cases

Vagal nerve stimulation
5 cases
Epilepsy surgery in Asia: A survey (2004)
Countries
Hong Kong
India
Indonesia
Japan
Korea
Mongolia
Philippines
Singapore
Taiwan
Thailand
Vietnam
Population
(million)
6.8
1,000.0
210.0
120.0
47.0
2.5
82.0
4.2
23.0
67.0
80.0
Epilepsy surgery program
Available
Y
Y
Y
Y
Y
N
Y
Y
Y
Y
N
Pediatric service
Y
N
N
Y
Y
N
Y
Y
Y
Y
N
No of case/yr
40
100
10
500
300
10
10
60
100
-
Prevalence of pts
requiring surgery
4,600 (270/yr)
68,000 (40,000/yr
14,000 (8,400/yr)
8,200 (4,800/yr)
3,200 (1,880/yr)
170 (100/yr)
5,500 (3,200/yr)
300 (170/yr)
1,500 (920/yr)
4,500 (2,180/yr)
5,400 (3,200/yr)
Current status of management in Thailand

A limited of antiepileptic drugs available in the rural area

Surgery is severely underutilized

Lack of expertise personnel and equipment

Only a few basic epilepsy surgery centers
Plan to improve epilepsy management in Thailand

Epilepsy training program / Research

Developing guideline for management of epilepsy

Public education program