COMPARATIVE EPIDEMIOLOGY OF EPILEPSY IN PAKISTAN AND TURKEY - POPULATION-BASED STUDIES USING IDENTICAL PROTOCOLS

Purpose: To determine comparative prevalence rates, demographics, phen omenology, seizure classification, presumptive etiology, treatment sta tus, and selected socioanthropological aspects of epilepsy in Pakistan and Turkey. Methods: A population-based, cross-cultural comparative s tudy of epilepsy was designed with identical protocols to be performed simultaneously in Pakistan and Turkey. The essential feature of the d esign was an unselected population, with reference to their previous m edical contact, and use of standardized International Community-Based Epilepsy Research Group (ICBERG) protocols to assess cross-cultural di fferences. Results: In all, 24,130 persons in Pakistan and 11,497 pers ons in Turkey (both urban and rural, of all ages and both sexes) were studied. The crude prevalence rate of epilepsy was 9.98 in 1,000 in Pa kistan and 7.0 in 1,000 in Turkey (14.8 in 1.000 in rural and 7.4 in 1 ,000 in urban areas of Pakistan; 8.8 in 1,000 in rural and 4.5 in 1,00 0 in urban areas of Turkey). In both countries, epilepsy was twice as prevalent in rural areas than in urban areas. Mean age of onset of epi lepsy was 13.3 years in Pakistan and 12.9 years in Turkey. Overall fre quency of seizure types was similar in both countries, with no urban/r ural differences. The frequency distribution in Pakistan and Turkey, r espectively, was as follows: generalized tonic-clonic, 80.5 and 65.4%; simple partial, 5 and 7.4%; complex partial, 5 and 12.3%; generalized absence, 0.8 and 4.9%; tonic and atonic, 5.8 and 3.7% each; and myocl onic, 5.8 and 1.2%. A putative cause for the epilepsy could be attribu ted in 38.4% of cases in Pakistan and 35.7% of cases in Turkey. Only 3 % of patients in Pakistan, but 71% of patients in Turkey, believed tha t their illness was due to supernatural causes. The treatment status w as very poor. In Pakistan, 27.5% of people with epilepsy in urban area s and 1.9% of people with epilepsy in rural areas were receiving antie pileptic drugs (AEDs) at the time of the survey. In, Turkey 30% of pat ients were receiving AEDs (marginally higher in rural areas). Conclusi ons: The prevalence of epilepsy is slightly higher in Pakistan than in Turkey; some marginal differences in age and sex distribution, are no t statistically significant. The results are comparable to those in Ec uador, where the same epidemiologic protocol was used.