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Dr.Yotin Chinvarun M.D. Ph.D. The Neurological Society of Thailand

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1 Dr.Yotin Chinvarun M.D. Ph.D. The Neurological Society of Thailand
Epilepsy in Thailand Dr.Yotin Chinvarun M.D. Ph.D. The Neurological Society of Thailand

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3 Diversity of the Asia-Pacific Region Population and Economical Development
(millions) 12 1,272 7 1,027 209 126 47 5 24 2 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 Cambodia China Hong Kong India Indonesia Japan Korea Rep Lao Malaysia Mongolia Papua New Guinea Philippines Singapore Thailand Vietnam World Bank, 2003

4 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 bout 20 – 30% Asia up to 10 million Thailand up to 30,000 cases

5 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

6 CEP in Thailand Basic CEP Advance CEP 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 Yes No Epilepsy clinic

7 CEP in Thailand Basic CEP Advance CEP Epilepsy surgery
Temporal lobectomy Extratemporal lobe surgery Corpus callosotomy Hemispherectomy Subpial resection Vagal nerve stimulation Ketogenic diet No Yes

8 AEDs in Thailand Traditional AEDs Phenytoin Cabarmazepine
Sodium valproate Phenobarbital Benzodiazepine Acetazolamide 2nd line AEDs Lamotrigine Oxcarbazepine Vigabatrin Gabapentin Topiramate Levetiracetam Zonisamide Pregabalin

9 Pramongkutklao Comprehensive epilepsy program
Secondary/Tertiary hospital, Bangkok CEP program created since 2001 Epilepsy and 1st seizure clinic Presurgical evaluations both basic and advance tests Epilepsy fellowship training program (2 yrs training)

10 Refractory epilepsy in PMK hospital
523 cases with epilepsy from Jan 2001-June 2005 Male 46% (241 cases) Female 54% (282 cases) Age between years old (mean 31 years) 3,220 visited within Jan 2001-June 2005

11 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.

12 Monotherapy vs Polytherapy
46% (235 cases) – Monotherapy 54 % (272 cases) - Polytherapy

13 Refractory cases 250 cases (49%) are refractory cases
243 cases- localization related epilepsy TLE 72 cases FLE 17 cases PLE 4 cases OLE 2 cases Unidentified lobe 148 cases 198 cases (79%) on duotherapy or polytherapy

14 MRI brain Total MRI brain 228 cases cases Normal 38
Hippocampal sclerosis 66 (35%) -(bilateral HS 6) Developmetal anomalies 32 (17%) Dual pathology 12 Tumor 24 (13%) (Astocytoma 21, gangloglioma 7, DNET 2) Vascular abnormalities 9 (Carvenoma 3, veneous angioma 1, AVM 5) Hippocampal atrophy only 7 Focal atrophy 6 Infraction 3 Cystic lesion 6 Calcified lesion 5 Hemiatrophy 2 Others Chinvarun 2005

15 MRI brain: Etiology 35% N=228 cases 17% 13% Chinvarun 2005

16 Presurgical evaluations PMK hospital
24 hrs video-EEG monitoring 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

17 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

18 Epilepsy surgery in Asia: A survey (2004)
Population (million) Epilepsy surgery program Countries Prevalence of pts requiring surgery Available Pediatric service No of case/yr Hong Kong India Indonesia Japan Korea Mongolia Philippines Singapore Taiwan Thailand Vietnam 6.8 1,000.0 210.0 120.0 47.0 2.5 82.0 4.2 23.0 67.0 80.0 Y N Y N 40 100 10 500 300 - 60 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)

19 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

20 Plan to improve epilepsy management in Thailand
Epilepsy training program / Research Developing guideline for management of epilepsy Public education program


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