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

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Presentation on theme: "Epilepsy in Thailand Dr.Yotin Chinvarun M.D. Ph.D. The Neurological Society of Thailand."— Presentation transcript:

1 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 Cambodia China Hong Kong India Indonesia Japan Korea Rep Lao Malaysia Mongolia Papua New Guinea Philippines Singapore Thailand Vietnam 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 World Bank, 2003

4 Epilepsy in Asia and Thailand Scale of the problem Epilepsy sufferers Worldwide50 million Asia30 million Thailand700,000 cases Refractory Epilepsy OverallAbout 20 – 30% Asiaup to 10 million Thailandup 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 CEPAdvance 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 NoYes No Yes NoYes NoYes NoYes Epilepsy clinic Yes

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

8 AEDs in Thailand Traditional AEDs Phenytoin Cabarmazepine Sodium valproate Phenobarbital Benzodiazepine Acetazolamide 2 nd 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 1 st 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) Female54% (282 cases) Age between 10-75 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 Normal38 Hippocampal sclerosis66 (35%) -(bilateral HS 6) Developmetal anomalies32 (17%) Dual pathology12 Tumor24 (13%) (Astocytoma 21, gangloglioma 7, DNET 2) Vascular abnormalities9 (Carvenoma 3, veneous angioma 1, AVM 5) Hippocampal atrophy only7 Focal atrophy6 Infraction3 Cystic lesion6 Calcified lesion 5 Hemiatrophy2 Others 18 Chinvarun 2005 Total MRI brain228 cases cases

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

16 Presurgical evaluations PMK hospital 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

17 Epilepsy surgery of refractory cases PMK hospital (June 2005) Temporal lobectomy60 cases Lesionectomy22 cases Hemispherectomy1 case Callosotomy3 cases Vagal nerve stimulation5 cases

18 Epilepsy surgery in Asia: A survey (2004) 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 YYYYYNYYYYNYYYYYNYYYYN YNNYYNYYYYNYNNYYNYYYYN 40 100 10 500 300 - 10 60 100 - 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) Countries Population (million) Epilepsy surgery program AvailablePediatric service Prevalence of pts requiring surgery No of case/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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