Epilepsia Open. 2021 Sep 12. doi: 10.1002/epi4.12538. Online ahead of print.
ABSTRACT
OBJECTIVE: The World Health Organization, International League Against Epilepsy (ILAE), and International Bureau for Epilepsy have called epilepsy a public health imperative, with appropriate emphasis on low-to-middle income countries (LMIC). Although Canada is a high-income country (HIC), income is not distributed uniformly. Furthermore, epilepsy data from the national statistical agency explicitly overlooks the Arctic by excluding these territories. A common neurologic emergency, status epilepticus (SE) is a life-threatening manifestation of epilepsy that demands prompt treatment to avoid death and long-term sequelae. Therefore, we examined the rate of SE in a well-defined Canadian Arctic region.
METHODS: This study takes epidemiologic advantage of the Kivalliq Region’s geographical isolation, which is accessible only by air. All SE patients requiring emergency care are consistently flown 1,200-1,900 kilometres to a single designated hospital in a distinct southern part of Canada for further management and electroencephalography (EEG). We conducted a retrospective database and chart review at this “bottleneck” hospital to identify patients with seizure(s) severe enough to justify emergency airborne medical evacuation over a 11.25 year period from 2009-2020.
RESULTS: We screened 40,392 EEGs to yield 117 distinct medical evacuations for “operational SE” from 99 patients to derive estimated SE incidences of 99.9 evacuations per 100,000/year, and 84.5 patients per 100,000/year. The average time from seizure onset to EEG was 3.2 days. Only 16.2% of SE patients had known epilepsy. For “confirmed SE” cases meeting ILAE criteria, or cases with persistently epileptiform EEG despite days of empiric treatment, estimated incidence was 77.7 evacuations per 100,000/year, and 64.9 patients per 100,000/year.
SIGNIFICANCE: High SE and epilepsy rates in the Canadian Arctic are consistent with LMIC rather than HIC. Our findings demonstrate the paradox of LMIC-equivalent epilepsy populations camouflaged within HIC. Our findings also highlight the longstanding plight of these under-served and overlooked populations hidden in plain sight.
PMID:34510825 | DOI:10.1002/epi4.12538
