Epilepsy - WHO | World Health Organization

文章推薦指數: 80 %
投票人數:10人

Epilepsy is defined as having two or more unprovoked seizures. Epilepsy is one of the world's oldest recognized conditions, with written records ... Home/ Newsroom/ Factsheets/ Detail/ Epilepsy IBE/AmirGhaiyoumi Epilepsyaccountsforasignificantproportionoftheworld’sdiseaseburden,affectingaround50millionpeopleworldwide. © Credits Epilepsy 9February2022 Keyfacts Epilepsyisachronicnoncommunicablediseaseofthebrainthataffectspeopleofallages. Around50millionpeopleworldwidehaveepilepsy,makingitoneofthemostcommonneurologicaldiseasesglobally. Nearly80%ofpeoplewithepilepsyliveinlow-andmiddle-incomecountries. Itisestimatedthatupto70%ofpeoplelivingwithepilepsycouldliveseizure-freeifproperlydiagnosedandtreated. Theriskofprematuredeathinpeoplewithepilepsyisuptothreetimeshigherthanforthegeneralpopulation. Threequartersofpeoplewithepilepsylivinginlow-incomecountriesdonotgetthetreatmenttheyneed. Inmanypartsoftheworld,peoplewithepilepsyandtheirfamiliessufferfromstigmaanddiscrimination. Epilepsyisachronicnoncommunicablediseaseofthebrainthataffectsaround50millionpeopleworldwide.Itischaracterizedbyrecurrentseizures,whicharebriefepisodesofinvoluntarymovementthatmayinvolveapartofthebody(partial)ortheentirebody(generalized)andaresometimesaccompaniedbylossofconsciousnessandcontrolofbowelorbladderfunction.Seizureepisodesarearesultofexcessiveelectricaldischargesinagroupofbraincells.Differentpartsofthebraincanbethesiteofsuchdischarges.Seizurescanvaryfromthebriefestlapsesofattentionormusclejerkstosevereandprolongedconvulsions.Seizurescanalsovaryinfrequency,fromlessthanoneperyeartoseveralperday.Oneseizuredoesnotsignifyepilepsy(upto10%ofpeopleworldwidehaveoneseizureduringtheirlifetime).Epilepsyisdefinedashavingtwoormoreunprovokedseizures.Epilepsyisoneoftheworld’soldestrecognizedconditions,withwrittenrecordsdatingbackto4000BCE.Fear,misunderstanding,discriminationandsocialstigmahavesurroundedepilepsyforcenturies.Thisstigmacontinuesinmanycountriestodayandcanimpactonthequalityoflifeforpeoplewiththediseaseandtheirfamilies.SignsandsymptomsCharacteristicsofseizuresvaryanddependonwhereinthebrainthedisturbancefirststarts,andhowfaritspreads.Temporarysymptomsoccur,suchaslossofawarenessorconsciousness,anddisturbancesofmovement,sensation(includingvision,hearingandtaste),mood,orothercognitivefunctions.Peoplewithepilepsytendtohavemorephysicalproblems(suchasfracturesandbruisingfrominjuriesrelatedtoseizures),aswellashigherratesofpsychologicalconditions,includinganxietyanddepression.Similarly,theriskofprematuredeathinpeoplewithepilepsyisuptothreetimeshigherthaninthegeneralpopulation,withthehighestratesofprematuremortalityfoundinlow-andmiddle-incomecountriesandinruralareas.Agreatproportionofthecausesofdeathrelatedtoepilepsy,especiallyinlow-andmiddle-incomecountries,arepotentiallypreventable,suchasfalls,drowning,burnsandprolongedseizures.RatesofdiseaseEpilepsyaccountsforasignificantproportionoftheworld’sdiseaseburden,affectingaround50millionpeopleworldwide.Theestimatedproportionofthegeneralpopulationwithactiveepilepsy(i.e.continuingseizuresorwiththeneedfortreatment)atagiventimeisbetween4and10per1000people.Globally,anestimated5millionpeoplearediagnosedwithepilepsyeachyear.Inhigh-incomecountries,thereareestimatedtobe49per100000peoplediagnosedwithepilepsyeachyear.Inlow-andmiddle-incomecountries,thisfigurecanbeashighas139per100000.Thisislikelyduetotheincreasedriskofendemicconditionssuchasmalariaorneurocysticercosis;thehigherincidenceofroadtrafficinjuries;birth-relatedinjuries;andvariationsinmedicalinfrastructure,theavailabilityofpreventivehealthprogrammesandaccessiblecare.Closeto80%ofpeoplewithepilepsyliveinlow-andmiddle-incomecountries.CausesEpilepsyisnotcontagious.Althoughmanyunderlyingdiseasemechanismscanleadtoepilepsy,thecauseofthediseaseisstillunknowninabout50%ofcasesglobally.Thecausesofepilepsyaredividedintothefollowingcategories:structural,genetic,infectious,metabolic,immuneandunknown.Examplesinclude:braindamagefromprenatalorperinatalcauses(e.g.alossofoxygenortraumaduringbirth,lowbirthweight);congenitalabnormalitiesorgeneticconditionswithassociatedbrainmalformations;asevereheadinjury;astrokethatrestrictstheamountofoxygentothebrain;aninfectionofthebrainsuchasmeningitis,encephalitisorneurocysticercosis,certaingeneticsyndromes;andabraintumour.TreatmentSeizurescanbecontrolled.Upto70%ofpeoplelivingwithepilepsycouldbecomeseizurefreewithappropriateuseofantiseizuremedicines.Discontinuinganti-seizuremedicinecanbeconsideredafter2yearswithoutseizuresandshouldtakeintoaccountrelevantclinical,socialandpersonalfactors.Adocumentedetiologyoftheseizureandanabnormalelectroencephalography(EEG)patternarethetwomostconsistentpredictorsofseizurerecurrence.Inlow-incomecountries,aboutthreequartersofpeoplewithepilepsymaynotreceivethetreatmenttheyneed.Thisiscalledthe“treatmentgap”.Inmanylow-andmiddle-incomecountries,thereislowavailabilityofantiseizuremedication.Arecentstudyfoundtheaverageavailabilityofgenericantiseizuremedicinesinthepublicsectoroflow-andmiddle-incomecountriestobelessthan50%.Thismayactasabarriertoaccessingtreatment.Itispossibletodiagnoseandtreatmostpeoplewithepilepsyattheprimaryhealth-carelevelwithouttheuseofsophisticatedequipment.WHOpilotprojectshaveindicatedthattrainingprimaryhealth-careproviderstodiagnoseandtreatepilepsycaneffectivelyreducetheepilepsytreatmentgap.Surgerymightbebeneficialtopatientswhorespondpoorlytodrugtreatments.PreventionAnestimated25%ofepilepsycasesarepreventable.Preventingheadinjuryisthemosteffectivewaytopreventpost-traumaticepilepsy.Adequateperinatalcarecanreducenewcasesofepilepsycausedbybirthinjury.Theuseofdrugsandothermethodstolowerthebodytemperatureofafeverishchildcanreducethechanceoffebrileseizures.Thepreventionofepilepsyassociatedwithstrokeisfocusedoncardiovascularriskfactorreduction,e.g.measurestopreventorcontrolhighbloodpressure,diabetesandobesity,andtheavoidanceoftobaccoandexcessivealcoholuse.Centralnervoussysteminfectionsarecommoncausesofepilepsyintropicalareas,wheremanylow-andmiddle-incomecountriesareconcentrated.Eliminationofparasitesintheseenvironmentsandeducationonhowtoavoidinfectionscanbeeffectivewaystoreduceepilepsyworldwide,forexamplethosecasesduetoneurocysticercosis.SocialandeconomicimpactsEpilepsyaccountsformorethan0.5%oftheglobalburdenofdisease,atime-basedmeasurethatcombinesyearsoflifelostduetoprematuremortalityandtimelivedinlessthanfullhealth.Epilepsyhassignificanteconomicimplicationsintermsofhealth-careneeds,prematuredeathandlostworkproductivity.Theeconomicimpactofepilepsyvariessignificantlydependingonthedurationandseverityofthecondition,responsetotreatment,andthehealth-caresetting.Out-of-pocketcostsandproductivitylossescreatesubstantialburdensonhouseholds.AneconomicstudyfromIndiaestimatedthatpublicfinancingforbothfirst-andsecond-linetherapyandothermedicalcostsalleviatesthefinancialburdenfromepilepsyandiscost-effective.Althoughthesocialeffectsvaryfromcountrytocountry,thestigmaanddiscriminationthatsurroundepilepsyworldwideareoftenmoredifficulttoovercomethantheseizuresthemselves.Peoplelivingwithepilepsycanbetargetsofprejudice.Thestigmaofthediseasecandiscouragepeoplefromseekingtreatment,toavoidbecomingidentifiedwiththedisease.HumanrightsPeoplewithepilepsycanexperiencereducedaccesstoeducationalopportunities,awithholdingoftheopportunitytoobtainadrivinglicence,barrierstoenterparticularoccupations,andreducedaccesstohealthandlifeinsurance.Inmanycountrieslegislationreflectscenturiesofmisunderstandingaboutepilepsy,forexample,lawswhich permittheannulmentofamarriageonthegroundsofepilepsyandlawsthatdenypeoplewithseizuresaccesstorestaurants,theatres,recreationalcentresandotherpublicbuildings.Legislationbasedoninternationally-acceptedhumanrightsstandardscanpreventdiscriminationandrightsviolations,improveaccesstohealth-careservices,andraisethequalityoflifeforpeoplewithepilepsy.WHOresponseWHOanditspartnersrecognizethatepilepsyisamajorpublichealthconcern.WHO,theInternationalLeagueAgainstEpilepsy(ILAE)andtheInternationalBureauforEpilepsy(IBE)ledtheGlobalCampaignAgainstEpilepsytobringthedisease“outoftheshadows”toprovidebetterinformationandraiseawarenessaboutepilepsyandtostrengthenpublicandprivateeffortstoimprovecareandreducethedisease’simpact.Theseeffortshavecontributedtotheprioritizationofepilepsyinmanycountries,whichresultedinregionaldeclarationsinall6WHOregions.TheWHORegionoftheAmericasendorsedtheStrategyandPlanofActiononepilepsyin2011andtheWorldHealthAssembly(WHA)resolutionontheglobalburdenofepilepsy(WHA68.20)wasapprovedin2015.TheResolutionurgesMemberStatestotakecoordinatedactionagainstepilepsyanditsconsequences.Projectshavebeencarriedoutinmanycountriestoreducethetreatmentgapandmorbidityofpeoplewithepilepsy,totrainandeducatehealthprofessionals,todispelstigma,toidentifypotentialpreventionstrategies,andtodevelopmodelsintegratingepilepsycareintolocalhealthsystems.Combiningseveralinnovativestrategies,theseprojectshaveshownthattherearesimple,cost-effectivewaystotreatepilepsyinlow-resourcesettings.TheWHOProgrammeonreducingtheepilepsytreatmentgapandthementalhealthGapActionProgramme(mhGAP)achievedthesegoalsinGhana,Mozambique,MyanmarandVietNam.Theseprojectsfocusedonexpandingtheskillsofprimarycareandnonspecialisthealthprovidersatthecommunityleveltodiagnose,treatandfollowuppeoplewithepilepsy. These4pilotprogrammeshaveledtoaconsiderableincreaseinaccess,suchthat6.5millionmorepeoplehaveaccesstotreatmentforepilepsyshouldtheyneedit. Related MoreinformationonepilepsyWHOglobalreportonepilepsyNeurologyAtlas2017Brainhealth FeaturesPilotstudieshelpclosetheepilepsytreatmentgapThefightagainstepilepsyinGhanaScalingupepilepsycareinMyanmar WHOvideo:Epilepsy,Treatit,Defeatit Factsheets Mentaldisorders 8June2022



請為這篇文章評分?