prevalence of epilepsy in the philippines population of 83 million and an estimated prevalence of...

Prevalence of Epilepsy in the Philippines

• Population of 83 million and an estimated prevalence of 0.9%

• an estimated 750,000 people with epilepsy in the country– majority in the productive years of their life (Chua

2007)

Chua, Annabelle. Epilepsy surgery in the Philippines Neurology Asia 2007; 12 (Supplement 2) : 43 – 45

WHO Western Pacific Region 2004 Key data on epilepsy: Epilepsy Professionals

Philippines Malaysia Singapore Australia

Specialist neurologists

Specialist Neurologists

Specialist neurologists

Specialist Neurologists

Neurosurgeons Neurosurgeons Neurosurgeons

Neuropediatricians Neuropediatricians Neuropediatricians Neuropsychologists

Neurophysiologists

Social workers Social workers

Neurological nurses Neurological nurses

World Health Organization. "Epilepsy in the Western Pacific Region: A call to action." Global Campaign Against Epilepsy, 2004.

WHO Western Pacific Region 2004 Key data on epilepsy: Epilepsy equipment, facilities, etc


•CT • CT • CT • CAT

•MRI • MRI • MRI • MRI

•EEG • EEG • EEG • PET

•Therpeutic Drug Monitoring

•Therpeutic Drug Monitoring

• SPECT • SPECT

•Long-term video/EEG monitoring




•Epilepsy surgery •Epilepsy surgery •Epilepsy surgery •Epilepsy surgery including intracranial electrophysiology

•Neuropsychological services



•Psychiatric counseling



•Special education


WHO Western Pacific Region 2004 Key data on epilepsy: Major causes of seizures


• Cerebrovascular accidents

• Idiopathic • Post-traumatic • Hippocampal sclerosis

•CNS infection (TB meningitis, bacterial meningitis)

• Post-traumatic • Post-cerebrovascular accident

• Post-traumatic

•Head Injury • Birth related injury/insult

• CNS infections • Stroke

•Brain tumors • Hippocampal sclerosis

• Mesial temporal sclerosis

• Perinatal injury

•Perinatal insults/injuries

• Brain infection • Tumors • Idiopathic


WHO Western Pacific Region 2004 Key data on epilepsy: Available AEDs and cost


•Phenobarbital, Php1.75 ($0.03)

• Acetazolamide

• Phenytoin,Php18.00 ($0.32)

• Phenytoin, 4¢ per 100mg ($0.11)

• Phenytoin, 9 ¢ per 100mg ($0.53)

• Clozabam, Diazepam

• Carbamazepine, Php16.00 ($0.29)

• Carbamazepine, 20¢ per 200mg ($0.05)

• Carbamazepine, 9¢ per 200mg ($0.53)

• Ethosuximide

• Valproate, Php18.00 ($0.32)

• Valproate, 20¢ per 200mg ($0.05)

• Valproate 24¢ per 200mg ($0.14)

• Gabapentin

• Lamotrigine, Php27.00 ($0.49)

• Lamotrigine, RM2.52 ($0.66) • Lamotrigine

•Also available: gabapentin, topiramate, clonazepam, diazepam

• Topimarate, RM 2.86 per 50mg•Gabapentin, RM 2.37 per 300mg• Phenobarbitone, 2¢ per 30mg• Clonazepam (22 per 0.5/24¢ prt mg)

• Often price of consultation includes medication and investigations

• Phenobarbiton, 3¢ per 30mg• Diazepam 3¢ per 5mg

• Levitiracetam, Ocarbazepine, Levitiracam, Nitrazepam, Oxcarbazepine, phenobarbitone, phenytoin, primidone, sulthiame, tiagabine, topimarate, valproate, vigabatrin•Subsidized under a national Pharmaceutical Benefits Scheme (PBS) which limits the cost to AU$ 23 per month’s supply


Awareness and understanding of epilepsy among patients, families, caregivers and health workers

• Awareness– 32% of patients and caregivers and 11% of health

workers have not heard or read any information about epilepsy

• Etiology – 17% of health workers and 4% of patients and

caregivers believe that epilepsy is contagious and can be transmitted by either marrying, caring for or living with a person with epilepsy or even by witnessing an epileptic attack

Salonga, A.M. et al. 1999, Epilepsy Education Program: It’s Role In the Comprehensive Management of Children with Epilepsy”

• Treatment – more parents and caregivers (86%) believe

epilepsy can be cured with medications than health workers (68%)

– 54-72% believe epilepsy can be cured with prayer



• What to do during an attack – about half of all the respondents will insert a

spoon into the mouth– 1/3-2/3 will fan the patient– 1/3-2/3 will do nothing and wait– A smaller percentage will massage the patient,

blow air on the face, put pressure on the stomach or even bite the patient.



Public Attitude and Awareness Towards EpilepsyA Public Pulse in a Tertiary Hospital

• Awareness– 94.84% have heard or

heard about epilepsy– 44.52% knows someone

w/ epilepsy– 69.68% had seen an

epileptic attack

• Understanding epilepsy– 10.32% did not know

what epilepsy was– 3.87% did not know

what an epileptic attack looks like

Piano, Anthony and Joanne Robles. "Public Attitude and Awareness Towards Epilepsy: A Public Pulse in a Tertiary Hospital ." (2008).

Public Attitude and Awareness Towards EpilepsyA Public Pulse in a Tertiary Hospital

• Attitude– 83.87% did not have any objections in having their

children interact w/ persons w/ epilepsy– 31.61% would object to having their children

marry someone w/ seizures– 76.77% believed that people w/ epilepsy should

be employed– 8.39% believed that epilepsy is a form of insanity

Piano, Anthony and Joanne Robles. "Public Attitude and Awareness Towards Epilepsy: A Public Pulse in a Tertiary Hospital ." (2008).

Is Epilepsy a Burden?

• Economic– Medical care is mostly shouldered out-of-pocket– Cost• Phenytoin 100mg/cap TID

– P26/tab x 3 = P78/day

• Levetiracetam 500mg/tab BID– P45/tab x 2 = P90/day

Patient’s Perception Towards Epilepsy

• Personal reaction to having epilepsy – fear– worry– uncertainty– anger,– confusion– self-pity– neutrality– heightened emotionality

Cabral-Lim, Leonor. Epilepsy in the Philippines. September 28, 2001. http://www.plae.org.ph/web/epilepsy_information4.php.


• Difficulties encountered – taunting and irritability from others– difficulty in accomplishing tasks– feeling of being abandoned by family members– inability to pursue work and other activities– feeling of being a burden to family


• Reaction from others – being overprotective and restrictive– making fun of the person and labeling person as crazy– distancing and fear– majority of parents would not want their normal children nor

themselves to marry a person with epilepsy

Cabral-Lim, Leonor. Epilepsy in the Philippines. September 28, 2001. http://www.plae.org.ph/web/epilepsy_information4.php.

Addressing the issues

• Financing and budget – Increase health budget– Reduce OOP and increase health insurance

coverage• Primary Prevention– Social• Increase awareness• Address social stigma

Philippine League Against Epilepsy Awareness Campaigns

http://www.plae.org.ph/web/plae_archives.php

Philippine League Against Epilepsy Awareness Campaigns

• Television Advertisement– "Tsismis" (Gossip)

• Radio Advertisment– " Romy”• Raymonde please embed attached wav file

http://www.plae.org.ph/web/plae_archives.php

prevalence of epilepsy in the philippines population of 83 million and an estimated prevalence of...

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