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Epilepsy in Thailand. Dr.Yotin Chinvarun M.D. Ph.D . The Neurological Society of Thailand. Diversity of the Asia-Pacific Region Population and Economical Development. Population (millions) 12 1,272 7 1,027 209 126 47 5 24 2 5 78 3 61 80. Gross National Income

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epilepsy in thailand

Epilepsy in Thailand

Dr.Yotin Chinvarun M.D. Ph.D.

The Neurological Society of Thailand

diversity of the asia pacific region population and economical development
Diversity of the Asia-Pacific RegionPopulation and Economical Development

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

Cambodia

China

Hong Kong

India

Indonesia

Japan

Korea Rep

Lao

Malaysia

Mongolia

Papua New Guinea

Philippines

Singapore

Thailand

Vietnam

World Bank, 2003

epilepsy in asia and thailand scale of the problem
Epilepsy in Asia and ThailandScale 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
epilepsy program in thailand
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
cep in thailand

Epilepsy clinic

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

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

No

Yes

Yes

Yes

Yes

Yes

No

CEP in Thailand

Basic CEP

Advance CEP

cep in thailand1

Epilepsy surgery

Temporal lobectomy

Extratemporal lobe surgery

Corpus callosotomy

Hemispherectomy

Subpial resection

Vagal nerve stimulation

Ketogenic diet

No

No

No

Yes

Yes

Yes

No

No

No

No

Yes

No

Yes

Yes

CEP in Thailand

Basic CEP

Advance CEP

aeds in thailand
Traditional AEDs

Phenytoin

Cabarmazepine

Sodium valproate

Phenobarbital

Benzodiazepine

Acetazolamide

2nd line AEDs

Lamotrigine

Oxcarbazepine

Vigabatrin

Gabapentin

Topiramate

Levetiracetam

Zonisamide

Pregabalin

AEDs in Thailand
pramongkutklao comprehensive epilepsy program
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)
refractory epilepsy in pmk hospital
Refractory epilepsy in PMK hospital
  • 523 cases with epilepsy from Jan 2001-June 2005
    • Male 46% (241 cases)
    • Female 54% (282 cases)
    • Age between 10-75 years old (mean 31 years)
  • 3,220 visited within Jan 2001-June 2005
seizure diagnosis
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.
monotherapy vs polytherapy
Monotherapy vs Polytherapy
  • 46% (235 cases) – Monotherapy
  • 54 % (272 cases) - Polytherapy
refractory cases
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
mri brain
MRI brain

Total MRI brain 228 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 18

cases

Chinvarun 2005

mri brain etiology
MRI brain: Etiology

35%

N=228 cases

17%

13%

Chinvarun 2005

presurgical evaluations pmk hospital
Presurgical evaluationsPMK 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
epilepsy surgery of refractory cases pmk hospital june 2005
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
epilepsy surgery in asia a survey 2004
Epilepsy surgery in Asia: A survey (2004)

Population

(million)

Epilepsy surgery program

Countries

Prevalence of pts requiring surgery

Hong Kong

India

Indonesia

Japan

Korea

Mongolia

Philippines

Singapore

Taiwan

Thailand

Vietnam

Available

Pediatric service

No of case/yr

6.8

1,000.0

210.0

120.0

47.0

2.5

82.0

4.2

23.0

67.0

80.0

Y

Y

Y

Y

Y

N

Y

Y

Y

Y

N

Y

N

N

Y

Y

N

Y

Y

Y

Y

N

40

100

10

500

300

-

10

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)

current status of management in thailand
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
plan to improve epilepsy management in thailand
Plan to improve epilepsy management in Thailand
  • Epilepsy training program / Research
  • Developing guideline for management of epilepsy
  • Public education program