Mortality of epilepsy in developing countries.

During the last two decades, there has been a renewed interest in studying epidemiology of epilepsy in developing countries. While there are data on prevalence of epilepsy from many developing countries, there is very little information on the mortality of epilepsy in these same populations. This is because incidence studies of epilepsy are difficult to perform, death certificates are unreliable and often unavailable, and the cause of death is difficult to determine. We report on several studies of mortality in epilepsy in developing countries: Ecuador; the Parsi community of Bombay; a semiurban community in Vasai, India; Mali; Martinique; and Africa. Overall, these studies in general illustrate excess mortality among people with epilepsy when compared with the general population.

Epidemiology of epilepsy in India.

The article briefly reviews literature pertinent to the incidence, prevalence, prognosis, etiology, and treatment gap of epilepsy in India. Despite defective methodology, Indian studies have shown prevalence rates comparable with those from other countries. No incidence studies exist. Prognosis for those with epilepsy is worse in developing countries. The role of infection, especially neurocysticercosis, in the etiology of epilepsy has still to be fully worked out, as must the relative contributions of the other known etiological factors. Neuroimaging is needed to calculate attributable risk. Reasons for the treatment gap are discussed briefly, pointing out that in India, people seek alternative forms of treatment concurrently. The occurrence and effects of stigma are mentioned. The article ends with the author's opinion on how and where the epidemiology of epilepsy should proceed in the future.

Cerebellar atrophy after acute phenytoin intoxication.

There is some evidence that long-term phenytoin (PHT) use may occasionally give rise to irreversible cerebellar atrophy, but it is unclear whether such changes can occur after acute PHT intoxication. We describe a 38-year-old patient with accidental acute PHT overdose who developed severe cerebellar atrophy. This case provides evidence that acute PHT intoxication can, on rare occasions, result in irreversible cerebellar degeneration.

The neuropathy of Dejerine and Sottas: report of an Indian family.

We report here a family in which 4 out of 11 sibs of unrelated parents showed the typical clinical features of Dejerine-Sottas disease. Sensory disturbance was present in only one case and age at onset was delayed to 4 years in another. The others all conformed to the infantile form of the disease. This is the first time in which mental retardation has been reported in this disorder.

Pituitary hyperplasia mimicking pituitary tumor.

Reactive enlargement of the pituitary gland in primary end organ failure may be indistinguishable from primary pituitary lesions in clinical presentation and on magnetic resonance imaging. The diagnosis of pituitary hyperplasia secondary to end organ failure must be based on endocrinologic investigations. Recognition of this condition and distinguishing it from primary pituitary tumors is important and may eliminate unnecessary surgery.

Prevalence of peripheral neuropathy in the Parsi community of Bombay.

We carried out a door-to-door survey to screen for neurologic diseases, including peripheral neuropathy, in a community of 14,010 Parsis living in housing colonies in Bombay, India. The most common neurologic disorder was peripheral neuropathy with 334 cases (2,384 cases/100,000 population). The most common neuropathy was compressive, with diabetes the most common noncompressive etiology. There was no leprosy, and nutritional neuropathies were rare.

Febrile seizures.

A door-to-door survey was carried out to screen a community of 14,010 people (Parsis living in colonies in Bombay, India) for possible neurological diseases. High school graduates, social workers, and a medical student administered a screening questionnaire that, in a pilot study, had a high sensitivity for identifying febrile seizures in children under the age of 14 years. Neurologists used defined diagnostic criteria to evaluate individuals positive on the screening survey. There were 1,581 children under the age of 14 years. Twenty-eight children (19 boys, 9 girls) suffered from febrile seizures (17.7/1,000 population). The present prevalence study is the first from India and suggests that, contrary to expectation, the frequency of febrile seizures may be no different in developing and developed countries.

Choreo-acanthocytosis.

This is the first report from India of a family of 4 sisters and 3 brothers in whom the proband showed a complete form of the choreo-acanthocytosis syndrome, whereas the 2 brothers who had died earlier of this disease had no examination of their blood. The apparently healthy members of this family also showed acanthocytosis, suggesting that this is a multisystem disorder affecting cell membranes.

Prevalence of Parkinson's disease in the Parsi community of Bombay, India.

A door-to-door survey was carried out to screen a community of 14010 people (Parsis living in colonies in Bombay, India) for possible neurologic diseases. High school graduates, social workers, and medical students administered a screening questionnaire that had been shown in a pilot survey to have a sensitivity of 100% for identifying those with Parkinson's disease. Neurologists used defined diagnostic criteria to evaluate individuals positive on the screening survey. There were 46 people (25 men, 21 women) who suffered from Parkinson's disease (328.3 cases per 1000 population). The age-specific prevalence ratios increased consistently with age. Age-adjusted prevalence ratios were slightly higher for men.

Prevalence of essential tremor in the Parsi community of Bombay, India.

A door-to-door survey for neurologic diseases was conducted in a community of 14,010 people (Parsis living in colonies in Bombay, India). Neurologists used defined diagnostic criteria to evaluate persons with positive results on the screening survey. Two hundred thirty-three people (104 men; 129 women) were identified as having essential tremor. The overall prevalence ratio was 1663.1 [corrected] per 100,000 population. Age-specific prevalence ratios increased with age. Age-adjusted prevalence ratios were similar for men and women. To the best of our knowledge, this is the first community-based survey for essential tremor in Asia.

Prevalence of multiple sclerosis in the Parsis of Bombay.

We carried out a door-to-door-survey to screen a community of 14,010 people (Parsis living in colonies in Bombay, India) for possible neurologic diseases, and used defined diagnostic criteria to evaluate people who tested positive on the screening survey. There were three clinically definite cases of multiple sclerosis (21/100,000). This is the first prevalence survey for multiple sclerosis in a large developing country.