Clinical and Demographic Profile of Epilepsy Patients in Rural Rajasthan

Objective: The present study attempted to explore the clinical and demographic profile of epileptic patients, and pharmacological management in these patients.

Methods: The prospective study was done in center situated at Ratannagar, a Community Health Centre in district Churu under the auspicious of Epilepsy Care and Research foundation, an NGO involved with epilepsy work. It included 6,993 epileptic patients who visited the center from majority of states from all over India from 1994 to 2018. Seizures were classified according to the International League against Epilepsy Classification (1981). Detailed clinical history and neurological examination was done in all patients. Routine blood tests, computerized tomography of head, and electroencephalography (EEG) were done only in some patients due to nonavailability, limited resources, and poor economic strata of the patients. All patients were given free medicines and were followed-up monthly for assessing the compliance, the response, and side effects of antiepileptic drugs.

Results: Male: female ratio was 2.51. The 36.45% patients were of age group 21 to 30 years and 20.9% were of age group from 11 to 20 years. Most of the patients (86%) were from rural areas. GTCS was the most common seizure type accounting for 67% followed by complex partial seizures (21%). In 68% of the patients no cause could be found for the seizures and they were labeled idiopathic. The commonest causes for symptomatic epilepsy were hypoxic ischemic insult and CNS infections. Majority of the patients were fully controlled on drugs. Fifty percent patients were controlled on monotherapy, 30% were controlled on two drugs, and 18% patients required more than two drugs. The most common drug used was phenytoin followed by phenobarbitone and levetiracetam, sodium valproate, and carbamazepine. Noncompliance of the drug was found to be the most common cause of the recurrent episodes of seizures followed by sleep deprivation and fever. The incidence of mental retardation was 12% and behavioral disorder was 22%. Loss of memory was reported in 48% of the patients, which was relatively very high.

Conclusion: Preventable causes of epilepsy share a significant portion in the etiology of the disease. Maximum patients can be managed at rural center without sophisticated investigations.