[Epilepsy in tropical areas]

Epilepsy in tropical areas, and in developing countries more generally, has certain specific characteristics (in particular its severity) which help to explain why this is still a major public health problem. The authorities often neglect this disease, even though numerous alarms have been raised by national leagues against epilepsy and by the World Health Organization, in order to bring epilepsy "out of the shadows". The prevalence is two to ten times higher and the incidence rate twice that in western countries. The mortality rate is very high, and many patients do not have access to appropriate treatment. In addition to the usual etiologies, certain causes are more common or specific to patients in poor countries, such as perinatal disorders and parasitic diseases (particularly cerebral malaria and neurocysticercosis). The impact of consanguinity is difficult to assess. Many associations against epilepsy have been created. Specific standardized guidelines have been written, validated and translated into several languages but they are under-utilized. A common language needs to be found between patients and caregivers, because of the numerous dialects spoken by ethnic groups, and the hidden meanings of the words used in this disease, where interpretations and perceptions cannot be dissociated from local culture. In most developing countries epilepsy is still considered a dangerous transmissible disease, and people with epilepsy are stigmatized. Specific training programs for healthcare personnel are needed, and efforts must be made to improve awareness among the population and the authorities. Some such programs are being supported by the pharmaceutical industry. This is particularly crucial in countries where counterfeit drugs are frequent and access to medicines is limited. Indeed, up to 80 % of people with epilepsy are treated poorly or not at all, and phenobarbitone is still the most widely used drug.