title: A large-scale study of epilepsy in Ecuador: methodological aspects.
abstract: The methodology is presented of a large-scale study of epilepsy carried out in a highland area in northern Ecuador, South America, covering a population of 72,121 people; The study was carried out in two phases, the first, a cross-sectional phase, consisted of a house-to-house survey of all persons in this population, screening for epileptic seizures using a specially designed questionnaire. Possible cases identified in screening were assessed in a cascade diagnostic procedure applied by general doctors and neurologists. Its objectives were: to establish a comprehensive epidemiological profile of epileptic seizures; to describe the clinical phenomenology of this condition in the community; to validate methods for diagnosis and classification of epileptic seizures by a non-specialised team; and to ascertain the community's knowledge, attitudes and practices regarding epilepsy. A sample was selected in this phase in order to study the social aspects of epilepsy in this community. The second phase, which was longitudinal, assessed the ability of non-specialist care in the treatment of epilepsy. It consisted of a prospective clinical trial of antiepileptic therapy in untreated patients using two standard anti-epileptic drugs. Patients were followed for 12 months by a multidisciplinary team consisting of a primary health worker, rural doctor, neurologist, anthropologist, and psychologist. Standardised, reproducible instruments and methods were used. This study was carried out through co-operation between the medical profession, political agencies and the pharmaceutical industry, at an international level. We consider this a model for further large-scale studies of this type.
authors.affiliation: Community Management of Epilepsy Project, Quito, Ecuador.
authors.forename: M
authors.initials: M
authors.lastname: Placencia
authors.forename: J
authors.initials: J
authors.lastname: Suarez
authors.forename: F
authors.initials: F
authors.lastname: Crespo
authors.forename: J W
authors.initials: JW
authors.lastname: Sander
authors.forename: S D
authors.initials: SD
authors.lastname: Shorvon
authors.forename: R H
authors.initials: RH
authors.lastname: Ellison
authors.forename: S M
authors.initials: SM
authors.lastname: Cascante
mesh_terms: D000293:Adolescent; D000328:Adult; D002220:Carbamazepine / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003906:Developing Countries; D004484:Ecuador / Q000453:epidemiology; D004827:Epilepsy / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010634:Phenobarbital / Q000627:therapeutic use; D011446:Prospective Studies; D012424:Rural Population / Q000706:statistics & numerical data*; D003294:Seizures, Febrile / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D002220:Carbamazepine; D010634:Phenobarbital