title: Epilepsy in Cambodia-treatment aspects and policy implications: a population-based representative survey.
abstract: BACKGROUND
  We tested two treatment strategies to determine: treatment (a) prognosis (seizure frequency, mortality, suicide, and complications), (b) safety and adherence of treatment, (c) self-reported satisfaction with treatment and self-reported productivity, and policy aspects (a) number of required tablets for universal treatment (NRT), (b) cost of management, (c) manpower-gap and requirements for scaling-up of epilepsy care.
  
  
  METHODS
  We performed a random-cluster survey (N = 16510) and identified 96 cases (≥1 year of age) in 24 villages. They were screened by using a validated instrument and diagnosed by the neurologists. International guidelines were used for defining and classifying epilepsy. All were given phenobarbital or valproate (cost-free) in two manners patient's door-steps (March 2009-March 2010, primary-treatment-period, PTP) and treatment through health-centers (March 2010-June 2011, treatment-continuation-period, TCP). The emphasis was to start on a minimum dosage and regime, without any polytherapy, according to the age of the recipients. No titration was done. Seizure-frequency was monthly and self-reported.
  
  
  RESULTS
  The number of seizures reduced from 12.6 (pre-treatment) to 1.2 (end of PTP), following which there was an increase to 3.4 (end of TCP). Between start of PTP and end of TCP, >60.0% became and remained seizure-free. During TCP, ∼26.0% went to health centers to collect their treatment. Complications reduced from 12.5% to 4.2% between start and end of PTP and increased to 17.2% between start and end of TCP. Adverse events reduced from 46.8% to 16.6% between start and end of PTP. Nearly 33 million phenobarbital 100 mg tablets are needed in Cambodia.
  
  
  CONCLUSIONS
  Epilepsy responded sufficiently well to the conventional treatment, even when taken at a minimal dosage and a simple daily regimen, without any polytherapy. This is yet another confirmation that it is possible to substantially reduce direct burden of epilepsy through means that are currently available to us.
authors.affiliation: Institut National de la Santé et de la Recherche Médicale UMR 1094, Tropical Neuroepidemiology, Limoges, France ; Univ. Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, Centre national de la recherche scientifique FR 3503 GEIST, Limoges, France ; Centre Hospitalier Universitaire, Limoges, France ; Cambodian Society of Neurology, Phnom Penh, Cambodia.
authors.forename: Devender
authors.initials: D
authors.lastname: Bhalla
authors.forename: Kimly
authors.initials: K
authors.lastname: Chea
authors.forename: Chamroeun
authors.initials: C
authors.lastname: Hun
authors.forename: Vichea
authors.initials: V
authors.lastname: Chan
authors.forename: Pierre
authors.initials: P
authors.lastname: Huc
authors.forename: Samleng
authors.initials: S
authors.lastname: Chan
authors.forename: Robert
authors.initials: R
authors.lastname: Sebbag
authors.forename: Daniel
authors.initials: D
authors.lastname: Gérard
authors.forename: Michel
authors.initials: M
authors.lastname: Dumas
authors.forename: Sophal
authors.initials: S
authors.lastname: Oum
authors.forename: Michel
authors.initials: M
authors.lastname: Druet-Cabanac
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Preux
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000191:economics / Q000627:therapeutic use; D002160:Cambodia / Q000453:epidemiology; D002648:Child; D003151:Community Health Centers; D004827:Epilepsy / Q000191:economics / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006291:Health Policy; D006297:Health Services Accessibility / Q000458:organization & administration; D006792:House Calls; D006801:Humans; D008297:Male; D055118:Medication Adherence; D017060:Patient Satisfaction; D011379:Prognosis; D012640:Seizures; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D000078329:Workforce; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
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