title: Epilepsy and treatment gap in urban and rural areas of the Southern Kazakhstan in adults.
abstract: There are no data in the English literature about the epidemiology of epilepsy in the large countries in the Asian region of the former Soviet Union. This paper presents the results of epidemiological studies of active epilepsy in the population 14years of age and older in the Province of South Kazakhstan.
  
  
  
  The study population consisted of 306.44 thousand persons: 139.42 in the urban Enbekshinskiy district of the city of Shymkent and 167.02 in the rural Sairam district. To collect patient's data, multiple medical sources were used. For each person with epilepsy (PWE), a questionnaire was completed by members of the research team. Clinical profiles, seizure type, clinical syndrome, etiology, seizure frequency, therapy, educational level, and social status were abstracted.
  
  
  
  Overall, 1351 PWE were identified: 459 in the urban district and 892 in the rural district. The age-adjusted prevalence of epilepsy was 3.14/1000 (CI95%: 2.86-3.45) in the urban district and 4.95/1000 (CI95%: 4.62-5.30) in the rural district. Prevalence for men was higher than for women. Focal seizures predominated in both regions. Traumatic brain injury was the most frequently identified cause of epilepsy. The other important antecedents were pre/perinatal disorders, CNS infection, and cerebrovascular disease. Half of PWE experienced more than 12seizures per year. Substantial social impacts of epilepsy were observed: 44% of PWE received disability pensions from the government; only 15.5% were employed. About a quarter of all PWE were not taking AEDs at the time of the record review. For those on treatment, regimens were frequently suboptimal.
  
  
  
  In the first study performed according to the guidelines for epidemiologic studies on epilepsy of ILAE in the Asian part of the former Soviet Union, poor seizure control and a substantial treatment gap were identified. The need for improvement of epilepsy care was highlighted, especially in the rural regions.
authors.affiliation: Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, 43, Donskaya ul., Moscow 115419, Russian Federation; Department of Neurology, Neurosurgery and Medical Genetics, Russian National Research Medical University, 8, Leninsky Prospekt, bl.8, Moscow 119049, Russian Federation. Electronic address: guekht@mail.ru.
authors.forename: Alla
authors.initials: A
authors.lastname: Guekht
authors.affiliation: Department of Neurology, Neurosurgery and Medical Genetics, Russian National Research Medical University, 8, Leninsky Prospekt, bl.8, Moscow 119049, Russian Federation; Shymkent Regional Clinical Hospital, 4, Mailykozha Str., Shymkent, South Kazakhstan Province 160050, Kazakhstan. Electronic address: naziragar@rambler.ru.
authors.forename: Nazira
authors.initials: N
authors.lastname: Zharkinbekova
authors.affiliation: The S. Fyodorov Eye Microsurgery Federal State Institution, 59A, Beskudnikovsky Blvd, Moscow 127486, Russian Federation. Electronic address: a_shpak@inbox.ru.
authors.forename: Alexander
authors.initials: A
authors.lastname: Shpak
authors.affiliation: Department of Neurology, Epidemiology and Sergievsky Center, Columbia University, 630, West 168 St., New York, NY 10032, USA. Electronic address: wahauser@optonline.net.
authors.forename: W Allen
authors.initials: WA
authors.lastname: Hauser
mesh_terms: D000293:Adolescent; D000328:Adult; D004827:Epilepsy / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007623:Kazakhstan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012424:Rural Population / Q000639:trends; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014505:Urban Population / Q000639:trends; D055815:Young Adult
keywords: Epilepsy; Etiology; Kazakhstan; Prevalence; Treatment gap