Perfil de la Epilepsia en el Ecuador

The point prevalence of active epilepsy in Ecuador is between 7/1000 and 12/1000, which is similar to that reported in developed countries; however, this finding does not necessarily indicate that the risk to develop epilepsy is the same in these two populations. The incidence of epilepsy in Ecuador is between 120/100,000 and 172/100,000, which is two to threefold higher than that reported in developed countries. These results should be confirmed by further studies. In Ecuador, the frequency of epilepsy is highest during adolescence and adulthood, probably due to the high prevalence of infectious and parasitic diseases in these age groups. Regarding the prognosis, seizures recur in 43% of patients with epilepsy. The risk of recurrence by the Kaplan-Meier actuarial analysis is 30% at 12 months, 51% at 24 months, and 79% at 45 months of follow-up. Statistically significant risk factors for recurrence are the etiology (52% recurrence risk in patients with symptomatic epilepsy) and the presence of an abnormal CT scan (51% recurrence risk in patients with abnormal CT scans). Mortality in patients with epilepsy is six-fold higher than in the general population of Ecuador (standardized mortality ratio SMR of 6.3). The SMR for sudden death in patients with epilepsy (3.9) is also higher than that reported in developed countries. These greater mortality ratios probably explain the relatively low prevalence rates in our country. In 1995, Ecuador spent 4.6% of the gross national product on the health system. The Ministry of Health, which funds the public health system, contributed only 1.5% of this amount. This government contribution is one of the lowest in South America. There are no government programs in Ecuador working to manage and prevent chronic diseases, such as epilepsy. There are also no laws to protect patients with epilepsy. This complex background obligates the health authorities, scientific community, and the society in general, to join together in the fight against epilepsy, as a bio-psycho- social problem.