Epilepsy in Latin America
Li Min Li, MD, PhD; Marilisa
M. Guerreiro, MD, PhD; Carlos A.M. Guerreiro, MD, PhD; Fernando Cendes, MD,
PhD.
Epilepsy
is a common chronic neurological condition with a prevalence of ~1%. According to a survey by International
League Against Epilepsy, ~85% of all patients with epilepsy live in developing
countries. Fifty percent of patients
had onset of their seizures in childhood.
It is estimated that 5,000,000 people in Latin America and the Caribbean
have epilepsy, of those 3,500,000 are not treated. Parasitic infections and poor prenatal and perinatal care figure
as causes of epilepsy, and can explain a higher incidence of epilepsy in some
countries in Latin America. The current
health system in Brazil was unified by a law passed on September 19, 1990,
creating the Unified Health System [Sistema
Único de Saúde (SUS)]. The total
expenditures in health care in Brazil in 2000 was around R$ 230-240 (US$ 134)
“per capita”, R$ 170-180 were from the federal and R$ 60-70 from the city and
state expenditures. SUS theoretically
offers total coverage but in reality, SUS covers about 77% of the whole
population. Of these, 22% do no receive
medical assistance (~34 million), and another 55% receive some type of
assistance (~86 million). The remaining
23% (~36 million) seek the private sector for assistance, which can be: medical
insurance, health maintenance organizations (HMOs), private medicine, and
others. The supply of anti-epileptic
medication (AED) by SUS is not regular or well distributed in Brazil. In general, phenobarbital is regularly supplied,
phenytoin and carbamazepine are irregularly supplied, and valproate is not
supplied by SUS. The lack of proper AED
treatment contributes to the overall stigmatization of patients with epilepsy. In addition, the laymen’s knowledge of
epilepsy is very unsatisfactory. The
high rate of illiteracy and low cultural standards help to perpetuate the old
prejudices against epilepsy. A
comprehensive educational effort to inform the patient and his environment
about epilepsy and adequate treatment are basic steps in a successful
management of this condition.