PRACA POGLĄDOWA / REVIEW ARTICLE

PADACZAKA – ZMIANY W EPIDEMIOLOGICZNYCH WSKAŹNIKACH WYSTĘPOWANIA, CHOROBOWOŚCI I NIEPEŁNOSPRAWNOŚCI U DZIECI W REGIONIE CHARKOWA (UKRAINA)

Tetyana A. Litovchenko1, Andriy E. Dubenko2, Olga Yu. Sukhonosova1, Anna A. Voitiuk1

1 Department of neurology and child neurology, Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine

2 Institute of Neurology, Psychiatry and Narcology of the Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine

ABSTRACT

Introduction: According to the World Health Organization, epilepsy is one of the most common diseases of the central nervous system, which affects 0.5 to 2% of the entire population

The aimis comparison of prevalence, incidence and disability from nervous diseases and epilepsy among children of the Kharkiv region of Ukraine and the results are compared with global figures.

Materials and methods: Epidemiological indicators, namely the prevalence and incidence. For the comparative analysis, the statistical data of the last 5 years are used.

Review:The prevalence of epilepsy in Ukraine amounts to 25 695 children (3.21%), higher than the prevalence of cerebral palsy or neuroinfections, the average value for 5 years is 24667 children (3.144%). In the Kharkiv region the number is 1451 children (3.43%), 5-year average is 1340 children (3.21%). The incidence of epilepsy in children in Ukraine is 3 306 children (0.43%), the average value for 5 years is 3569 children (0.454%). In Kharkiv region the incidence is 252 persons (0.53%), an average is 201.2 children (0.468%).

Conclusions: Reliable epidemiological indicators will make it possible to improve the system of rendering specialized medical care to children with epilepsy, carry out a pharmaco-economic analysis, calculation and estimation of the costs for patients’ treatment, which is especially important in the framework of the health care system reformation.

Thus, the compilation of patients’ registers with epilepsy is one of the urgent tasks to optimize the medical care.

 

Wiad Lek 2018, 71, 4, 883-887

 

INTRODUCTION

According to the World Health Organization, epilepsy is one of the most common diseases of the central nervous system, which affects 0.5 to 2% of the entire population [1-5]. Epilepsy prevalence in developed countries is 5-10 cases per 1,000 capita [6-8]. According to the results of population studies conducted in developed countries, the incidence of epilepsy varies from 0.28 to 0.53 per 1,000 capita [9-12].

There are discrepancies between prevalence and incidence of epilepsy in Europe and Ukraine [1], as well as the heterogeneity of prevalence and incidence of epilepsy in various regions of Ukraine: the prevalence of 4.28 per 1,000 children in Chernivtsi region to 2.47 in Khmelnytsky region [1,2] .

THE AIM

The aim of the work is to carry out a population-statistical study of epilepsy among children in Kharkov region, Ukraine by registering and comparing the results with national and international indicators.

MATERIALS AND METHODS

For the study the information from medical documentation was used: outpatient cards, the patient’s clinical record.

The primary material was collected by filling in a specially designed epilepsy registration card, as approved reporting forms showing general figures of prevalence, incidence and disability of children with a particular pathology do not give an idea of the etiology, pathogenesis, pathomorphosis of the disease, gender and age composition of patients. Based on the data obtained, a register of patients with paroxysmal conditions was created, which is cumulative for surveillance study. As of 01.01.17, 1301 children were included into the register, which allows monitoring of not only epidemiological, but also clinical, and paraclinical indicators, as well as the effectiveness of treatment and the level of patients’ socialization. However, in this article, we analyze only epidemiological indicators, namely the prevalence and incidence. The data obtained are specified with the help of the reporting forms approved by the Order of the Health Ministry of Ukraine of 10.07.2007 № 378 in agreement with the State Statistics Committee of Ukraine (indicators for forms Nos. 12 and 19). For the comparative analysis, the statistical data of the last 5 years are used.

REVIEW AND DISCUSSION

Kharkiv region is located in the north-east of Ukraine. The area is 31 415 km ² (5.2% of the territory of Ukraine). In terms of area, the region occupies the fourth place in Ukraine. The length: from north to south – 210 km, from east to west – 220 km.

The population of the region according to the State Statistics Service is 2,715,666 people (6% of the population of Ukraine, the third place in Ukraine), including urban population – 2 180947 people (80.4%), rural population – 534,719 people (19, 6%). The population growth is due to the migration increase of 15125 people.

Kharkov region is one of the most urbanized in Ukraine. There are 27 districts in Kharkov region (in this indicator the region takes the first place in Ukraine alongside with Vinnytsia region).

The number of children’s population of Kharkiv region in 2011 was 415,618 people, 2012 – 413718, 2013 – 416442, 2014 – 418984, 2015 – 422956 [3].

The prevalence of the disease is the number of all reported cases in a given population.

The prevalence of epilepsy in Ukraine is 23225 children – 3.05 ‰, exceeding the prevalence of infantile cerebral palsy, neuroinfection.

Kharkiv region ranks 14th among all regions of Ukraine in terms of epilepsy prevalence, the index for Kharkiv region is 3.43 per 1,000 children. The prevalence of epilepsy does not differ between the urban and rural population of Kharkiv region (the average value for 5 years is 3.204 per 1000 capita of both urban and rural children’s population). The prevalence of epilepsy in Kharkiv region and Ukraine for 2011-2015 is presented in Table I, according to which it can be concluded that the prevalence of epilepsy has increased in the last 2 years.

The epilepsy prevalence is 4-6 per 1000 capita. Studies conducted in various countries show epilepsy prevalence rates of 1.5 in Japan, 2.3 in Norway per 1000 capita, up to 6.0 in the United Kingdom, and 6.7 in the United States. The prevalence of epilepsy in developing countries is much higher (in some cases, 4-5 times) than in industrialized countries. The epilepsy prevalence in the CIS countries ranged from 1.1 to 5-6 per 1000 capita [1.4].

The official statistics may not correspond to the actual number of patients with epilepsy diagnosis, for instance, in some cases of symptomatic epilepsy it is not recorded statistically, but the underlying disease that led to the development of epilepsy is registered.

Another advantage of the register is in the registration of other paroxysmal conditions, for example, febrile seizures, which according to different authors are related to the risk factors of epilepsy development. According to the register data of 2015, febrile convulsions were recorded in 62 children, 53% of which were then transformed into epilepsy. Therefore, the register data can contribute to the early identification of risk factors for epilepsy, monitoring patients and secondary prevention of epilepsy.

Morbidity is the incidence of new, first-reported cases of the disease in the population in a particular year.

The incidence of epilepsy in Ukraine among children aged 0-17 years is 0.43 ‰ (3,306 children). According to the incidence of epilepsy among children population (0-17 years), Kharkiv region ranks 17th among all regions of Ukraine [2].

The incidence of epilepsy among children in Kharkov region and Ukraine in 2011-2015 are presented in Table II.

It should be noted that there was a significant prevalence of morbidity among urban population until 2014. However, in 2015 the difference between the incidence of epilepsy among the population of the city and regions was not recorded, which can be explained by migration of the population mainly to the districts of the region. 16 children with epilepsy from other regions migrated to Kharkov region.

In the world, the incidence of epilepsy varies from 11 to 190 per 100,000 of child population, making up in Denmark 39, Great Britain 52-70, Germany 50, Italy 80-100, Sweden 82, Norway 72, Chile 114, Ecuador 190 per 100,000 children [4,5].

Thus, the incidence of epilepsy in Kharkov region is higher than in Ukraine. However, in general, it is lower than in developed European countries.

The distribution of epilepsy patients by age and gender, according to the compiled register, is given in Table III.

The table shows that the greatest prevalence of the disease is recorded in boys under 6 years old, and then in girls aged 14-17 years.

The onset-age distribution in boys and girls with epilepsy as a percentage of each age group is shown in Table IV.

Analyzing the obtained data presented in Table V, we can say that the maximum incidence of epilepsy falls on the age groups 1-6 and 6-14 years. Girls predominate at the age of 6-14, which can be explained by pre-pubertal age, and in boys 1-6 years old, which can be explained by greater activity, frequent craniocerebral trauma.

Symptomatic epilepsies were recorded in 61% of patients, idiopathic – in 27%, cryptogenic – in 12% of cases.

The distribution of various forms of epilepsy is presented in Table V, from which it can be seen that symptomatic epilepsy is observed equally often in boys and girls, idiopathic forms are more commoearn in girls, and cryptogenic ones – in boys.

Etiological factors of symptomatic epilepsy are: perinatal lesions of the central nervous system 28%, congenital anomalies of the CNS – 24%, neuroinfections – 8%, craniocerebral trauma – 14%, brain neoplasms – 2%, phacomatosis – 1%.

According to children’s disability indicators Kharkiv region ranks seventh in Ukraine. The epilepsy disability indicators among the children of Kharkiv region in 2011-15 are presented in Table VI.

The register data made it possible to analyze the medical and social status of children with epilepsy in different age groups. (Table VII).

The greatest number of socially-maladjusted children is between the ages of 7 and 14, i.е. they are school-aged children. These data are necessary for calculating the provision of inclusive education for children with epilepsy in comprehensive schools. About 300 children in Kharkov region require such education.

In 2011, disabled children with epilepsy accounted for 38.36% of all epilepsy patients, in 2012 – 32.9%, in 2013 – 31.45%, in 2014 – 31.45%, in 2015 – 29.42%. This indicates that the monitoring of patients with epilepsy, their treatment taking into account the individual age and gender characteristics of the patient, the clinical form and nature of the clinical course contribute to reducing the number of socially-maladjusted patients, improve the quality of patients’ and their families’ lives.

CONCLUSIONS

Thus, the results of the work presented here made it possible to analyze a group of epileptic patients under 18 years of age, to determine a number of epidemiological indicators in Kharkov region, which in the future will enable to set comparative characteristics and more in-depth studies of the problem of children’s epilepsy throughout Ukraine. Reliable epidemiological indicators, in their turn, will make it possible to improve the system of rendering specialized medical care to children with epilepsy, carry out a pharmaco-economic analysis, calculation and estimation of the costs for patients’ treatment, which is especially important in the framework of the health care system reformation. Thus, the compilation of patients’ registers with epilepsy is one of the most urgent tasks to optimize the provision of medical care to patients.

REFERENCES

1. Golubchikov M. V. Nadannia medychnoi dopomohy z psykhiatrii, nevrolohii ta neirokhirurhii ditiam 0–17 rokiv u zakladakh okhorony zdorovia, shcho perebuvaiut u sferi upravlinnia MOZ Ukrainy: statystychno-analitychnyi dovidnyk [Provision of medical care in psychiatry, neurology and neurosurgery for children 0-17 years in health care institutions in the management of the Ministry of Health of Ukraine: statistical and analytical directory]: ukrmedstat@medstat.gov.ua

2. Osnovni pokaznyky zdorovia naselennia ta diialno¬sti zakladiv okhorony zdorovia Kharkivskoi oblasti za 2006–2015 rr. [The main indicators of health of the population and the activity of the health care institutions of the Kharkiv region for 2006-2015.] / KSZZ “Kharkiv Regional Information and Analytical Center of Medical Statistics” of the Department of Health Protection of the Kharkiv Regional State Administration: khomiac.org

3. P.N. Banerjee, D. Filippi, W. Clen Hauser, The descriptive epidemiology of epilepsy. A review. Epilepsy Res. 2009. 85:31-4

4. Prasad A., Corbett B. A national profile of neurodevelopmental disabilities in Canadian children: data from the National Longitudinal Study of Children and Youth. Materials of the 32nd International epilepsy congress
Barcelona, Spain 2nd – 6th September 2017

5. Jallon P. Epidemiology of epilepsies. In Panayiotopoulos C.P., ed. V. 1: A practical guide to childhood epilepsies. – Oxford: Medicinae: 2006: 17-20

6. Ackers R., Murray M. L.,Besag F. M., Wong I. C. Prioritizing children’s medicines for research: a pharmacoepidemiological study of antiepileptic drugs. Br J Clin Pharmacol. 2007 Jun; 63 (6):89-97

7. Strom B. L., Kimmel S. E., Hennessy S. Pharmacoepidemiology. 5th Ed. 2012. 976:13

8. R. E. Gliklich, N. A. Dreyer, Editor: M. B. Leavy, Registries for Evaluating Patient Outcomes: A User’s Guide /Senior Editors:. 2nd ed. – Rockville, MD : Agency for Healthcare Research and Quality (US), 2010: 348

9. Syvertsen M., Nakken K. O., Edland A.et al. Prevalence and etiology of epilepsy in a Norwegian county – A population based study. Epilepsia. 2015.May 56(5):699-706

10. C. E. Begley, T. L. Durgin, The direct cost of epilepsy in the United States: A systematic review of estimates, Ibid. 2015. Sep 56(9):1376-87

11. P. Wicks, N. B. Fountain, Patient assessment of physician performance of epilepsy quality-of-care measures. NeurolClin Pract. 2012. Dec 2(4):335-342

12. Bennett L., Bergin M., Gooney M. et al. Epilepsy services in Ireland:‘A survey of people with epilepsy in relation to satisfaction, preferences and information provision. Epilepsy Res.2015.Jul 113: 11-8

Conflict of interest:

The Authors declare no conflict of interest

ADDRESS FOR CORRESPONDENCE

Tetyana A. Litovchenko

Kharkiv Medical Academy of Postgraduate Education

58, Amosova str., 61176, Kharkiv, Ukraine

tel: +380577113556

e-mail: office@med.edu.ua

Received: 25.12.2017

Accepted: 20.05.2018

Table I. The prevalence of epilepsy in the Kharkiv region and Ukraine in 2011-2015

 

2011

2012

2013

2014

2015

 

Cases registered

Prevalence per 100000 population

Cases registered

Prevalence per 100000 population

Cases registered

Prevalence per 100000 population

Cases registered

Prevalence per 100000 ppopulation

Cases registered

Prevalence per 100000 нpopulation

Kharkiv region

1301

3,13

1310

3,17

1295

3,11

1345

3,21

1451

3,43

Ukraine

25695

3,21

25802

3,24

25933

3,25

22549

2,97

23225

3,05

Table II. The incidence of epilepsy among children in Kharkov region and Ukraine in 2011-2015.

 

2011

2012

2013

2014

2015

 

First-reported cases of the disease

Prevalence of disease per 1000

First-reported cases of the disease

Prevalence of disease per 1000

First-reported cases of the disease

Prevalence of disease per 1000

First-reported cases of the disease

Prevalence of disease per 1000

First-reported cases of the disease

Prevalence of disease per 1000

Kharkiv region

132

0,67

99

0,5

105

0,53

89

0,44

114

0,56

Ukraine

3971

0,5

3861

0,48

3579

0,45

3128

0,41

3306

0,43

Table III. Distribution of epilepsy patients by age and gender

Age

Girls

Boys

Total

 

Number

of the sick

%

Number

of the sick

%

Number

of the sick

%

1-12 months

34

49

35

51

69

5

1-6 years

121

46

141

54

262

20

6-14 years

208

52

193

48

401

31

14-17 years

324

57

245

43

569

44

Total

687

53

614

47

1301

100

Table IV. The onset-age distribution in patients with epilepsy by gender in different age groups

Age

Girls

Boys

Total

 

Number

of the sick

%

Number

of the sick

%

Number

of the sick

%

1-12 months

99

49

102

51

201

15

1-6 years

231

47

264

53

495

38

6-14 years

273

60

185

40

458

35

14-17 years

84

57

63

43

147

11

Total

687

53

614

47

1301

100

Table V. Gender distribution of patients with different forms of epilepsy

Type of epilepsy

Girls

Boys

Total

Number of the sick

%

Number of the sick

%

Number of the sick

%

Symptomatic

385

48

408

52

793

61

Idiopathic

251

71

101

29

352

27

Cryptogenous

51

32

105

68

156

12

Total

687

 

614

 

1301

100

Table VI. Epilepsy disability indicators among the children of Kharkiv region in 2011-2015

 

2011

2012

2013

2014

2015

АBс

indicator

АBс

indicator

АBс

indicator

АBс

indicator

АBс

indicator

Kharkiv region

499

12

480

11,6

426

10,2

422

10,1

427

10,1

Table VII. Epilepsy disability indicators among children of different age groups in Kharkov region in 2011-15

Year

Including at the age of

0-2 years

3-6 years

7-14 years

15-17 years

2011

19

2,4

73

7,8

260

15,9

147

18,5

2012

10

1,3

78

8

248

15,3

144

19,3

2013

11

1,4

68

6,7

214

13,1

133

18,6

2014

15

1,9

71

6,8

216

13

120

17,6

2015

13

1,6

63

6,0

240

13,9

111

17,3