Status epilepticus in the Canadian Arctic: A public health imperative hidden in plain sight
Abstract Objective The World Health Organization, International League Against Epilepsy (ILAE), and International Bureau for Epilepsy have called epilepsy a public health imperative, with appropriate emphasis on low‐to‐middle‐income countries (LMIC). Although Canada is a high‐income country (HIC), i...
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ftdoajarticles:oai:doaj.org/article:9f1e156b40194f31a3a039c9a12d3b11 2023-05-15T14:52:59+02:00 Status epilepticus in the Canadian Arctic: A public health imperative hidden in plain sight Marcus C. Ng Milena Pavlova 2021-12-01T00:00:00Z https://doi.org/10.1002/epi4.12538 https://doaj.org/article/9f1e156b40194f31a3a039c9a12d3b11 EN eng Wiley https://doi.org/10.1002/epi4.12538 https://doaj.org/toc/2470-9239 2470-9239 doi:10.1002/epi4.12538 https://doaj.org/article/9f1e156b40194f31a3a039c9a12d3b11 Epilepsia Open, Vol 6, Iss 4, Pp 703-713 (2021) epilepsy health care inequity Nunavut seizures underserved population Neurology. Diseases of the nervous system RC346-429 article 2021 ftdoajarticles https://doi.org/10.1002/epi4.12538 2022-12-31T15:20:44Z Abstract Objective The World Health Organization, International League Against Epilepsy (ILAE), and International Bureau for Epilepsy have called epilepsy a public health imperative, with appropriate emphasis on low‐to‐middle‐income countries (LMIC). Although Canada is a high‐income country (HIC), income is not distributed uniformly. Furthermore, epilepsy data from the national statistical agency explicitly overlook the Arctic by excluding these territories. A common neurologic emergency, status epilepticus (SE) is a life‐threatening manifestation of epilepsy that demands prompt treatment to avoid death and long‐term sequelae. Therefore, we examined the rate of SE in a well‐defined Canadian Arctic region. Methods This study takes epidemiologic advantage of the Kivalliq Region's geographical isolation, which is accessible only by air. All SE patients requiring emergency care are consistently flown 1200‐1900 kilometers to a single designated hospital in a distinct southern part of Canada for further management and electroencephalography (EEG). We conducted a retrospective database and chart review at this “bottleneck” hospital to identify patients with seizure(s) severe enough to justify emergency airborne medical evacuation over a 11.25‐year period from 2009 to 2020. Results We screened 40 392 EEGs to yield 117 distinct medical evacuations for “operational SE” from 99 patients to derive estimated SE incidences of 99.9 evacuations per 100 000/year and 84.5 patients per 100 000/year. The average time from seizure onset to EEG was 3.2 days. Only 16.2% of SE patients had known epilepsy. For “confirmed SE” cases meeting ILAE criteria, or cases with persistently epileptiform EEG despite days of empiric treatment, estimated incidence was 77.7 evacuations per 100 000/year and 64.9 patients per 100 000/year. Significance High SE and epilepsy rates in the Canadian Arctic are consistent with LMIC rather than HIC. Our findings demonstrate the paradox of LMIC‐equivalent epilepsy populations camouflaged within HIC. Our ... Article in Journal/Newspaper Arctic Kivalliq Nunavut Directory of Open Access Journals: DOAJ Articles Arctic Nunavut Canada Epilepsia Open 6 4 703 713 |
institution |
Open Polar |
collection |
Directory of Open Access Journals: DOAJ Articles |
op_collection_id |
ftdoajarticles |
language |
English |
topic |
epilepsy health care inequity Nunavut seizures underserved population Neurology. Diseases of the nervous system RC346-429 |
spellingShingle |
epilepsy health care inequity Nunavut seizures underserved population Neurology. Diseases of the nervous system RC346-429 Marcus C. Ng Milena Pavlova Status epilepticus in the Canadian Arctic: A public health imperative hidden in plain sight |
topic_facet |
epilepsy health care inequity Nunavut seizures underserved population Neurology. Diseases of the nervous system RC346-429 |
description |
Abstract Objective The World Health Organization, International League Against Epilepsy (ILAE), and International Bureau for Epilepsy have called epilepsy a public health imperative, with appropriate emphasis on low‐to‐middle‐income countries (LMIC). Although Canada is a high‐income country (HIC), income is not distributed uniformly. Furthermore, epilepsy data from the national statistical agency explicitly overlook the Arctic by excluding these territories. A common neurologic emergency, status epilepticus (SE) is a life‐threatening manifestation of epilepsy that demands prompt treatment to avoid death and long‐term sequelae. Therefore, we examined the rate of SE in a well‐defined Canadian Arctic region. Methods This study takes epidemiologic advantage of the Kivalliq Region's geographical isolation, which is accessible only by air. All SE patients requiring emergency care are consistently flown 1200‐1900 kilometers to a single designated hospital in a distinct southern part of Canada for further management and electroencephalography (EEG). We conducted a retrospective database and chart review at this “bottleneck” hospital to identify patients with seizure(s) severe enough to justify emergency airborne medical evacuation over a 11.25‐year period from 2009 to 2020. Results We screened 40 392 EEGs to yield 117 distinct medical evacuations for “operational SE” from 99 patients to derive estimated SE incidences of 99.9 evacuations per 100 000/year and 84.5 patients per 100 000/year. The average time from seizure onset to EEG was 3.2 days. Only 16.2% of SE patients had known epilepsy. For “confirmed SE” cases meeting ILAE criteria, or cases with persistently epileptiform EEG despite days of empiric treatment, estimated incidence was 77.7 evacuations per 100 000/year and 64.9 patients per 100 000/year. Significance High SE and epilepsy rates in the Canadian Arctic are consistent with LMIC rather than HIC. Our findings demonstrate the paradox of LMIC‐equivalent epilepsy populations camouflaged within HIC. Our ... |
format |
Article in Journal/Newspaper |
author |
Marcus C. Ng Milena Pavlova |
author_facet |
Marcus C. Ng Milena Pavlova |
author_sort |
Marcus C. Ng |
title |
Status epilepticus in the Canadian Arctic: A public health imperative hidden in plain sight |
title_short |
Status epilepticus in the Canadian Arctic: A public health imperative hidden in plain sight |
title_full |
Status epilepticus in the Canadian Arctic: A public health imperative hidden in plain sight |
title_fullStr |
Status epilepticus in the Canadian Arctic: A public health imperative hidden in plain sight |
title_full_unstemmed |
Status epilepticus in the Canadian Arctic: A public health imperative hidden in plain sight |
title_sort |
status epilepticus in the canadian arctic: a public health imperative hidden in plain sight |
publisher |
Wiley |
publishDate |
2021 |
url |
https://doi.org/10.1002/epi4.12538 https://doaj.org/article/9f1e156b40194f31a3a039c9a12d3b11 |
geographic |
Arctic Nunavut Canada |
geographic_facet |
Arctic Nunavut Canada |
genre |
Arctic Kivalliq Nunavut |
genre_facet |
Arctic Kivalliq Nunavut |
op_source |
Epilepsia Open, Vol 6, Iss 4, Pp 703-713 (2021) |
op_relation |
https://doi.org/10.1002/epi4.12538 https://doaj.org/toc/2470-9239 2470-9239 doi:10.1002/epi4.12538 https://doaj.org/article/9f1e156b40194f31a3a039c9a12d3b11 |
op_doi |
https://doi.org/10.1002/epi4.12538 |
container_title |
Epilepsia Open |
container_volume |
6 |
container_issue |
4 |
container_start_page |
703 |
op_container_end_page |
713 |
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1766324389454807040 |