Epilepsy is a group of neurological disorders characterized by epileptic seizures. Epileptic seizures are episodes that can vary from brief and nearly undetectable to long periods of convulsive shaking. Epilepsy leads to decrease in patients’ quality of life. But the caring attitude of patients with epilepsy to their condition, close attention of the public health system and adequate social and economic policies can improve the diagnostics and therapy of epilepsy.
The epilepsy prevalence rate in Russia is growing with the average annual CAGR5(2012-2016) (Compound Annual Growth Rate) increase of 1.23% (2012-2016). Only one region, the Far Eastern Federal District shows a negative dynamics of -0.71%. According to the epilepsy prevalence data, children in the Russian Federation are most affected by the disease. The prevalence rates per 100,000 population are 71.0 for children, 24.3 for working-age adults, and 13.9 for elderly people.
Average epilepsy incidence among children is 3 times higher than among adults. However, despite high disease prevalence among children, working-age adults are the most affected group: prevalence rate amounts to 55% working-age vs 31% children. Higher adult rate is explained by the chronic nature of epilepsy.
Prevalence of epilepsy among children
Epilepsy prevalence rates among children are the highest in Krasnoyarsk Krai, the Chukotka Autonomous Okrug, Kaliningrad Oblast, the Mari El and Chuvashia republics, the Nenets and Yamalo-Nenets autonomous okrugs, Karelia, Arkhangelsk Oblast and Yakutia.
Prevalence of epilepsy among working-age adults
Data for working-age adults shows a very similar pattern with lower prevalence, except the Chechen Republic that has a pretty high rate for this group.
Prevalence of epilepsy among elderly people
The majority of elderly people suffering from this condition are estimated to reside in Yakutia, Kamchatka Krai, Magadan Oblast, Nenets Autonomous Okrug and also in the Republic of Ingushetia and the Chechen Republic, North Caucasus.
Climate zones in the Russian Federation
Surprisingly, there is a correlation between the prevalence of epilepsy and climate zones in the Russian Federation. Climate zoning is determined by the latitude, and in the Russian Federation climate zones mostly match 20th, 40th, 60th and 80th meridians.
The highest child disease prevalence of 92.3 is observed in climate zone IV. Data analysis shows no significant differences across climate zones, however, the morbidity rates are the highest in climate zone IV. The vast majority of the epileptic population is concentrated in Volga, Central and Siberian federal districts. Distributions among age groups are similar across federal regions.
And as working-age adults are the most economically active group and represent the majority of the potential workforce, the social and economic aspects of epilepsy are of extreme importance. It is worth mentioning that epilepsy has mortality rates of 918 cases, officially registered in 2016, which, in our opinion, does not reflect the real situation.
Availability of Neurological Care
Russia has a decent number of neurologists per 100,000 population: the average of 18.8 (CAGR5 -0,21%), with max of 22.1 in Northwestern Federal District and min of 16.5 in South Federal District. This figure is higher compared to European countries, where the same metric varies from the highest of 10.0-16.5 in Lithuania, Latvia, Estonia and Bulgaria, to the lowest of 2.7 in Great Britain, or 1.8 in Ireland, and low 3% growth of specialists has been a tendency over the past decade. However, direct comparison is not correct due to significant differences in patient routing systems and doctor’s functions. In Europe, it is common that general practitioner provides neurological care.
And just 25% of those organizations provide specialized training in children's epileptology. Professional enhancement courses are available in full-time and low-residency formats: 1026 contact hours for full-time, 2016 contact hours for low-residency programs. Full-time courses are available in 52.1% of regions, low-residency programs available in 39.1% of regions. Course tuition can be covered by the State and/or Federal Compulsory Medical Insurance Fund in all regions.
Two main providers of low-residency programs (approximately 972 contact hours) are the Pirogov Russian National Research Medical University (RNRMU) and the Krasnoyarsk State Medical University. Tuition fees vary between 80 and 570 Rubles.
High prevalence rates among children in Zone IV can be considered as a stimulus to conduct additional epidemiological studies of children’s epilepsy, however, it is good to keep in mind that correlation does not mean causation. At the same time, this knowledge is significant for organizing the public health system in general and providing broader access to health care in remote regions of Russia, including the popularization of telemedicine services for patients and their relatives.
High incidence among working-age and elderly adults is also observed in regions of Zone IV, but the possibility to arrange the specialized Epileptology education is limited by the almost complete lack of relevant organizations, so doctors have to travel to other regions.
These issues directly show that more attention should be paid to the financing of telemedicine, especially for “problem” regions. It is also vital to launch the specific Federal training programs for neurologists and to expand their geographical reach.
Prevalence calculations are based on 2011-2016 data analysis
Unit of labor input (ULI) is an equivalent 36 hours (reference model European Credit Transfer System, ECTS)