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Título

Analysis of seizure control and risk factors for refractoriness in people with epilepsy in an isolated indigenous population in Pará, Brazil

Resumo

Introduction: The prevalence of epilepsy is variable, being higher in developing countries. Rates of 57/1000 were found within the Guaymi indigenous in Panama and 18,6/1000 within the Bakairi in Mato Grosso, central Brazil, but there was no study in isolated populations, wich may have peculiar life habits and genetic features. Objectives: To evaluate risk factors, clinical and electroencephalographic characteristics and the evolution of people with epilepsy in a geographically isolated indigenous population. Methods: Retrospective, historical cohort study. It used the medical records of patients seen from 2003 to 2018 at the neurology outpatient clinic in the city of Oriximiná-PA, a reference for 2,503 Waiwai tribe’s indigenous people. They are unmixed and inhabit a forest reserve in the Amazon. There were 25 patients with epilepsy among the 118 indigenous treated. Clinical aspects, electroencefalogram (EEG) and neuroimaging exams, family history, comorbidities, the treatment and the response were studied. A survival analysis was performed, whose outcome was seizure control. Results: The occurrence of epilepsy diagnosis in the Waiwai population was 10/1000, most cases started in childhood (68%), with no difference regarding gender. The number of seizures before the first consultation was high in 44%, family history was reported in 24%, perinatal hypoxia and febrile seizures in 20% each. There was intellectual disability in one-fifth of the patients. Neurological examination and neuropsychomotor development were abnormal in one third. EEG showed abnormalities in 68% of the patients, with a predominance of focal epileptiform discharges (44%). Focal epilepsies were 64% and probably genetic and unknown etiologies were prominent. Treatment controlled 72% of patients (monotherapy in 64%). The analysis of seizure control over time showed, through Kaplan-Meier estimation curves and Cox and Weibull regression models, that the factors most related to refractoriness with observation time of 24 months were abnormal neurological examination and the presence of a family history (p=0.001). Epilepsy classification and age had not statistical significance for the outcome (Log-rank=0.2 and 0.7, respectively). Conclusions: Unlike other indigenous peoples described in the literature, the Waiwai have a low incidence of epilepsy. Therapeutic results were similar to the general population.