Profile of neurologists in Brazil: a glimpse into the future of epilepsy and sudden unexpected death in epilepsy

The main focus of a nation’s health system revolves around the development of effective strategies and new options of treatment, with the aim of preventing or even reversing human diseases (1). The spectrum of disorders of the brain, part of the central nervous system (CNS), is large, covering hundreds of disorders that are listed in either the mental or the neurological disorder chapters of established international diagnostic classification systems. Brain disorders account for the majority of shortand long-term impairments and disabilities (2). As such, the best available estimates of the prevalence and cost per person for 19 groups of brain disorders in Europe have been reported (2). In brief, the total cost of brain disorders is estimated at J798 billion (2). Furthermore, the European per capita cost of brain disorders is J1550 on average but varies by country (2). The costs (in billion JPPP 2010) of the included brain disorders are as follows: mood disorders J113.4; dementia: J105.2; psychotic disorders: J93.9; anxiety disorders: J74.4; addiction: J65.7; stroke: J64.1; headache: J43.5; mental retardation: J43.3; sleep disorders: J35.4; traumatic brain injury: J33.0; personality disorders: J27.3; child/adolescent disorders: J21.3; somatoform disorder: J21.2; multiple sclerosis: J14.6; Parkinson’s disease: J13.9; epilepsy: J13.82; neuromuscular disorders: J7.7; brain tumor: J5.2 and eating disorders: J0.8 (2). Leading scientific journals and primary funding agencies suggest that neuroscience is the most rapidly growing field within the biomedical sciences in the world (1). For Latin American countries, especially Brazil, these assertions are especially relevant. For example, Nitrini conducted a study in 2006 that assessed the evolution of scientific production by 295 Brazilian clinical neuroscientists from 1995 to 2004 (3). The author showed that more than 40% of the Brazilian papers were published in Arquivos de Neuro-Psiquiatria, the official journal of the Brazilian Academy of Neurology, and that epilepsy was one of the sub-areas with the highest scientific production (3). The growing number of publications on epilepsy detected in this study may be a consequence of several well-established factors. By definition, epilepsy is a transient occurrence of signs and/or symptoms due to abnormal, excessive, or synchronous neuronal activity in the brain (4). Furthermore, epilepsy is considered to be the most common serious neurological condition. Epilepsy knows no geographic, social, or racial boundaries, it occurs in both men and women, and it affects people of all ages, though it more frequently affects young people in the first two decades of life and people over the age of 60 (5,6). Epilepsy has a prevalence of approximately 1% in developed countries; each year, 24 per 100,000 persons suffer from this neurological condition in Europe and 53 per 100,000 in North America (1,3,7-9). The incidence of epilepsy is higher in developing countries compared to industrialized countries, with up to 190 affected individuals per 100,000 people (10,11). Epilepsy is considered a serious chronic disease, with a number of factors that negatively affect the quality of life of these individuals. Stigma and exclusion have become common global features of epilepsy (5,12,13). In addition, physical, psychological, and social consequences are very severe, as seizures may cause fear, misunderstanding, secrecy, stigmatization, and social isolation (5,12,13). Additionally, we must not fail to mention that, unfortunately, epilepsy is associated with a high rate of premature death compared with the general population (14,15). Sudden unexpected death in epilepsy (SUDEP) is the most common epilepsy-related category of death, accounting for 7.5% to 17% of all deaths in people with epilepsy and 1:500 to 1:1,000 patient-years among adults (14-18). The main risk factors described thus far are the presence or number of generalized tonic–clonic seizures (GTCS), nocturnal seizures, young age at epilepsy onset, long duration of epilepsy, dementia, the absence of cerebrovascular disease, asthma, male gender, the symptomatic etiology of epilepsy, and alcohol abuse (14,15,18-21). Regarding epilepsy causal factors, experimental and clinical studies suggest that respiratory and cardiovascular abnormalities during and after seizures and genetic factors likely contribute to SUPEP risk (19,20,22-27). Obviously, it is extremely difficult to estimate SUDEP occurrence. However, discovery and careful evaluation of new risk factors, greater specificity regarding mechanisms, and the development of effective preventive measures may help prevent the occurrence of fatal events in affected individuals. Along these lines, proposals for future research that expand on existing clinical, genetic, and basic science research and that support the education of health care practitioners and people with Email: [email protected] Tel.: 55 11 5549-2064