A Short Perspective on the Risk Profile of Epilepsy in Iran

                                                        mathewsopenaccess.com

Epilepsy is a major neurological disorder with differing particularities in different cultural set-ups [1]. Middle East, for multitude of reasons, is culturally unique and assorted across religious, dietary, social, familial, political aspects. Recently, it has been demonstrated that the median prevalence of lifetime epilepsy had been under-estimated by three fold for this region [2]. Iran, one of the important Middle Eastern countries located in the southwest of Asia and has a population of over 70 million. A meta-analysis conducted for Iran reports an epilepsy prevalence of 5.0/1000; however, a closer look indicates several issues in this work with inappropriate inclusion, and cluster of studies [3]. Despite seeming apprehensions, Iran has a very sophisticated healthcare system with all population covered under insurance and upto 90.0% of medical cost reimbursed [4]. Here we provide a short quick overview of epilepsy risk profile for Iran.

The burden of neurocysticercosis (NCC) in Iran is unknown but is reportedly unexpected [5]. A PubMed search with words ‘neurocysticercosis’ and ‘Iran’ provided only two publications; none of them provide suitable details. Although, The Holy Quran prohibits consumption of pork, its availability and consumption may not necessarily be completely inexistent; although limited, as observed in other Muslim populations [6]. Incidence of tuberculosis in Iran is low (21/100,000) with restricted only to Sistan region of Iran, at the Border with Afghanistan [7]. Malaria, another important risk factor of epilepsy, is at pre-elimination stage in Iran; with epilepsyrelevant falciparum infection (Plasmodium vivax malaria: An unusual presentation) restricted to endemic East and South East regions of the country [8]. Iran similarly has progressed with near elimination of Schistosomiasis with nearly no cases since 2001 [9]. Although Iran is not endemic for paragonimiasis, the burden of toxoplasmosis is particularly high, including children [10,11]. The prevalence of HIV-AIDS in Iran is low, mostly among injected users, even among prison population (2.1%) which traditionally has high HIV prevalence [12]. 

Although pregnancy and birth related factors (hemorrhage, gestational hypertension, prematurity, etc.) are highly important risk factors for epilepsy, more than infections, the burden of these disorders also seem to be low in Iran [13,14]. In this country, in 2010, antenatal care coverage was 94.0% adequate with 97.0% births were attended, equally so in rural populations[15]. However, one of the interesting observations comes from the high frequency of desired cesarean sections that are not medically needed [16]. Similar trends are also noted in other Asian settings such as China; where such trends, like Iran, are to be due to high insurance coverage of the populations [17]. Moreover, although some studies in Iran fail to show the protective role of breast feeding in epilepsy; this does show a major role in more sophisticated surveys performed by the author [18,19].