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].
