Epilepsy Research (2012) 102, 100108

journal homepage: www.elsevier.com/locate/epilepsyres

Prevalence and clinical characteristics of epilepsy in

the South of Spain
Guillermina Garcia-Martin a,, Francisco Perez-Errazquin a,
M. Isabel Chamorro-Munoz a, Manuel Romero-Acebal a,
Guillermina Martin-Reyes b, Marc Stefan Dawid-Milner c

a
Department of Neurology, Virgen de la Victoria Hospital, Malaga, Spain
b
Department of Econometrics, Faculty of Economics, Malaga, Spain
c
Department of Human Physiology and Physical Sprts Education, Faculty of Medicine, Malaga, Spain

Received 9 April 2012; received in revised form 14 May 2012; accepted 20 May 2012
Available online 29 June 2012

KEYWORDS Summary
Epidemiology; Purpose: Epilepsy is a common neurological disorder found in all societies. There are extensive
Etiology; epidemiologic studies of different European areas. However, not much information about the
Seizure; South-West of Europe exists. In Mlaga, Health Care is free and there are only two public
Active epilepsy; hospitals with Neurological Services that assist Eastern or Western areas depending on the
Epileptic population case. The purpose is to estimate the epidemiology in Mlaga through a hospital-based study
and compare it to the other European studies.
Methods: Review on the hospital data base and gathering of consecutive patients with a diag-
nosis of active epilepsy served by the Epilepsy outpatient clinic in Virgen de la Victoria Hospital
throughout a year.
Results: 2 281 patients fulfilled the criteria and 515 patients were recruited in order to study
the epidemiologic characteristics. Male gender and focal onset seizures predominate (75.5%).
Medium age 40. 58% of patients have been seizure-free in the last year. Known etiology in half
of the patients. 54% of patients are treated with monotherapy. Valproic acid is the commonest
drug. Other epidemiologic and demographic important data are provided. Data are analysed
and compared to other European studies.
Conclusions: Prevalence rate in Western Mlaga is 4.79 cases/1000 inhabitants. Characteristics
of the sample are similar to those of other European studies. Although this is a hospital-based
study, the particular characteristics of the Health Care System in our region enable us to gather
real data concerning epidemiology and prevalence.
2012 Elsevier B.V. All rights reserved.

Corresponding author at: Department of Neurology, Virgen de la Victoria Hospital.Campus de Teatinos s/n 29010, Malaga, Spain.

Tel.: +34 951032096; fax: +34 952290779.

E-mail address: guillerminagmartin@gmail.com (G. Garcia-Martin).

0920-1211/$ see front matter 2012 Elsevier B.V. All rights reserved.
http://dx.doi.org/10.1016/j.eplepsyres.2012.05.008
Prevalence and clinical characteristics of epilepsy
Introduction
Epilepsy is a common neurological disorder found in all soci-
eties that has an important medical as well as economical
and social impact. In fact, it is the commonest neurological
disease found in all age groups. It is estimated that up to 50
million subjects are diagnosed with epilepsy at some stage
during their lives (WHO, 2001).
World prevalence rate ranges between 5 and 10 cases
of epilepsy per 1000 inhabitants depending on the studies
(Sander and Shorvon, 1996). According to Forsgren et al.s
(2005) and Banerjee et al.s (2009) reviews there are at least
40 studies carried out in Europe. However, little is known
about large areas, and about the South-West in particular,
there are just three studies. A French one (Picot et al., 2008)
and two Spanish ones (Benavente et al., 2009; Luengo et al.,
2001), including Benaventes one just adolescents. All of
them, with population samples of less than 500 patients.
The area of investigation of this study is the West of
Mlaga province, located in the South of Spain with a total
surface area of 7306 km2 . According to the 2010 population
census, its population is over 1 600 000 inhabitants which
makes it the second largest province in Andalusia and the
sixth in Spain (INE National Institute of Statistics, 2010).
Epileptic patients in this province are mainly served by
the Neurological Departments of the two public hospitals in
the capital as there is no other Neurological Department in
other public hospitals of the province and as Health Care in
Spain is free for all citizens.
Thus, approximately, 55% of the population in Mlaga
capital (according to official data from the Andalusian
Health Care Service) and slightly under half of the province
population (800 000 inhabitants) depend on the Virgen de
la Victoria Hospital. Therefore, the approximate number of
the epileptic population which depends on our hospital is
3296 patients (according to the prevalence rates given by
Luengo et al., 2001).
Purpose
To estimate the epidemiology of the epileptic population in
Western Mlaga by a hospital record placing it in the general
epidemiologic frame of the disease.
1. Get to know the real characteristics of patients
who attend epilepsy-outpatient clinic in the Neurology
Department of the Virgen de la Victoria Hospital in
Mlaga to get to an estimation of the characteristics of
the epileptic population in Mlaga.
2. Compare the epidemiological situation of this area to the
general epidemiologic patterns.
Methods
Recruitment of patients for the sample
Data concerning patients served by the Outpatient Epileptic
Neurology Office of the Virgen de la Victoria Hospital were
collected between September 2009 and July 2010 (the office
is closed in August). All of the epileptic patients who attend
101
our hospital are served by these offices except those who
are yet to be diagnosed or those who due to good control or
other reasons are treated in Primary Care.
Patients positively diagnosed with epilepsy, according to
the criteria for epileptic activity of the International League
Against Epilepsy (ILAE Commission Report, 1997), who con-
secutively attended at least one of the weekly epilepsy
clinics, were recruited.
In each case we collected:
epidemiologic information about the patient: age and
gender, consumption of toxics, relevant illnesses and fre-
quently consumed drugs not related to epilepsy.
medical information concerning their disease: type of
epilepsy, etiology, disease activity (date of the last seizure
and its frequency), factors that could contribute to the
occurrence of a seizure and antiepileptic treatment.
We did not used a structured questionnaire for this, but
collected information from the interview and data base. The
information about illnesses different from epilepsy was col-
lected during the interview or from reports in their medical
history (like mental retardation, previously studied in their
infancy, due we attend this patients since 14 years old, so
we did not calculate it).
To calculate the prevalence, the entire office data base
was reviewed so those patients who fulfilled active epilepsy
criteria and/or those who were undergoing antiepileptic
treatment at the time of the study were added.
Data processing and statistical analysis
All the information concerning each patient was collected in
a data base. We used SPSS 13.0 software for the descriptive
analysis and the correlation studies.
Situation-epidemiology comparative study of
Western Mlaga and its comparison to the general
epidemiologic patterns
Bibliography was consulted in PubMed, MEDLINE and EMBASE
by introducing the keywords epidemiology and epilepsy
and prevalence and epilepsy. We first selected the
relevant articles and then the relevant bibliographical refer-
ences in them. We found some reviews that included specific
data from other publications. For our study we took data
from the reviews although we will refer to the original bib-
liographical reference.
Results
Demographic data
The total number of patients currently served by the
Epilepsy Office is 2892 of which only 2281 fulfill the active
epilepsy criteria, according to the ILAE criteria. In order to
compare our results to most of the researchers, we have
also included those patients who are still undergoing phar-
macological treatment although they have been seizure-free
in the last 5 years.
102 G. Garcia-Martin et al.

carried out. The rest were still undergoing pharmacological

treatment although they have not had seizures in the last 5
years.
Half of the patients of the sample (57.5%) had been
seizure-free for at least one year when the medical inter-
view was done; 3.9%, have seizures every day; 10.3% have 1
or 2 seizures per week; 12.3% have 1 or 2 per month; 6.4%
one every 23 months; 8.6% have between 1 and 3 per year
and 58.5% have one or less than one per year.
It must be remarked that focal onset seizures were found
in 75.5% of the cases. 17.5% of the patients had mainly
generalized epilepsy and 7% of the cases showed seizures
that suggested a not yet proved focal onset in spite of
being considered generalized due to their possible etiol-
ogy. Specifically, 33.8% of the sample had a temporal lobe
epilepsy. The type of epilepsy was defined depending on the
seizure semiology and the findings of the electroencephalo-
gram when available.
Information on epilepsy etiology was gathered from 495
Figure 1 Histogram of the sample patients age. patients. According to ILAEs current classification (Engel,
2001), the commonest etiology is the structural or metabolic
For this study 515 patients were recruited. 53.4% patients (47.6%) although this includes numerous different etiologies
of the sample were males and 46.6% females. The medium that we gathered separately (Table 1). Unknown or crypto-
age was 40 with a range between 14 and 89 years old. The genic etiology was found in 31.8% cases whereas genetic or
median age was 39. Only a 10% of the studied population idiopathic was found in 16.7% of the cases.
was over 65 years old. Only a 7% of the patients were under Analysis of the pathological structure resulted in 24.5% of
18 years old (Fig. 1). the sample which showed congenital origin causes. Lower
The genderage combined analysis indicated that only percentages corresponded to mesial temporal sclerosis,
over the age of 55 there are more females than males. In cranioencephalic trauma, consumption of toxic substances,
the group between 45 and 54 years old it is equal. In all vascular or infectious origin as reported in the table. Due
the rest of groups there was a higher rate for males. How- to the diversity of the congenital etiology, we have divided
ever, Pearsons Coefficient was not significant which shows it into different subetiologies of which perinatal hypoxia is
independence between age and gender. the commonest (Table 2).
After losing 64 patients of the total sample, who were not Only 20% of the patients admitted one of the suggested
asked about the consumption of toxics, 10% of the remaining possible factors for the occurrence of seizures. 14% of the
declared an addiction to tobacco currently or in the past. patients admitted having experienced seizures under depri-
Alcohol consumption was found in 1.4% of the patients and vation of sleep or breach of treatment. The rest of factors
3.7% of them admitted being addicted to alcohol in the past. included in the study resulted in very low percentages of
Consumption of other toxic substances, cocaine mainly, was patients (Table 3).
latent only in one of our patients although 1.4% of the sample Of all the patients treated with antiepileptic drugs,
admitted its consumption in the past. approximately half of them were treated with monother-
Of the 493 patients who showed associated pathologies, apy (54.3%), 30.87% with bitherapy, 12.2% tritherapy and
we detected 13% of patients with some kind of psychopathol- approximately 1% was treated with 4 drugs. Of all the
ogy. The commonest was the mixed anxiety depressive
disorder diagnosed by the patients general practitioners
Table 1 Etiology of epilepsy in the sample.
or during the medical interview that took place in the
Epilepsy Office. We also collected a total percentage of Percentage
28.4% patients suffering from different grades of mental
retardation. 18.1% of the patients reported other patholo- Structural or Congenital 24.5
gies. metabolic (S/M)
Consumption of non-antiepileptic drugs was also S/M Mesial temporal sclerosis 4.3
recorded. Although this information was not gathered from S/M CET 5.8
30% of the patients, it must be pointed out that 9.1% took S/M Toxic 2.5
benzodiazepines not used for regulating seizures and 8.2% S/M Vascular 4.1
took antidepressant drugs. 5% took neuroleptics and at S/M Infectious 1.9
least 20% of the patients took hypolipemiants. S/M Tumoral/postsurgical 4.5
Unknown Previously criptogenic 31.8
Genetic Previously idiopatic 16.7
Epidemiologic data Total 96.1
Lost System 3.9
In accordance to ILAES guidelines, 85.7% of the patients Total 100.0
of the sample showed active epilepsy when the study was
Prevalence and clinical characteristics of epilepsy 103

by carbamazepine, oxcarbacepine and levetiracetam (7%,

Table 2 Connatal or congenital focal epilepsies.
6% and 5% respectively).
Percentage Valid percentage

Valid Hypoxia 14.2 49.7

Maternal infection 1.4 4.8
Discussion
Altered cortical 6.4 22.4
development Taking into account the patients with active epilepsy in our
Vascular 1.4 4.8 data base, hospital prevalence rate in Western Mlaga for
malformation this disease in over 14 year old population is 4.79 cases
Congenital origin 5.2 18.4 per 1000 inhabitants which is considered visible epilepsy in
disease terms of Health Care. This prevalence can be considered the
Total 28.5 100.0 most important from the point of view of health resources
Lost System 71.5 management.
Total 100.0 Although we have only taken into account patients served
by one hospital of the province, we consider that the
epidemiologic analysis can provide information about the
epileptic population in the area as patients from all over
Table 3 Precipitant factors in the occurrence of seizures. Western Mlaga come to this hospital. The result, adjusted
Percentage to the strict population of our area, is very realistic and
between the common limits of 510 cases per 1000 inhab-
Valid Breach of treatment 6.0 itants that were mentioned in the introduction. Therefore,
Deprivation of sleep 6.0 it is an expected prevalence for a population similar to ours
Alcohol/drugs 1.7 and similar to the only Spanish study in adults to date too
Drug change 0.6 (Luengo et al., 2001).
Dose change 0.8 However, as this is a hospital-based study, we assume sev-
Brand change 2.9 eral important selection biases. We only took into account
Other 0.4 patients who came to the Epilepsy Office in our hospital. We
Breach of treatment or 1.7 have not included other patients treated in other neurology
deprivation of sleep offices in our centre or in other hospitals of Eastern Mlaga or
None admitted 78.8 Western Mlaga where there is no neurologist. We have not
Total 99.0 included neither those patients who are not treated in any
Lost System 1.0 way due to social isolation or lack of diagnosis of epilepsy
Total 100.0 (according to some authors, it is possible that up to 37% of
the epileptic population is not treated (Beghi et al., 1991))
nor those who are treated privately.
The fact that we receive patients from all over the West-
patients treated in the Epilepsy Office a total of 8 patients of ern area, further than our circumscription limits, enables
the sample were taking no antiepileptic drug. The common- us to add those patients characteristics to our foresight to
est drug is valproic acid (28.3%), followed by levetiracetam define the characteristics of all the West area. However, the
and lamotrigine with 23% each approximately (Fig. 2). patients who come to our Epilepsy Office are just those who
The most used drug for monotherapy in our sample was present a more complicated follow-up and it is possible that
valproic acid and lamotrigine (14% each). This is followed those who show a good control do not come to our office.
This could be another possible bias for the description of the
population.
We did not analyse the impact of the patients flow
between the two public hospitals in Malaga or between
Malaga and other provinces of Spain. But we have to mention
that Western Malaga, because of its soft weather, receives
a big amount of people from the rest of Spain and also from
other European countries, that are usually integrated in our
Health Service.
Table 4 shows summarized information from several pub-
lished studies and a comparison to our study.
In studies based on medical data bases and popula-
tion surveys, carried out mainly in developed countries,
Figure 2 Most consumed antiepileptic drugs. Abbreviations; prevalence rates range between the 2.7/1000 inhabitants
PTH phenytoine; PB phenobarbital; VPA valproic acid; in the 1940 Rochesters study (Hauser et al., 1991) and the
CBZ cabamazepine; OXC oxcarbazepine; CLB clobazam; 10.9/1000 inhabitants in a recent Croatian study in 2011
CLN clonazepam; LTG lamotrigine; TPM topiramate; LEV (Josipovic-Jelic et al., 2011). The average is 5.4 (see Table 4
levetiracetam; ZNS zonisamide; GBP gabapentin; PGB for detailed results). The published Spanish study in adults
pregabaline; RFM rufinamide. (Luengo et al., 2001) shows a crude prevalence rate of 4
104 G. Garcia-Martin et al.

Table 4 Epidemiologic data of the studies compared to our sample.

Ref. Region No. cases Prev/1000 inhab Prev per age Population Sex
e = elderly ad = adults
ad = adults ch = children
Ch = children

Hauser et al. (1991) USA, 1940 66 2.7 M

Hauser et al. (1991) USA, 1950 124 4.4 M
Hauser et al. (1991) USA, 1960 198 5.1 M
Hauser et al. (1991) USA, 1970 285 5.4 M
Hauser et al. (1991) USA, 1980 383 6.8 E > Ad > Ch Ad and Ch F
Haerer et al. (1986) USA 160 6.8 Ad and Ch M
Kelvin et al. (2007) USA 42 5.2 Ad and Ch F
Brewis, 1966 England 340 4.8 Ad and Ch
De Graaf, 1974 Norway 749 3.5 Ad and Ch M=F
Zielinski, 1974 Poland 33 7.8 Ad and Ch
Granieri et al. (1983) Italy 278 6.2 Ch > Ad > E Ad and Ch M
Joensen, 1986 Denmark 333 7.6 Ad > E > Ch Ad and Ch M
Kernen et al. (1989) Finland 1233 6.3 Ad > E Ad M
Maremmani et al. (1991) Italy 51 5.1 Ch > Ad > E Ad and Ch M
Giuliani et al. (1992) Italy 235 5.2 Ad and Ch M
Forsgren (1992) Sweden 713 5.5 Ad > E Ad M
Sidenvall et al. (1996) Sweden 868 5.2 Ch M
Reggio et al. (1996) Italy 27 2.7 Ad and Ch F
De la Court et al. (1996) Netherlands 43 7.7 E > Ad >55 years old
Erickson and Koivikko (1997) Finland 329 3.9 Ch
Olafsson and Hauser (1999) Iceland 428 4.8 E > Ad > Ch Ad and Ch M
Waaler et al. (2000) Norway Ch
Rocca et al. (2001) Italy 81 3.3 E > Ch > Ad Ad and Ch M
Luengo et al. (2001) Spain 405 4.1 E > Ch > Ad >10 years old
Oun et al. (2003) Estonia 396 5.3 Ad > Ch Ad M
Gallitto et al. (2005) Aeolian 42 3.1 Ch and Ad and Ch F
Islands E > Ad
(Italy)
Bielen et al. (2007) Croatia 1022 4.8 Ch > Ad > E Ad and Ch M
Picot et al. (2008) France 360 5.4 Ad > E >16 years old M
Benavente et al. (2009) Spain 122 6.3 1019 years F
Guekht et al. (2010) Russia 1753 3.4 Ad > Ch > E Ad M
Linehan et al. (2010)a Ireland 749 8.7 E > Ad > Ch Ad M
Josipovic-Jelic et al. (2011) Croatia 1228 10.9 Ad > E > Ch Ad and Ch M
Garcia-Martin et al. (this paper) Spain 515 4.79 Ad > E >14 years old M

Ref. Epi type Etiol Vasc CET Neopl Infect Congenit % seiz-free Com AEDS
% % % % % >1 year

Hauser et al. (1991)

Hauser et al. (1991)
Hauser et al. (1991)
Hauser et al. (1991)
Hauser et al. (1991) 59%P 76% unknown 6 5 2 4 5
Haerer et al. (1986) 75%G 63% unknown
Kelvin et al. (2007) 52.4%G 66.7 idiop/cripto
Brewis, 1966
De Graaf, 1974
Zielinski, 1974
Granieri et al. (1983) 60%G 60% unknown
Joensen, 1986 51%P
Kernen et al. (1989) 55%P
Maremmani et al. (1991) 33%P
Giuliani et al. (1992) 74%G 66% unknown
Prevalence and clinical characteristics of epilepsy 105

Table 4 (Continued )

Ref. Epi type Etiol Vasc CET Neopl Infect Congenit % seiz-free Com AEDS
% % % % % >1 year

Forsgren, 1992 60%P 65% unknown 21 2 7 0 7 26

Sidenvall et al. (1996) 48
Reggio et al. (1996)
De la Court et al. (1996) 83%P
Erickson and Koivikko (1997) 53
Olafsson and Hauser (1999) 63%G 62% unknown 8 4 7 3 18 36 CBZ
Waaler et al. (2000) 31
Rocca et al. (2001) 74%G
Luengo et al. (2001) 64%P 33% idiop36%
cripto
Oun et al. (2003) 56% symptomatic 20 16 10 1 4
Gallitto et al. (2005) 62%P 52% unknown 8.5 4.2 6.3 14.9 23.4 PB
Bielen et al. (2007)
Picot et al. (2008) 63.6%P 20% criptog 29% 15.8 18.7 17 9.4 25.1
idiop 46%
symptomatic
Benavente et al. (2009) 53.2%G 80.3%idiopcripto
19.7%
symptomatic
Guekht et al. (2010) 81.6%P >Idiop/cripto 12.3 27.8 4.8 7.8 12 8.8 CBZ
Linehan et al. (2010)a
Josipovic-Jelic et al. (2011) 58.9%P 62.4%symptomatic 16.8 9.4 4
Garcia-Martin (this paper) 75.5%P 33.1%cripto 4.1 5.8 4.5 1.9 24.5 57.5 VPA
17.4%idiop
Epi type = epilepsy type; etiol = etiology; vasc = vascular; CET = cranioencephalic trauma; neopl = neoplasic; infect = infectious; con-
genit = congenital; idiop = idiopatic; cripto = criptogenic; com AED = commonest AED; P = partial; G = generalized.
a Studies carried out without clearly established criteria for active epilepsy.

(very similar to ours) although the Spanish study in teen
population shows a bigger one (Benavente et al., 2009).
However, as the ILAE points out, the differences between
studies can be caused by geographic and/or etiological dif-
ferences that can contribute to geographic variations or
changes in the incidence due to variations in specific age
groups (ILAE Commission Report, 1997).
If we consider gender, as most of other studies have
revealed, there seems to be a higher frequency of epilepsy
between males (Granieri et al., 1983; Joensen, 1986; Haerer
et al., 1986; Hauser et al., 1991; Forsgren, 1992; Giuliani
et al., 1992; Sidenvall et al., 1996; Olafsson and Hauser,
1999; Rocca et al., 2001; Oun et al., 2003; Bielen et al.,
2007; Picot et al., 2008; Guekht et al., 2010), with a differ-
ence of percentages males/females similar to those of the
above mentioned studies (Picot et al., 2008; Bielen et al.,
2007).
For our sample the medium age is 40. It is difficult to
compare this information with other studies due to the
differences between the inclusion criteria between them
(some include people under 18, others do not and others,
like we do, include people from 14 on).
It must be remarked that in our sample, the age group
over 60 years old is very small. If we compare this to the
different studies the situation varies. In contrast to our
results, some studies (De la Court et al., 1996; Olafsson
and Hauser, 1999; Luengo et al., 2001; Rocca et al., 2001)
show the highest prevalence rates for this age group. How-
ever most studies, according to Banerjeees review, show a
stable frequency in the third and fourth decade and then
change from the fifth decade on, as our study and the stud-
ies done after Banerjees review reveal (Picot et al., 2008;
Banerjee et al., 2009; Guekht et al., 2010; Josipovic-Jelic
et al., 2011).
It is possible that the actual proportion of epileptics over
60 is higher than the one we got in our sample. This infor-
mation could be biased due to our selection of patients,
limited to those who attended specifically the Epilepsy
Office. It is highly probable that epileptic patients over 60,
as Christensen points out in Denmark (Christensen et al.,
2007), can have a higher incidence of epilepsy of vascu-
lar origin or related to dementia. These easy-to-treat cases
normally require only one drug and consequently do not
require the assistance of an expert epileptologist. There-
fore, these patients do not get to our office (Poza-Aldea,
2006).
It is remarkable that we have a high percentage of mental
retardation, comparing to other studies (Benavente et al.,
2009). It may be because the area we treat is culturally an
endogamic region but also because here it is located one of
the main institutions for mentally disabled persons in the
province, so it could be another selection bias.
The proportion between focal and generalized seizures
varies from one study to the other. Those European studies
106
which include adults coincide with our study in the predom-
inance of the focal onset seizures (Joensen, 1986; Kernen
et al., 1989; Forsgren, 1992; De la Court et al., 1996; Luengo
et al., 2001; Forsgren et al., 2005; Gallitto et al., 2005;
Picot et al., 2008; Guekht et al., 2010; Josipovic-Jelic et al.,
2011) whereas those which include younger patients (chil-
dren and teenagers) show smaller percentages (Benavente
et al., 2009). This may be due to the increase of the inci-
dence of epilepsies of acquired etiologies with age.
The analysis of the commonest etiologies implied in the
origin of epilepsy in the patients of our sample coincides
with most of the studies (Forsgren, 1992; Giuliani et al.,
1992; Granieri et al., 1983; Haerer et al., 1986; Olafsson
and Hauser, 1999; Oun et al., 2003; Gallitto et al., 2005;
Kelvin et al., 2007; Picot et al., 2008; Josipovic-Jelic et al.,
2011) with some differences, as it can be seen in the table,
probably related to the inner characteristics of each popu-
lation and to the criteria used for its classification (as some
etiologies could be included in different sections depending
on the researchers criteria).
It is noteworthy that we have a small number of hip-
pocampal sclerosis and cortical dysplasias, and probably
associated to it, the group of cryptogenic origin is not so
small as it should be. The explanation is that the access
to 3 T Magnetic Resonance Imaging (MRI) was not easy until
recently and we have an economic limitation to ask for it in
all the cases, overcoat if they are not candidates to surgery.
Data on the frequency of the seizures for the patients of
our sample are, once again, similar to the ones which the
European studies show (Baker et al., 1997; Forsgren, 1992;
Sidenvall et al., 1996; Olafsson and Hauser, 1999; Waaler
et al., 2000; Gallitto et al., 2005). The proportion of seizure-
free patients in the last year is generally between 31% and
53% except in Russia (Guekht et al., 2010) and in the last
Croatian study (Josipovic-Jelic et al., 2011) where the per-
centage is much inferior (8% and 4.3% respectively).
In the analysis of precipitant factors in the occurrence
of seizures, the low percentage of breach of treatment is
explained because we only collected those who recognized
it in the last seizure.
The most consumed antiepileptic drug in our sample is
valproic acid. Not many of the studies reviewed for this work
mention this topic. In Gallittos Italian study the commonest
drug is phenobarbital (Gallitto et al., 2005). In the Russian
(Guekht et al., 2010) and the Icelandic studies (Olafsson
and Hauser, 1999) the commonest drug was carbamazepine
(36%).
As we can clearly appreciate from the above mentioned,
consumption of classical drugs is more common although in
our sample consumption of new generation drugs is increas-
ing (Fig. 2).
It seems the situation in Russia and the Aeolian Islands is
different as new generation drugs are only consumed in 5%
of the cases (Gallitto et al., 2005; Guekht et al., 2010). This
can have an economical explanation as there is a difference
in the cost of classical and new drugs.
Finally, considering the associated pathologies of the
patients in the sample, we have 28.4% patients with any kind
of psychic disability. Although Forsgren et al. (2005) and Bie-
lens studies (Bielen et al., 2007) provide similar results (23%
and 23.4% respectively), in general, all of the studies pro-
vide smaller percentages than ours (Olafsson and Hauser in
G. Garcia-Martin et al.
1999, 14.5%; Picot et al. in 2008, 21%; Josipovic-Jelic et al.
in 2011, 16.4%). This could be due to the fact that this is a
hospital-based prevalence study carried out in the Epilepsy
Office which, proportionately, probably assists more cases
of refractory epilepsy, commonly associated to disabilities.
Psychiatric pathologies represent 13% of the pathologies
in the sample although we would have to add a great number
of patients with mental retardation (more than the fourth
of the sample) who commonly show a psychiatric disorder. If
we consider the number of patients who consume drugs for
anxiety and/or depression, there would be 19.9% of patients
with some kind of possible psychopathology alteration. Our
results are in accordance to those of many other authors
(1319.9%) (Jalava and Sillanp, 1996; Mensah et al., 2006;
Tellez-Zenteno et al., 2007; Picot et al., 2008).
Limitations
As it has been explained through the whole article, the main
bias of it has to do with the fact that patients were recruited
at a hospital level. This supposes a bias for the calculation of
the prevalence but also for the characteristics of the sam-
ple. Probably there would be an increase of refractoriness.
Furthermore, there are some patients who have not been
included like those who have not been diagnosed, those who
are not treated, those who are treated in the General Neu-
rology Office, those who are treated in Primary Care or those
who are treated by other specialists. Probably all of them
would have more benign epilepsies. Those patients who are
treated in the private sector have not been included either.
We did not analyse the patients flow between hospitals or
provinces, what may also influence on the results.
Another limitation in this study is that none structured
questionnaire was used for the compilation of information
about patients. This explains the high percentage of patients
in whom some information gets lost.
In other field, the scanty diagnostic resources may influ-
ence the findings in Etiology, so that these results should be
verified in a better economic situation in the future.
However, given the particular characteristics of our
province Health Care Service, we can consider that this arti-
cle provides real and relevant information on the epileptic
population of the area.
Conclusions
This study is the first epidemiologic of epilepsy carried out
in the South of Spain with a prevalence rate of 4.79 epilep-
tic patients out of each 1000 inhabitants. Although it is a
hospital-based study, it provides significant data on the char-
acteristics of the study population in Western Mlaga and on
the prevalence, given the particular characteristics of the
Health Care Service of the province.
The results that we provide are in agreement with those
provided by other European authors, more precisely with
those by Spanish and French authors. Therefore, these
results confirm the characteristics of epilepsy in the South-
West of Europe where information was lacking.
From our point of view, knowing the epileptic population
who require hospital treatment is vital in terms of Health
Prevalence and clinical characteristics of epilepsy
Care management. Consequently, this knowledge may be the
most relevant finding from a financial point of view.
Conflicts of interest
None of the authors has any conflict of interest to disclose.
Acknowledgements
We should like to offer our warmest thanks to Dr. Pedro
Serrano Castro, Head of the Neurology Department in
Torrecardenas Hospital (Almeria, Spain), for his useful sug-
gestions for this epidemiological study.
We also have to thank Paula Ocana Lopez for her contri-
bution in the translation of the paper.
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