Epilepsy among the homeless
Contact : A. Laporte
Epilepsy is a common chronic neurological disorder, with an estimated prevalence of 5–8 cases per 1000 persons in industrialized countries. Many people with epilepsy feel socially
stigmatized. Discriminatory behaviours still persist, notably in the workplace. Homelessness is associated with increased morbidity and mortality compared with the general population, and some medical problems are particularly prevalent such as seizures. In 2003, a study was initiated among the homeless people seeking assistance from a welfare organization (samusocial) in Paris (France), to estimate the prevalence of epilepsy and to determine its characteristics, management practices, the impact of the disease on professional career and the consequences of street life on seizure frequency.
During the study period, 592 adults attended at least one medical consultation 86 subjects reported at least one seizure over their lifetime history which amounts to 14.5% (95% CI 11.8–17.6) for the overall sample. A logistic regression among men showed an increased risk of seizures among alcoholics and persons homeless for more than 2 years; and a lower risk among persons aged more than 60 years. Among the 86 patients who reported a history of seizures, 59.3% were classified as having epilepsy and 40.7% as having alcohol related seizure (ARS). The prevalence of active epilepsy in the entire population was 8.1% (6.0–10.6). Among the 86 patients, 57.1% had anti-epileptic treatment and 77.1% took their drug daily. In 46.5% of cases the frequency of seizures increased following the onset of homelessness; the principal stated reasons were alcohol (75%), sleep privation (42.5%), anxiety (32.5%), and stress (27.5%). Seizures had an impact on the employment of 30.6% of subjects in the epilepsy group, of whom 78.6% had given up work entirely.
The prevalence of active epilepsy in the study population (8.1%) is markedly higher than that estimated in the general population (<1%). These results suggest that epilepsy is a serious health problem among the homeless and that it contributes to the social exclusion process. The proportion of subjects taking treatment for epilepsy and the compliance rate challenge certain prejudices regarding non-compliance and widespread alcoholism and call for reflection on the optimal management of epilepsy in this population.
Grants : Sanofi-Aventis
Partnerships : Ligue Française Contre l’Epilepsie, Fondation Française pour la Recherche sur l’Epilepsie.
"Epilepsy among the homeless: prevalence and characteristics", Laporte A., Rouvel-Tallec A., Grosdidier E., Carpentier S., Benoit C., Gérard D., Emmanuelli X., European Journal of Public Health, 16, 5, p. 484–486.
Consensus conference, 17 novembre 2004, Paris.
Conclusions of the consensus conference, Paris, novembre 2004.
Publication des recommandations dans les revues médicales suivantes :Neurologies (avril 2005 ;8 (70) : 177-180) ; La lettre du NeurologueEpilepsies (2005 ; 17 (3) : 141-3) ; Urgences pratiques (juillet 2005 ;71 : 43-45) ; La revue des SAMU (juillet 2005 ; 27 (5) : 224-26) ; JEUR(Journal Européen des URgences)(2005 ; 18 : 179-182) ; La revue Neurologique (2006 ; 162(2) : 265-267). (juin 2005 ;9 (6) :212-14) ;