Socioeconomic consequences of drug-resistant epilepsy in an adult cohort from southern India Aparajita Chatterjee, Radhika Nair, Ranjith Gandeti, Goutham Kumar Puppala, Vijay Chandran, Sankar Prasad Gorthi, Kurupath Radhakrishnan ⁎ ,1 Department of Neurology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India abstract article info Article history: Received 3 April 2020 Revised 12 May 2020 Accepted 13 May 2020 Available online xxxx Objective: The objective of this study was to describe the socioeconomic consequences of drug-resistant epilepsy (DRE). Methods: This study comprised 132 (equal males and females) consecutive patients aged ≥18 years, who fulfilled the International League Against Epilepsy (ILAE) definition for DRE, prospectively seen in a tertiary care center in South India. We used a structured questionnaire to gather relevant information. Results: The mean age was 31 (range 18–70) years. Mean age of onset of epilepsy was 17 years and mean duration of epilepsy 14 years. The most common epilepsy type and etiology were focal epilepsy and gliotic lesions secondary to perinatal insults, respectively. The average out of the pocket expenditure on antiseizure drugs annually amounted to 19% of the gross national product (GNP)/capita, which was borne by family members in more than two-thirds of the subjects. Almost 60% reported epilepsy having affected their education, 40% their employment, and 90% their marital prospects. Female patients were less often employed outside their homes and had more marital problems compared with males. Conclusions: In addition to high seizure burden, DRE adversely affects the pursuit of higher education, employment, and marriage. Besides the direct cost of epilepsy, these issues augment both the patient and the caregiver's liability. Socioeconomic consequences of DRE are widely prevalent in developing countries, and this study highlights the need to address them. © 2020 Elsevier Inc. All rights reserved. Keywords: Disability Drug-resistant epilepsy Education Employment Marriage Socioeconomic consequences 1. Introduction Epilepsy is a disease of the brain that is characterized not only by a lasting predisposition to generate seizures, but also by its neurologic, cog- nitive, psychological, social, and economic consequences [1, 2]. It is one of the commonest diseases encountered in routine neurologic practice and affects approximately 65 million people worldwide, of which more than 80% reside in the low- and middle-income countries (LAMIC) of the world [3]. Although for a majority of people with epilepsy (PWE), the seizures get controlled with antiseizure drugs (ASD), nearly 30% of PWE are drug-resistant [4]. People with drug-resistant epilepsy (DRE) are at an increased risk for premature death, injuries, and a variety of psychoso- cial problems [5]. People of LAMIC are ill-equipped to tackle the enor- mous medical, psychosocial, and economic challenges posed by DRE [3]. We designed this prospective study to evaluate the socioeconomic consequences of DRE among a consecutively collected cohort of adult patients from South India. Knowledge of these factors is essential for us to address them, which in addition to the conventional therapy of epilepsy would improve the quality of life of patients with DRE and their caregivers. 2. Subject and methods 2.1. Patient selection This prospective observational study was undertaken at the Kasturba Medical College Hospital, a tertiary care center in coastal Karnataka, South India, from May 2015 to July 2016. We recruited 132 consecutive patients aged 18 years or more with DRE from the Epilepsy Program of the Depart- ment of Neurology. The scalp electroencephalogram (EEG) revealed interictal epileptiform abnormalities in every patient. A 1.5-Tesla brain magnetic resonance imaging (MRI) according to epilepsy protocol was available for every patient. Additionally, 108 (81.8%) patients had prolonged video-EEG (VEEG) recordings; in 87 (80.5%) of them, seizures were recorded. We used the 2017 International League Against Epilepsy (ILAE) classifications of seizures [6] and epilepsies [7]. We adhered to the ILAE consensus definition for drug resistance as failure to achieve Epilepsy & Behavior 110 (2020) 107173 ⁎ Corresponding author at: Department of Neurosciences, Avitis Institute of Medical Sciences, Nemmara, Palakkad – 678 508, Kerala, India. E-mail address: drradhakrishnan.k@avitishospital.com (K. Radhakrishnan). 1 Present address. YEBEH-107173; No of Pages 6 https://doi.org/10.1016/j.yebeh.2020.107173 1525-5050/© 2020 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh Please cite this article as: A. Chatterjee, R. Nair, R. Gandeti, et al., Socioeconomic consequences of drug-resistant epilepsy in an adult cohort from southern India, Epilepsy & Behavior, https://doi.org/10.1016/j.yebeh.2020.107173