Abstracts

Rationale: Qatar is a small country on the eastern coast of the Arabian Peninsula. Its population is a mixture of native citizens and immigrants. We aim at describing the features of epilepsy in Qatar as such information is virtually lacking from the current literature.Methods: A database was created in 2014 to summarize information retrospectively collected on patients with epilepsy seen through the national health system (HMC) adult neurology clinic. For each subject, in addition to the typical demographic variables, we identified the age at onset, seizure types, epilepsy syndrome, etiology, treatment and outcome. Brain imaging and EEG results were also tabulated. All these variables were analyzed using the statistical package for social science (IBM-SPSS, version 20).Results: Of 504 patients included in the database, 467 with sufficient information were analyzed. Sixty percent were men. The mean age at the last clinic visit was 35. Native Qataris represented 38.5%, Asian subjects 33%, and Middle Eastern/North African (MENA) origin accounted for 25% of the studied population. Generalized tonic-clonic seizures were the most common seizure type, noted in 89% of subjects. Epilepsy was classified as focal in 65.5% of the cases, and generalized in 23%. EEGs were abnormal in 55.5 %, showing epileptiform discharges in 49% of subjects. Imaging studies revealed epileptogenic pathologies in 40% of reports. Common causes of epilepsy were: vascular (11%), hippocampal sclerosis (8%), infectious (6%) and trauma (6%). Sixty six percent of patients were receiving a single antiepileptic drug, and 53% were seizure free at the last follow-up. When the patients were divided by geographical background, some differences were noted. Remote infections caused the epilepsy in 15% of Asian patients (with neurocysticercosis accounting for 10%), but only in 1% of Qatari and 3% of MENA subjects (with no reported neurocysticercosis) (p<0.001). Vascular and neurodegenerative etiologies were prominent in Qataris, accounting for 18% (p=0.005) and 4% (p=0.03) of cases respectively. Levetiracetam was the most prescribed drug for MENA and Qatari patients (48%), whereas Phenytoin was the most prescribed in Asian subjects (33%) (p<0.001). This difference in treatment trends did not influence the seizure free rate amongst the different geographical subgroups (p=0.1).Conclusions: To our knowledge, this is the first detailed cohort-based information about epilepsy in Qatar, a country with a rich mix of ethnic backgrounds. The geographical origin of patients adds to the heterogeneity of this disorder. Neurocysticercosis should be in the etiological differential diagnosis of epilepsy in patients coming from Southeastern Asian countries. With the resident Qatari subgroup accounting for most elderly patients with epilepsy, it is not surprising to see a higher contribution of stroke and neurodegeneration to the burden of epilepsy in this group. The choice of antiepileptic drugs is influenced by the availability of individual agents in patients’ native countries, but had no bearing on the final seizure outcome. Study supported by: QNRF.