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Methodologic issues in assessing risk factors for epilepsy in an epidemiologic study in India

From the Neurosciences Unit, Institute of Child Health, University College London, London, UK; and SANCHAR-AROD, Pailan, West Bengal, India.

Address correspondence and reprint requests to Dr. D.K. Pal, Neurosciences Unit, Institute of Child Health, University College London, The Wolfson Centre, Mecklenburgh Square, London WC1N 2AP, UK.

OBJECTIVES: To test a field questionnaire for epilepsy risk factors in rural India.

BACKGROUND: Case–control studies are necessary to plan appropriate prevention and intervention strategies against epilepsy but difficult to mount in developing countries for various logistic and cultural reasons. Recent studies have proposed nutritional and infective risk factors not reported in Western studies.

METHODS: A structured questionnaire including known and putative risk factors was administered to parents of 61 children with epilepsy and 59 randomly selected population control subjects in rural West Bengal. ORs of effect were calculated using a multiple logistic regression model with 95% CIs.

RESULTS: Socioeconomic status, febrile convulsions, and reproductive history were easily assessable. Ages, dates, and some proxy infection markers were unreliable. Febrile convulsions were an independent risk factor (OR 6.45; 95% CI, 1.45 to 28.66). Associations with family history and infective symptoms were suggested. No association was demonstrated with socioeconomic status or reproductive factors.

CONCLUSIONS: Known risk factors were confirmed, and novel factors were suggested. A retrospective questionnaire does not allow accurate study of infective exposures. Greater statistical power is needed to study weaker associations and interacting effects.

Key words: Epilepsy—Childhood—Risk factors—Epidemiology—Infection.