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Challenges in the management of epilepsy in resource-poor countries

Nature Reviews Neurology volume 5, pages 323–330 (2009)Cite this article

Abstract

Of the 50 million people with epilepsy worldwide, around 80% reside in resource-poor countries, which are ill-equipped to tackle the enormous medical, social and economic challenges posed by epilepsy. The capability to identify people with epilepsy and provide cost-effective care is compromised by widespread poverty, illiteracy, inefficient and unevenly distributed health-care systems, and social stigma and misconceptions surrounding the disease. Several studies have reported that a large proportion of patients with epilepsy in resource-poor countries never receive appropriate treatment for their condition, and many, although diagnosed and initiated on treatment, soon discontinue treatment. The high cost of treatment, a lack of availability of antiepileptic drugs, and superstitious and cultural beliefs contribute to a large epilepsy treatment gap. A substantial proportion of the current burden of epilepsy in resource-poor countries could be minimized by educating the public about positive features of life with epilepsy, informing primary and secondary physicians about current trends in the management of epilepsies, scaling up routine availability of low-cost antiepileptic drugs, and developing cost-effective epilepsy surgery programs. A comprehensive epilepsy care model should consider the marked heterogeneity of the disorder and its variable effects on the patient, family and community.

Key Points

  • Resource-poor countries carry an enormous burden of epilepsy

  • A substantial proportion of patients in resource-poor countries never receive appropriate treatment

  • This treatment gap can be minimized by educating primary care physicians on how to diagnose epilepsy and administer phenobarbital treatment

  • Few of the epilepsy surgery programs in resource-poor countries have produced results comparable to those in wealthier countries

  • Epilepsy care programs in resource-poor countries must adjust to local sociocultural, political and economic scenarios

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Figure 1: The epilepsy care pyramid.

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Acknowledgements

I wish to thank my colleagues at the R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Trivandrum, Kerala, India for their help in compiling this review.

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Author notes

  1. K. Radhakrishnan, Department of Neurology, R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695 011, Kerala, India krk@sctimst.ac.in

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  1. R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India

    Kurupath Radhakrishnan

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Radhakrishnan, K. Challenges in the management of epilepsy in resource-poor countries. Nat Rev Neurol 5, 323–330 (2009). https://doi.org/10.1038/nrneurol.2009.53

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