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  • Updated 07.30.2022
  • Released 10.14.2009
  • Expires For CME 07.30.2025

Epilepsy: treatment in low and middle income countries



About 80% of persons with epilepsy inhabit low and middle income countries (LMICs). Studies have shown that up to 70% of newly diagnosed children and adults with epilepsy are successfully treated with antiseizure medications. In lower income regions, up to 75% of people with epilepsy may not receive the treatment they need. The treatment gap in these regions needs to be narrowed to decrease morbidity and mortality due to epilepsy.

Historical note. The earliest detailed account of epilepsy resides in the British Museum in London. It is part of a Babylonian text on medicine, Sakikku, written over 3000 years ago. The Babylonians provided descriptions of many of the seizure types (miqtu), including what are now called “tonic-clonic seizures,” “absences,” “drop attacks,” “focal impaired awareness or focal aware seizures,” “gelastic seizures,” and “focal motor (Jacksonian) seizures.” The supernatural view has dominated thinking about epilepsy since then and even now remains a deeply rooted negative social influence in many parts of the world.

The supernatural basis was challenged by the school of Hippocrates in the fifth century BC Greece, which first suggested that the brain was the seat of this disorder; however, this concept was later replaced by supernatural causes in much of the world (42). By the seventeenth and eighteenth centuries, the Hippocratic concept of epilepsy as a brain disorder began to resurface. During these 2 centuries, efforts was made to separate “nervous disorders” from “mental disorders,” which led to the beginnings of modern neurology in the nineteenth century. Many treatises during this era covered convulsive diseases and also included hysteria, tetanus, tremors, rigors, and other paroxysmal movement disorders. The latter were gradually separated from epilepsy in the nineteenth century.

The understanding of the basis of epilepsy among poorly educated people in the developing world varies widely, and the supernatural and mental illness concepts remain the understanding for many. Even now, many who live with epilepsy in low and middle income countries believe the cause of their disease to be related to fever, demonic power, curses, beatings, witchcraft, and God (31).

Fortunately, modern treatments are sometimes available. In recent decades, many new drugs have been developed, some of which are available in developing countries.

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