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  • Updated 04.08.2024
  • Released 10.14.2009
  • Expires For CME 04.08.2027

Epilepsy: treatment in low and middle income countries



About 80% of people with epilepsy live in low- and middle-income countries (43; 66). Studies have shown that up to 70% of newly diagnosed children and adults with epilepsy can be successfully treated with antiseizure medications (27). In lower income regions, up to 75% of people with epilepsy may not receive the treatment they need (13). Earlier and more recent studies have reported a theoretical improvement in the epilepsy treatment gap, though this is still unproven (16; 56).

Historical note. The earliest trace of a seizure portrayal goes back to an inscription in a 4000-year-old tablet found in Mesopotamia (30). About 2000 years later, the Babylonians wrote the Sakikku, a medical text that provides a detailed report of distinct types of seizures and their characteristic presentations, with terms such as miqtu (fall), hayyatu (fit), and sibtu (seizure) and a description of the postictal state. They were also able to recognize prognostic features, though evil spirits were tied to causation, and spiritual interventions were thought to be the treatment (23). Since that time, humanity has linked epilepsy to supernatural events, and even now, a deeply rooted negative social influence prevails around the world.

Later, the Egyptians (circa 1700 BC), the Chinese (770–221 BC), and the school of Hippocrates (around the fifth century BC) challenged the supernatural basis of epilepsy and hypothesized that the brain was the source of this disorder (70; 23). By the seventeenth and eighteenth centuries, the Hippocratic concept of epilepsy as a brain disorder began to resurface (23). Among the many distinct diagnoses confused with epilepsy, the most frequent ones were hysteria, tetanus, tremors, rigors, and other paroxysmal movement disorders. During these two centuries, health entities such as the World Health Organization (WHO) and the International League Against Epilepsy (ILAE) made efforts to separate “nervous disorders” from “mental disorders,” which led to the beginning of modern neurology in the nineteenth century.

An understanding of the basis of epilepsy among individuals without formalized education has been an issue. Consequently, a considerable number of people residing in low- and middle-income countries believe that the cause of seizures and epilepsy is supernatural (demonic possession, witchcraft, and the divine). Additionally, mental illness is also confused as being part of the disease (59). A growing number of pharmacological treatments have become available year after year at a reasonable price all over the world, including in low- and middle-income countries. However, archaic ideas on the etiology of seizures and epilepsy create a predicament when attempting to ensure treatment initiation and compliance.

Key points

• The gap in epilepsy treatment between low-, middle- and high-income countries is a well-known reality.

• The first step in correcting the disparity in the treatment of epilepsy is to identify the precise etiology of the problem.

• Treatment guidelines, as well as applicable health policies, are crucial in the appropriate management of epilepsy in low- and middle- income countries.

• The utilization of newer, advanced technologies could be paramount in teaching, preventing, and treating epilepsy.

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