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Epileptic Disorders - Editor's Choice

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May, 2015

Management of epilepsy in resource-limited settings  

Epileptic Disorders December 2014

Roberto Caraballo, Natalio Fejerman. Neurology Department, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina.
Epileptic Disorders 2015; 17(1): 13-18.

Commentary by Mike Kerr, Associate Editor
Professor of Learning Disability Psychiatry, Insititute of Psychiatric Medicine & Clinical Neurosciences, Cardiff

The Epilepsy Treatment Gap is huge, as the authors state, 80% of the Global epilepsy population living in resource poor nations; and 90% of these receive no treatment. This seminars series article highlights the challenges including: high incidence, frequent preventable causes, prohibitive cost of treatment and limited availability of trained professionals.

The message for solutions is well made. Information is the key, through high quality epidemiological studies. Though such studies are themselves challenging due to the multiple aetiologies and clinical presentations, especially in countries who have sparse diagnostic resources. Such information can lead to policy focusing on international human rights standards. Rare local neurological professionals need a broad role as educators, advisors and advocates. The next generation of neurologists should be offered training in better resourced epilepsy settings enabling them to cascade their knowledge to less trained local professional.

There are many other good suggestions in this article. In fact I suspect many readers from higher income countries will find the problems resonate with their own experience especially a lack of policy, poor information and continued stigma.

The authors reflect on the importance of the Global Campaign Against Epilepsy. For me their most powerful message is the way a lack of epidemiological evidence means the burden of disease is not communicated, patients are not identified and as a result of this epilepsy does not feature in public health priorities.

Lastly there could not be a more timely publication in the light of the recent fantastic announcement that the resolution, Global burden of epilepsy and the need for coordinated action at the country level to address its health, social and public knowledge implications, was approved on May 26, 2015by the WHO General Assembly and it is now an official WHO document. This great work by ILAE and IBE should be further step to reducing the treatment gap.

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