Epilepsy care challenges in developing countries.
OBJECTIVE
This review discusses recent literature relevant to the diagnosis and treatment of epilepsy in developing countries with particular attention to underlying causes, natural history, and advances made toward optimizing systems of care and bridging the treatment gap.


RESULTS
Prospective data suggest that cerebral malaria-induced brain injury may explain the high prevalence of epilepsy in malaria-endemic regions. Population-based mortality studies support the long proposed hypothesis that seizure-related deaths contribute to excessive premature mortality. WHO guidelines have the potential to improve care, but macrolevel barriers related to pharmaceutical regulation and distribution continue to contribute to the treatment gap. Evidence-based guidelines endorsed by the WHO and American Academy of Neurology regarding the optimal management of comorbid epilepsy and HIV may raise awareness regarding critical drug interactions between antiepileptic drugs and antiretrovirals, but are also problematic as the treatment regimen and diagnostic facilities routinely available in developing countries will prevent most healthcare providers from following the recommendations.


CONCLUSIONS
New insights into the causes, natural history and best care practices for epilepsy in developing countries are available but without prioritization and action from policy makers, the present treatment gap will likely to persist.
Department of Neurology, Vanderbilt University Medical Center, Medical Center North, Nashville, Tennessee, USA.
Michelle P
MP
Kvalsund
Gretchen L
GL
Birbeck
D003695:Delivery of Health Care / Q000592:standards / Q000706:statistics & numerical data*; D003906:Developing Countries; D004827:Epilepsy / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D017410:Practice Guidelines as Topic