title: Epilepsy care in the southern Caribbean.
abstract: Very little has been reported about the health resources available for patients with epilepsy in the five English-speaking southern Caribbean countries of Trinidad and Tobago, Barbados, Grenada, Saint Vincent and the Grenadines, and Saint Lucia. There is no comprehensive resource describing their health systems, access to specialty care, antiepileptic drug (AED) use, and availability of brain imaging and EEG. The purpose of this study was to profile epilepsy care in these countries as an initial step toward improving the standard of care and identifying gaps in care to guide future policy changes. In each southern Caribbean country, we conducted study visits and interviewed health-care providers, government health ministers, pharmacy directors, hospital medical directors, pharmacists, clinic staff, radiologists, and radiology and EEG technicians. Health-care providers completed extensive epilepsy care surveys. The five countries all have integrated government health systems with clinics and hospitals that provide free or heavily subsidized care and AEDs for patients with epilepsy. Only Trinidad and Tobago and Barbados, however, have neurology specialists. The three smaller countries lack government imaging and EEG facilities. Trinidad had up to one-year waits for public MRI/EEG. Government formularies in Grenada, Saint Vincent and the Grenadines, and Saint Lucia are limited to first-generation AEDs. One or more second-line agents are formulary in Trinidad and Barbados. Nonformulary drugs may be obtained for individual patients in Barbados. Grenada, Saint Lucia, and Saint Vincent and the Grenadines participate in an Organization of Eastern Caribbean States formulary purchasing system, which added levetiracetam following the survey. Newer generic AED formulations with the lowest risks for pregnancy malformation were not in use. In conclusion, patients with epilepsy in the southern Caribbean have excellent access to government clinics and hospitals, but AED choices are limited. Local medical providers reported that the major limitations in care were lack of specialty care, lack of imaging and EEG services, financial barriers to care, long wait times for care, and limited access to additional AEDs.
authors: Department of Neurology, Johns Hopkins University, Meyer 2-147, 600 N Wolfe St., Baltimore, MD 21287, USA. Electronic address: gkrauss@jhmi.edu.
authors: Gregory
authors: G
authors: Krauss
authors: Medicine Department, University of the West Indies, Champ Fleurs, St. Augustine, Trinidad and Tobago. Electronic address: drsherrysandy@yahoo.com.
authors: Sherry
authors: S
authors: Sandy
authors: Queen Elizabeth Hospital, Bridgetown, Barbados. Electronic address: doccpec@yahoo.com.
authors: David O C
authors: DO
authors: Corbin
authors: Community Child Health Service, Ministry of Health, La Pansee Road, Castries, Saint Lucia. Electronic address: jbird@candw.lc.
authors: Jacqueline
authors: J
authors: Bird-Compton
authors: Medicine Department, Trinity School of Medicine, Ratho Mill, Kingstown, Saint Vincent and the Grenadines. Electronic address: tsomdesk.fj@gmail.com.
authors: Frances
authors: F
authors: Jack
authors: Ministry of Health, General Hospital Grenada, Ministerial Complex, Botanical Gardens, St. George's, Grenada. Electronic address: beverley@spiceisle.com.
authors: Beverly
authors: B
authors: Nelson
authors: Department of Physiology and Neuroscience, St. George's University School of Medicine, Grenada. Electronic address: TJalonen@sgu.edu.
authors: Tuula O
authors: TO
authors: Jalonen
authors: Andrews Memorial Hospital, Epilepsy Centre of Jamaica, New Kingston, Kingston, Jamaica. Electronic address: amzamd@yahoo.com.
authors: Amza
authors: A
authors: Ali
authors: Department of Neurology, Johns Hopkins University, Meyer 2-147, 600 N Wolfe St., Baltimore, MD 21287, USA. Electronic address: drtaryn@gmail.com.
authors: Taryn
authors: T
authors: Fortuné
authors: Dell Children's Medical Center, Pediatric Neurology/Epilepsy, 4900 Mueler Blvd., Austin, TX 78723, USA. Electronic address: dfClarke@seton.org.
authors: Dave
authors: D
authors: Clarke
authors: Department of Neurology, Johns Hopkins University, Meyer 2-147, 600 N Wolfe St., Baltimore, MD 21287, USA. Electronic address: jacqueline389@gmail.com.
authors: Jacqueline
authors: J
authors: Okolie
authors: Department of Neurology, Johns Hopkins University, Meyer 2-147, 600 N Wolfe St., Baltimore, MD 21287, USA. Electronic address: mcerven1@jhmi.edu.
authors: Mackenzie C
authors: MC
authors: Cervenka
mesh_terms: D000927:Anticonvulsants / Q000600:supply & distribution; D001460:Barbados; D017691:Caribbean Region / Q000453:epidemiology; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D003906:Developing Countries; D004363:Drug Utilization; D004569:Electroencephalography; D004827:Epilepsy / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D005569:Formularies as Topic; D006282:Health Personnel / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009462:Neurology / Q000706:statistics & numerical data; D011247:Pregnancy; D019431:Saint Lucia; D019436:Saint Vincent and the Grenadines
chemical_list: D000927:Anticonvulsants
keywords: Antiepileptic drug; Caribbean; Electroencephalography; Epilepsy; Health-care resources; Seizure