Treatment Gap in Patients with Epilepsy

Introduction

There are nearly 50 million people with epilepsy (PWE) worldwide according to WHO 80% of the people reside in developing countries, [1] among which, approximately 12 million people reside in India, accounting to nearly one- fifth of the global burden [2]. The estimated proportion with active epilepsy among general population, worldwide at a given time is between 4 to10 per 1000 people. While, in low and middle-income countries, the proportion are considered to be much higher, between 7 and 14 per 1000 people [1]. Active epilepsy is been defined as “the affected person who has or had at least one seizure in previous 5 years, irrespective of antiepileptic drugs (AEDs) used. The treatment gap in epilepsy i.e., the percentage of people with untreated epilepsy in India ranges from 22% in the urban setting to as high as 90% in villages [3].

Following are few points which need to be considered to control epilepsy or cure the disease in a majority of people with epilepsy (PWE) in India:

1. To estimate the actual number of people with epilepsy,

2. To identify the drug sensitive and drug resistant people among PWE,

3. To initiate the therapy and maintenance with first line anti-epileptic drugs as monotherapy,

4. To refer people with drug resistant epilepsy (PWDRE) to comprehensive epilepsy care centres (CECC), Letter to Editor

5. To initiate life-style modifications, rational polytherapy as well as alternate methods of treatment,

6. To identify people who can be treated with surgery for remedial lesional epilepsy syndromes by simple evaluation and to perform standard surgical procedures,

7. To provide long-term support for prevention and management of comorbidities and to improve quality of life.

Enormous effort is required by the government and NGO’s in educating PWE, also the general public along with medical communities regarding awareness in recent advances with regards to treatment of epilepsy [4].

Despite availability of numerous AEDs, there is a huge treatment gap ranging between 50%-70% among PWE. For cases which are treatable, this gap can be due to poverty, poor education, blind beliefs, social stigma, and poor healthcare infrastructure. While for chronic epilepsy, the gap can be attributed to lack of proper diagnosis, treatment, poor treatment adherence and compliance and cost of the AED prescribed by the PR actioner. The knowledge, attitude and practice among people with epilepsy play an important role to prevent, treat, and cure epilepsy.