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Epilepsy Treatment in Developing Countries

Epilepsy Treatment in Developing CountriesAround 50 million people experience recurrent and unprovoked seizures globally. People living with this condition have many triggers for these seizures such as psychological stress, missed medication and dehydration. Half of those living with the disease also have additional physical or psychiatric conditions.

While the physical toll of epilepsy is difficult to manage, the emotional toll is equivalently burdensome. In many countries, a large stigma surrounds patients as people perceive those with the disease as insane, untreatable and contagious. As a result, epilepsy affects people’s education, marriage and employment opportunities. The exclusion of epilepsy patients from society can even lead to increased mental health issues and delay access to proper healthcare treatments.

Epilepsy is a treatable condition if people have access to anti-seizure medication. However, roughly 80 percent of all cases are found in low or middle-income countries. Three-quarters of epilepsy patients living in low-income countries do not have access to life-saving treatment. This fact has sparked a movement in global organizations to raise more awareness about the issue of epilepsy treatment in developing countries.

Three Organizations Raising Awareness about Epilepsy Globally:

World Health Organization (WHO)

Up to 70 percent of people living with epilepsy could become seizure-free with access to treatment that costs 5 dollars per person. In order to address this treatment gap, epilepsy awareness must be prioritized in many countries. The WHO suggests that by labeling epilepsy as a public health priority the stigma surrounding the disease can be reduced. The organization believes that preventing acquired forms of epilepsy and investing in better health and social care systems can truly make a difference in alleviating millions.

Since 2012, the WHO has led a program centered around reducing the epilepsy treatment gap. The projects were implemented in Ghana, Mozambique, Myanmar and Vietnam, and utilized a community-based model to bring early detection and treatment closer to patients. Over time, the program yielded some major results in each of the countries it assisted.

Within four years, coverage for epilepsy increased from 15 to 38 percent in Ghana. The treatment gap for 460,000 people living with epilepsy in Vietnam decreased by 38 percent in certain regions. In Myanmar, over 2,000 health care providers were trained to diagnose and treat epilepsy, and around 5,000 community stigma awareness sessions were held. Continued efforts like the ones found in these countries can help spread treatment to regions of the world that need it most.

 

International League Against Epilepsy (ILAE)

The ILAE is another organization raising awareness around epilepsy treatment. The organization consists of health care professionals and scientists who help fund global research for treatment and potential cures to epilepsy. The major goals of the League are to spread knowledge about epilepsy, promote research, and improve services for patients globally.

With six different regions, the ILAE finds various ways to reach its goals of promoting epilepsy awareness, research and access to care globally. For example, the African region will conduct the 4th African Epilepsy Congress in Uganda to share new developments in epilepsy research in August 2019. These types of Congresses are held once a year in certain regions to continue spreading new information effectively.

The ILAE regularly publishes journals to show research findings and breakthroughs in epilepsy treatments and cures. The organization also provides information to patients themselves on topics such as psychological treatments, diet therapies and information for caretakers. With so many resources available, the ILAE has done a major service by spreading information about epilepsy treatment in developing countries.

 

International Bureau for Epilepsy (IBE)

The IBE focuses primarily on improving the social conditions and quality of life for people living with epilepsy. By addressing issues such as education, employment and driver’s license restrictions, this organization helps create environments free of detrimental stigmas. The IBE’s social improvement programs, designed for people with epilepsy and their families, are some of the main ways this organization impacts epilepsy awareness.

International Epilepsy Day is an example of an initiative created by this organization to promote awareness in over 120 countries. On that day, many global events are held to increase public understanding of epilepsy and new research developments that are available. In addition, the Promising Strategies program also funds initiatives improving the quality of life for people living with epilepsy. The program supports 81 projects in 37 countries and provides $300,000 in support of the projects. For example, Mongolia: Quality of Life was a program designed to improve public knowledge and reduce stigma in Mongolia after the number of epilepsy cases increased by 10 percent in 2004. Soon after the program started in 2008, the quality of life in Mongolia for people with epilepsy increased and better services were given to those in need.

These three organizations often collaborate to create new programs to spread information about epilepsy treatment in developing countries. By raising awareness of the condition and providing better healthcare services, the efforts of these organizations have created a more inclusive and helpful environment for those living with epilepsy in countries around the world.

– Sydney Blakeney
Photo: Flickr

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Epilepsy Among Indigenous Peoples

Epilepsy, Indigenous
Epilepsy represents an important public health issue, particularly in low-income communities where significant disparities are present in the care available to patients with epilepsy.

Where there is annually between 30 to 50 per 100 thousand people in the general population in high-income countries who suffer from epilepsy, this figure could be two times higher in low- and middle-income countries. Up to 80 percent of people with epilepsy live in low- and middle-income communities.

Due to the higher incidence of psychological stress, nutritional deficiencies and missed medication, poverty-stricken countries are prompted with greater seizure triggers, situations that precipitate seizures. Mortality associated with epilepsy in low-income countries is substantially higher because of untreated epileptic seizures.

According to a study by The World Bank, indigenous peoples are more likely to be poor as opposed to the general population due to their likelihood of living in rural areas and lack of education. Therefore, what can be said about their epilepsy rates?

Epilepsy in Indigenous Populations

Within the indigenous populations of Bolivia, the prevalence of this non-communicable disease is 12.3 persons out of 1000. This prevalence is also reflected within Canada’s First Nations, wherein 122 per 100,000 persons were found to have epilepsy, twice more than the non-indigenous populations. The numbers were even greater among the Australian Aboriginals, with over 44 percent of patients who were admitted to hospitals identifying as indigenous.

Despite the similarity in epilepsy syndromes among the indigenous and non-indigenous populations, the former presents with more serious degrees of the disease when diagnosed. Research has stated this is related to the inequitable access of healthcare resulting from geographic isolation and cultural issues to treatment.

Geographic Isolation and Epilepsy

The Bolivian Guaraní live in the Bolivian Chaco, a hot and semi-arid region of the Río de la Plata Basin. This area is sparsely populated, but of the 49 percent of indigenous persons, 68.9 percent of them live in conditions of poverty, with everyday issues of energy and sanitation.

Nevertheless, in 2012, an educational campaign directed to the Bolivian Guaraní has been implemented by general practitioners to teach the population about the main causes of epilepsy, its diagnosis, treatment and first aid. They also target the social stigma that exists around the disease.

With the help of programs like Bono Juana Azurduy, Programa Mi Salud, Ley de Gratuidad and Seguros Departamentales, there has been an increase in the social security and improvement in the treatment for epilepsy among the geographically isolated community.

Cultural Issues

Apart from geographic isolation, indigenous populations such as the Aboriginals of Australia also have traditional health beliefs about the causes of epilepsy. For instance, environmental factors like the moon are seen as an epileptic precursor. They also associate a connection with the supernatural due to transgressions as causes of the diseases, making it more difficult to find treatment for the neurological condition.

When such cultural issues arise due to a difference in beliefs, it is important for general practitioners and patients to find a suitable course of treatment that is acceptable for both parties. Various clinics in Far North Queensland, where many Aboriginals reside, have assessed and managed the situation through gathering as much information as possible about the person’s original function and the impact of the disease on them.

They also advise other hospitals treating Aboriginal people to identify and implement strategies, whether they be medication, behavioral, environmental or social, to be developed in conjunction with the patient, their families and communities. In time, it is believed that this will lead to the best interim solution for all parties in the support network and the patient themselves.

Within the Aboriginals living in Canada, the British Columbia Aboriginal Network on Disability Society (BCANDS) has also successfully delivered treatment for epilepsy patients by working as a liaison between service agencies and clients to find the best possible treatment. Their services extend to alleviate anxiety from patients who have previously had negative experiences with healthcare.

Moving Forward

Knowing that epilepsy is a neurological condition that receives substantial stigma in indigenous communities, there is a barrier for patients to have access to biomedical treatment and have it become integrated within the society they live in. Therefore, in order to reduce the burden of epilepsy in poor regions of the world, and especially within indigenous populations, hospitals, non-governmental organizations and the government have much to do. Aid can come in the form of risk factor prevention, offering check-up clinics in rural areas, stigma-reducing educational programs, improving access to biomedical diagnosis and treatment as well as providing a continuous supply of good quality anti-epileptic drugs to patients who need it, irrespective of their background.

– Monique Santoso
Photo: Pixabay

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Ten Facts on Epilepsy in Developing Countries

Epilepsy in Developing Countries

As one of the most common neurological conditions in the world, epilepsy hits resource-poor communities particularly hard. Although there are simple and inexpensive ways to treat epilepsy, the stigmatization of the disorder in developing countries leaves those suffering from epilepsy misunderstood and untreated. In addition, health care providers in developing countries often lack training in diagnosing and treating neurological disorders like epilepsy. Thus, shedding light on the facts about epilepsy is crucial to improving the lives of those affected by epilepsy in developing regions of the world.

  1. Epilepsy is characterized by recurrent and unprovoked seizures, so a single occurrence of an epileptic seizure does not guarantee that a person has epilepsy. Epileptic seizures occur due to abnormal neuronal activity in the brain. The most common visible effect of an epileptic seizure is uncontrollable jerking movements, but the effects can also be as subtle as a momentary loss of awareness.
  2. An estimated 50 million people worldwide have epilepsy, and 80 percent of those live in developing countries, according to the World Health Organization (WHO).
  3. Epilepsy in developing countries is commonly caused by neurocysticercosis. Cysticercosis is a parasitic infection that occurs from the ingestion of eggs from the adult tapeworm, Taenia solium, according to the National Center for Biotechnology Information (NCBI). When cysticercosis affects the central nervous system, it is referred to as neurocysticercosis and can lead to recurrent epileptic seizures.
  4. Some common causes of epilepsy include head trauma, genetic susceptibility, and malnutrition.
  5. Epilepsy is a chronic neurological disorder, not a mental illness. In many developing countries, including Uganda, epilepsy care is relegated to the mental health sector–often the most underfunded health sector in resource-poor countries, according to NCBI.
  6. Another erroneous belief is that epilepsy is contagious. The stigmatization of epilepsy in developing countries is partly due to the fear of contagion from bodily fluids, such as saliva, that can be emitted during a seizure. However, epilepsy is a non-communicable disease.
  7. The mortality rate of people with epilepsy is estimated to be two to three times higher than the general population in resource-poor communities. This is mostly due to the increased risk of fatal injury, trauma, or drowning during an epileptic seizure.
  8. Of the 35 million people with epilepsy who live in developing countries, around 85 percent receive no treatment at all, according to WHO. In order to close the treatment gap, WHO is calling for consistent and reliable access to anti-epileptic drugs (AED) that are critical to addressing the prevalence of epilepsy in the developing world.
  9. Educating primary care providers in developing countries on the facts about epilepsy is vital to ensuring that epilepsy is de-stigmatized and properly treated. Since access to equipment used to test for epilepsy are rare or often inaccurate in developing countries, increasing the number of neurologists and/or health care providers that can diagnose epilepsy is important, especially in rural areas.
  10. Cost-effective drugs exist to treat epilepsy. Phenobarbital, an older AED that costs $0.12 per daily dose, is currently being used in countries throughout Africa to some success. Although phenobarbital is known to have adverse side effects, the WHO supports the conclusion that phenobarbital is relatively well tolerated in developing countries as evidenced by observational studies.

By ensuring healthcare providers know how to diagnose epilepsy, consistently distributing AED’s to both rural and urban communities and erasing the stigma surrounding the disorder, the prevalence of epilepsy in developing countries has the potential to be reduced as low or lower than in developed countries.

– Daniela Sarabia

Photo: Medscape