Date Published: October 13, 2009
Publisher: Public Library of Science
Author(s): Caroline K. Mbuba, Charles R. Newton, Vikram Patel
Abstract: In the second in a series of six articles on packages of care for mental health disorders in low- and middle-income countries, Caroline Mbuba and Charles Newton discuss treatment for epilepsy.
Partial Text: Epilepsy is one of the most common and widespread neurological disorders. Recent estimates suggest that it accounts for 1% of the global burden of disease  and affects over 65 million people . In addition, because the relatives and friends of people with epilepsy (PWE) also bear the burden of this condition, more than 500 million people are indirectly affected by epilepsy . Thus, epilepsy imposes a large economic burden on global health care systems and is a major public health problem in low- and middle-income countries (LMICs) .
The evidence for most aspects of the management of epilepsy is poor in both high- and low-income settings (Table 1).
Delivery of efficacious interventions in LMICs can only be achieved if PWE are correctly identified. Unfortunately, the symptoms of some types of epilepsy (for example, hallucinations) may not be recognized as part of an illness, particularly in LMICs where epilepsy is interpreted within traditional belief systems. Furthermore, in LMICs, trained personnel for the detection and management of epilepsy and facilities for investigations of underlying causes are scarce . However, nurses, community health workers, and key informants such as teachers can improve the identification of PWE ,, and these PWE can then benefit from various interventions (Table 2).
Epilepsy, one of the most common neurological conditions, is under-resourced and undertreated in LMICs. A large number of people have significant morbidity and mortality because of the failure to identify cases, difficulties with infrastructure, and the unavailability of suitable AEDs. Education of the community and of health care workers will improve the identification of PWE and thus reduce the treatment gap, provided inexpensive and reliable supplies of AEDs are available. Governments in LMICs need to recognize the burden of epilepsy and need to develop packages of care to reduce the disability associated with this condition in an efficient, sustainable, and equitable manner. We propose two packages of care based on the availability of resources (Table 3). Ideally, the delivery of these packages should be integrated into existing primary health care with the help of NGOs and other nonmedical staff involved in community-based and mental health care.