Low-income countries have low levels of epilepsy treatment

Three quarters of people living with epilepsy in low-income countries do not get the treatment they need, increasing their risk of dying prematurely and condemning many to a life of stigma, according to the World Health Organisation.

Those findings are published in Epilepsy, a public health imperative and released by WHO, the International League Against Epilepsy, and the International Bureau for Epilepsy.

“The treatment gap for epilepsy is unacceptably high, when we know that 70 per cent of people with the condition can be seizure-free when they have access to medicines that can cost as little as US$5 per year and can be delivered through primary health systems,” said Dr Tarun Dua, from WHO’s Department of Mental Health and Substance Abuse.

The risk of premature death in people with epilepsy is up to three times higher than for the general population. In low- and middle-income countries, early death among people with epilepsy is significantly higher than in high-income countries. Reasons for this premature mortality in low- and middle-income countries are likely associated with lack of access to health facilities when seizures are long-lasting or occur close together without recovery in between, and preventable causes such as drowning, head injuries and burns.

Roughly half of adults with epilepsy have at least one other health condition. The most common are depression and anxiety – 23 per cent of adults with epilepsy will experience clinical depression during their lifetime and 20 per cent will have anxiety. Mental health conditions such as these can make seizures worse and reduce quality of life. Development and learning difficulties are experienced by 30 to 40 per cent of children with epilepsy.

Stigma about the condition is also widespread. “The stigma associated with epilepsy is one of the main factors preventing people from seeking treatment,” said Dr Martin Brodie, President of the International Bureau for Epilepsy.

“Many children with epilepsy do not go to school and adults are denied work, the right to drive and even to get married. These human rights violations experienced by people with epilepsy need to come to an end.”

Public information campaigns in schools, workplaces, and the broader community to help reduce stigma and the introduction of legislation to prevent discrimination and violations of human rights are also important elements of the public health response.

But the report also shows that when the political will exists, the diagnosis of and treatment for epilepsy can be successfully integrated into primary health services. Pilot programs introduced in Ghana, Mozambique, Myanmar and Vietnam as part of WHO’s Reducing the epilepsy treatment gap program have led to a considerable increase in access, such that 6.5 million more people have access to treatment for epilepsy should they need it.

“We know how to reduce the epilepsy treatment gap. Now action to introduce the measures needed to make a difference needs to be accelerated,” said Dr Samuel Wiebe, President of the International League Against Epilepsy.

“Ensuring uninterrupted supply of access to antiseizure medicines is one of the highest priorities, as is training of non-specialist health providers working in primary health-care centres.”