Fumbled Priorities and Lost Perspectives: Epilepsy in LMICs Today

Three cheers for Dr. Mamta Bhushan Singh whose candid editorial in the November issue of Seizure really sums up the problems of epilepsy research and care in the developing world today. 1  Such a maddening paradox—70% of epilepsy cases would respond to basic treatment, if provided. And rather than expending efforts to assure we put systems in place to roll out sustainable care to the masses, we in the global epilepsy arena continue to focus most of our attention and resources on the 30% of patients with treatment resistant epilepsy. This approach might make sense in developed settings, but certainly not in low and middle income settings where the treatment gap really hasn’t budged in more than two decades.

In May 2015, the World Health Assembly approved the World Health Organizations Resolution on the Global Burden of Epilepsy but no tangible benefits of this are evident from my perspective. If anything, failure to deal internationally with regulatory hurdles has made the situation worsen over the past 3 years. 2  A growing emphasize on the establishment of epilepsy surgery programs where even basic services may not be established further illustrates the problem. 3, 4  Dr. Singh’s editorial is a refreshing voice of reason in an otherwise discouraging time.

  1. Singh MB. What should drive epilepsy research? Seizure 2018;62:1-2
  2. Birbeck GL. The Forgotten. Neurology 2018;91:800-803
  3. Mansouri A, Ibrahim GM. Providing Surgery for Medically Intractable Epilepsy in Low- and Middle-Income Countries: Shifting the Focus From If to How. JAMA Neurol 2018;75:1041-1042.
  4. Steven DA, Vasquez CM, Delgado JC, et al. Establishment of epilepsy surgery in Peru. Neurology 2018;91:368-370
Gretchen L. Birbeck, MD, MPH

Gretchen L. Birbeck, MD, MPH

Gretchen Birbeck is a neurologist who divides her time between the US and Africa. Her US academic home is the University of Rochester where she is the Rykenboer Professor of Neurology and Research Director for the Strong Epilepsy Center with adjunct appointments in the Center for Human Experimental Therapeutics and the Department of Public Health. Her additional skills in epidemiology, health services research, and tropical medicine are brought to bear during the 6-months annually she spends in Africa where she serves as Director for the Chikankata Epilepsy Care Team in rural Mazabuka, Zambia, an Honorary Lecturer at the University of Zambia and a consultant for the Paediatric Research Ward at Queen Elizabeth Central Hospital in Blantyre, Malawi. Gretchen’s research programs are aimed at identifying opportunities to prevent or ameliorate the medical and social morbidities of common neurologic conditions in low-income, tropical settings with the ultimate goal of developing successful interventions feasible for scale up and broad implementation. She has been recognized as an Ambassador for Epilepsy by the International League against Epilepsy, a Global Health Research Ambassador by the US Paul Rogers Society, a National Outreach Scholar by the WK Kellogg Foundation and a Leader in Medicine by the American Medical Students Association.

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One thought on “Fumbled Priorities and Lost Perspectives: Epilepsy in LMICs Today

  1. I agree that the treatment gap for epilepsy in LMIC has changed imperceptibly in the last decade or longer. The truth is that epilepsy is a low priority for domestic health spending and international development assistance for health. A much larger contributor to the burden of neurologic disease in LMIC, stroke, suffers from the same misguided emphasis on high-cost high-tech acute treatments over low-cost high-impact primary preventive interventions targeting the leading risk factor for stroke, high blood pressure. For those of us with the passion and resolve to close the treatment gaps for neurologic disorders in LMIC, we must push on and never lose sight of the bigger picture.

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