Global Health: Epilepsy

Abstract

Epilepsy is a frequently misunderstood and highly stigmatized condition. Major treatment gaps exist across the world, most so in areas of financial constraint. Classification permits the best approaches to treatment and to ascertaining prognosis. The International League Against Epilepsy's new classification system emphasizes clinical aspects and utilizes all available resources to determine whether it is a focal or generalized epilepsy. The most important tools are a careful history, clinical examination, electroencephalography, and appropriate neuroimaging. Inadequate, delayed, and incomplete evaluation may lead to misdiagnosis and costly mismanagement. Treatment is generally pharmacological, with approximately 20 to 30% of patients eventually proving refractory to medications and thus becoming potential surgical candidates. The type of epilepsy, age, gender, comorbidities, drug interactions, and drug cost are important factors in choosing an antiepileptic drug (AED). The teratogenic potential of some AEDs, weight gain, and menstrual hormone-related issues are important considerations in women. The impact of AEDs on bone health is critical in all age groups, particularly in the elderly. Psychiatric problems, mostly depression and anxiety, can have a great impact on seizure control and overall quality of life. Finally, effective partnerships and collaborations can bring resources, both human and financial, to regions that would otherwise find it impossible to effect change on their own.

Decentralized, primary-care delivered epilepsy services in Burera District, Rwanda: Service use, feasibility, and treatment

“…Our findings reinforce the feasibility of task-sharing to deliver epilepsy care to populations without access to specialized services. According to the World Health Organization (WHO), one hundred million people worldwide will be diagnosed with epilepsy at some point in their lives, the majority of whom live in resource-limited settings, yet basic pharmacological and psychosocial care for epilepsy for the majority of these individuals has not been achieved [ 16 ]. The innovative PIH/MoH collaborative implementation program MESH MH addresses this treatment gap by using a set of basic implementation strategies to facilitate front-line public primary care nurses to provide basic care for patients with epilepsy and mental disorders.…”

The Effects Of Stem Cells On Epilepsy

“…There are several modalities of treatments for individuals diagnosed with epilepsy; antiepileptic drugs (AEDs), surgery, and neurostimulation have all served as viable options, with AEDs being the most customary option [14]. The ultimate goal of AEDs is to completely inhibit seizure activity in the patient's brain, without introducing side effects; only 50% of AED treatments have accomplished this goal [15]. Cognitive side effects are the most common consequence of opting for pharmaceutical treatment; sedation, somnolence, distractibility, insomnia, dizziness, and an altered perception of quality of life are all examples of cognitive side effects patients may experience [16].…”

“…(Table 2) shows each individual AED and its classification. The medication selected for treatment of epilepsy is dependent of several qualities of the patient, including the type of seizure experienced, age, gender, drug interactions, and cost [15]. In most patients, polytherapy is recommend over monotherapy, due to the implications of multiple therapeutics functioning in a simultaneous fashion; however, in pregnant woman, monotherapy is recommended [14].…”

“…An estimated 4 in every 5 individuals that suffer from epilepsy live in middle or low income countries [24]. Analyzing the treatment gap, the number of individuals that need treatment but do not receive it, there are many more untreated epilepsy cases in countries with a low average income, compared to countries with a high average income [15].The sizable treatment gap in low income countries is due to various factors, such as lack of knowledge, poverty, deficient health delivery infrastructure, and limited of professional health care workers [24]. It is estimated that the mortality rate of people with epilepsy is two to three times higher in low income areas than that of the entire population [24].…”

Health Technology Assessment Report on Vagus Nerve Stimulation in Drug-Resistant Epilepsy

“…Epilepsy is one of the most common neurological diseases [ 1 ]. According to World Health Organization data (WHO) [ 2 ], epilepsy affects about 50 million people worldwide, with approximately 6 million in Europe, and around 500,000 in Italy.…”