Perspectives from a Developing Nation with Special Reference to Rural Areas

Mani, K.; Dk, Subbakrishna

doi:10.1046/j.1528-1157.44.s.1.2.x

Cited by 6 publications

(3 citation statements)

References 5 publications

(4 reference statements)

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“…Although multivariate modeling did not demonstrate significant associations between the treatment gap and most neurology and epilepsy specific health care resources, our analysis reflects availability of these resources at a national level and may not be representative of the barriers faced by individuals attempting to obtain care or medications for their epilepsy. For example, in India, 70% of medical practitioners reside in urban locations, whereas 70% of the population lives in rural areas (Mani & Subbakrishna, 2003). Furthermore, although AEDs may be listed as essential drugs by a particular country, this may not correspond to a reliable supply of AEDs to rural areas.…”

Section: Discussionmentioning

confidence: 99%

Critical determinants of the epilepsy treatment gap: A cross‐national analysis in resource‐limited settings

et al. 2012

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Purpose Epilepsy is one of the most common serious neurological disorders worldwide. Our objective was to determine which economic, healthcare, neurology and epilepsy specific resources were associated with untreated epilepsy in resource-constrained settings. Methods A systematic review of the literature identified community-based studies in resource-constrained settings that calculated the epilepsy treatment gap, the proportion with untreated epilepsy, from prevalent active epilepsy cases. Economic, healthcare, neurology and epilepsy specific resources were taken from existing datasets. Poisson regression models with jackknifed standard errors were used to create bivariate and multivariate models comparing the association between treatment status and economic and health resource indicators. Relative risks were reported. Key Findings Forty-seven studies of 8285 individuals from 24 countries met inclusion criteria. Bivariate analysis demonstrated that individuals residing in rural locations had significantly higher risks of untreated epilepsy [Relative Risk(RR)=1.63; 95% confidence interval(CI):1.26,2.11]. Significantly lower risks of untreated epilepsy were observed for higher physician density [RR=0.65, 95% CI:0.55,0.78], presence of a lay [RR=0.74, 95%CI:0.60,0.91] or professional association for epilepsy [RR=0.73, 95%CI:0.59,0.91], or post-graduate neurology training program [RR=0.67, 95%CI:0.55, 0.82]. In multivariate models, higher physician density maintained significant effects [RR=0.67; 95%CI:0.52,0.88]. Significance Even among resource-limited regions, people with epilepsy in countries with fewer economic, healthcare, neurology and epilepsy specific resources are more likely to have untreated epilepsy. Community-based epilepsy care programs have improved access to treatment but in order to decrease the epilepsy treatment gap, poverty and inequalities of healthcare, neurological and epilepsy resources must be dealt with at the local, national, and global levels.

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Section: Discussionmentioning

confidence: 99%

Critical determinants of the epilepsy treatment gap: A cross‐national analysis in resource‐limited settings

et al. 2012

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“…Although the result of epilepsy surgery has improved over time [ 9 , 10 , 11 , 12 ], the few studies that have assessed chronological changes in surgical outcome in medial TLE have generally reported cross-sectional analyses limited to seizure outcomes in low- and middle-income countries. Additionally, the Engel and ILAE classification systems address only seizure outcome, and do not assess psychosocial, behavioral, cognitive and vocational development; all vital to gauge the utility of epilepsy surgery [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Electroclinical and Employment Follow up in Temporal Lobe Epilepsy Surgery. A Cuban Comprehensive Epilepsy Surgery Program

Chacón

Maeso

Martín

et al. 2018

Behavioral Sciences

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The purpose of this paper is to present a long- term electroclinical and employment follow up in temporal lobe epilepsy (TLE) patients in a comprehensive epilepsy surgery program. Forty adult patients with pharmacoresistant TLE underwent detailed presurgical evaluation. Electroencephalogram (EEG) and clinical follow up assessment for each patient were carried out. The occurrence of interictal epileptiform activity (IEA) and absolute spike frequency (ASF) were tabulated before and after 1, 6, 12, 24 and 72 months surgical treatment. Employment status pre- to post-surgery at the last evaluated period was also examined. Engel scores follow-up was described as follows: at 12 months 70% (28) class I, 10% (4) class II and 19% (8) class III-IV; at 24 months after surgery 55.2% (21) of the patients were class I, 28.9% (11) class II and 15.1% (6) class III-IV. After one- year follow up 23 (57.7%) patients were seizure and aura-free (Engel class IA). These figures changed to 47.3%, and 48.6% respectively two and five years following surgery whereas 50% maintained this condition in the last follow up period. A decline in the ASF was observed from the first year until the sixth year after surgery in relation to the preoperative EEG. The ASF one year after surgery allowed to distinguish “satisfactory” from “unsatisfactory” seizure relief outcome at the last follow up. An adequate social functioning in terms of education and employment in more than 50% of the patients was also found. Results revealed the feasibility of conducting a successful epilepsy surgery program with favorable long term electroclinical and psychosocial functioning outcomes in a developing country as well.

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“…Even within LMIC there are rural and urban disparities in the level of epilepsy care available and this can be confounded by the demographic patterns of a country. In India 70% of the population live in rural areas and generally have a low economic status, while any epilepsy expertise is confined to urban centres where 30% of the population exist (Mani & Subbakrishna, 2003). There is often no supply of epilepsy medications to the rural communities and, if there is, the supply is irregular and expensive.…”

Section: Epilepsy Epidemiologymentioning

confidence: 99%

Biobank participation of persons with epilepsy in South Wales

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Perspectives from a Developing Nation with Special Reference to Rural Areas

Cited by 6 publications

References 5 publications

Critical determinants of the epilepsy treatment gap: A cross‐national analysis in resource‐limited settings

Critical determinants of the epilepsy treatment gap: A cross‐national analysis in resource‐limited settings

Long-Term Electroclinical and Employment Follow up in Temporal Lobe Epilepsy Surgery. A Cuban Comprehensive Epilepsy Surgery Program

Biobank participation of persons with epilepsy in South Wales

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