The Treatment Gap

Epilepsy provides the clearest example of a neurological disorder for which effective and cost-efficient treatment is available. The epilepsy treatment gap, defined as the proportion of people living with epilepsy who require treatment but do not receive it, has been proposed as a useful parameter to compare access to and quality of care for epilepsy patients across populations. The World Health Organization estimates that of the 10 million people in Africa who live with epilepsy, 80% or eight million are not treated with readily available modern anti-epileptic drugs, the cheapest of which cost about US$ 5.00 per patient per year. It is important to note that consistent epilepsy treatment is needed to prevent the recurrence of seizures, to avoid the mortality, morbidity and psycho-social effects associated with seizures.

Epilepsy can be treated easily and affordably with inexpensive daily medication that costs as little as US$ 5 per year. Recent studies in both low- and middle-income countries have shown that up to 70% of children and adults with epilepsy can be successfully treated (i.e. their seizures completely controlled) with anti¬epileptic drugs (AEDs). Furthermore, after 2 to 5 years of successful treatment and being seizure-free, drugs can be withdrawn in about 70% of children and 60% of adults without subsequent relapse.

In low- and middle-income countries, about three fourths of people with epilepsy may not receive the treatment they need. This is called the “treatment gap”.
In many low- and middle-income countries, there is low availability of anti-epileptic drugs. A recent study found the average availability of generic anti-epileptic medicines in the public sector of low- and middle-income countries to be less than 50%. This may act as a barrier to accessing treatment.
It is possible to diagnose and treat most people with epilepsy at the primary health- care level without the use of sophisticated equipment.
WHO demonstration projects have indicated that training primary health-care providers to diagnose and treat epilepsy can effectively reduce the epilepsy treatment gap. However, the lack of trained health-care providers can act as a barrier to treatment for people with epilepsy.