The treatment gap in epilepsy: A global perspective

Epilepsy is one of the commonest neurological conditions, estimated to affect over 60 million people worldwide, the majority of whom live in low and middle-income countries where access to medical treatment is limited. We consider some of the aspects and factors that underlie the epilepsy treatment gap (ETG), which is defined as the percentage of people with active epilepsy who are not being appropriately treated (either as a result of lack of access to treatment or of being on inadequate treatment) in a given population at a given time.

We examine some of the evidence of the relative impact of various cultural, demographic economic and logistical factors that are believed to be at the origin of the ETG in resource-poor settings. We contend that the high cost and subsequent poor availability of first line anti-epileptic drugs including phenobarbital in low and low-middle income (compared to high income countries), is a major determinant of the ETG in these countries. Until this issue is tackled, little progress in reducing the global ETG is likely to be made.