Medical and surgical strategies for epilepsy care in developing countries

Epilepsy is a major health problem, and there is hope that current international initiatives--epitomized in the "Epilepsy: Out of the Shadows" campaign--will increase the commitment of the general public and health officials to the care of patients. Particularly in developing countries, there is great need for alleviation of the extremely difficult situation of people with epilepsy and their families. Doctors can play their part by adhering to specific medical and surgical strategies aimed at the improvement of epilepsy care in these countries. Included in the former are joining efforts to guarantee a regular distribution of conventional antiepileptic drugs (AEDs), make optimal use of the more easily available AEDs, and improve communication with patients and families at all levels. It is also important to support the creation of local and regional specialized epilepsy centers with the capability to perform presurgical evaluation and epilepsy surgery in many patients with medically refractory seizures. The establishment of such centers in developing countries will face several challenges, including a critical view of technological advances and the need to support well-trained, creative people who can evaluate and operate on patients with relatively limited resources. This article proposes that the success of such an approach depends on the progressive build-up of a "critical mass" of specialized people who are trained locally to select or reject epilepsy patients for surgery using the available resources. A stepwise approach to the increasing levels of complexity involved in the evaluation and surgical treatment is proposed, with the expectation that each center will find its level and adhere to its capability.