Treatment gap for convulsive status epilepticus in resource-poor countries

Area of Science:

• Neurology
• Global Health
• Pharmacology

Background:

• The treatment gap for convulsive status epilepticus (CSE) in resource-poor settings is not well-defined.
• Previous studies suggest suboptimal CSE management in developing countries due to resource limitations.
• However, comparable outcomes in mortality and morbidity between developed and developing nations challenge the assumption of a significant treatment gap.

Purpose of the Study:

• To investigate potential sources of a treatment gap for CSE in Asian developing countries.
• To gather expert opinions on factors influencing CSE management in the region.

Main Methods:

• An expert survey was conducted across 16 Asian countries.
• Questionnaires assessed the availability of antiepileptic drugs (AEDs) and healthcare resources.
• Identified barriers to optimal CSE management.

Main Results:

• Injectable diazepam was universally available, but intravenous lorazepam was scarce.
• Second-line AEDs were available in tertiary hospitals but not primary care facilities.
• Key contributors to the treatment gap included limited second-line AEDs, transportation delays, insufficient ICU facilities, and a shortage of trained physicians.

Conclusions:

• While a significant treatment gap for CSE in developing countries is not definitively proven, expert opinion highlights critical areas for improvement.
• Enhancing access to second-line AEDs at primary care levels, improving transportation, expanding ICU capacity, and increasing physician training are crucial.
• Addressing these factors may help mitigate potential treatment disparities in CSE management.