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Study into epilepsy control in rural areas of less-developed countries

30 April, 2001

Inexpensive drugs given by appropriately trained health workers to compliant patients could help control epilepsy in rural areas of less-developed countries, conclude authors of a study published in the medical journal The Lancet.

For most families in rural areas of less-developed countries, treatment of epilepsy is often delayed because of the inaccessibility of specialist neurological assessment facilities. K S Mani and colleagues from Bangalore, India, aimed to find a practical solution to rural epilepsy control by doing a non-randomised trial in south India.

135 patients with seizures agreed to long-term treatment with phenobarbital (68 patients), phenytoin (60 patients), or both (7 patients). Drugs were given once daily by trained primary-care physicians and health workers. The primary outcome measure was the absence of seizures for at least two years.

The proportion of patients with remission at each of 4 successive years of follow-up ranged from 58 per cent to 66 per cent for those who were drug compliant and who had a lifetime total of 30 or fewer generalised tonic-clonic seizures. The corresponding range for patients who were not compliant and who had ever had more than 30 such seizures was 6-16 per cent. Statistical analysis confirmed that strict drug compliance and early treatment were important predictors of a 2-year remission.

A member of the research team, D K Subbakrishna, commented:

“The Yelandur project can be used as a model for epilepsy control in rural areas of developing countries where primary health centers without major investigating facilities can coordinate and train health workers to detect epilepsy in population and provide and supply treatment. Governmental agencies may provide Phenobarbital\Phenytoin free to the patients so that at least 60 per cent of the cases can be helped to achieve remission”.