Abstract
Epilepsy is now more prevalent in many countries than HIV/AIDS. Building upon the advances of global policymaking for HIV/AIDS and creating a framework for countries and organizations to monitor progress in epilepsy care will help direct and justify much-needed novel programming. Given the clarity of the HIV/AIDS care continuum model and the UNAIDS 90-90-90 targets, I propose this same approach to the cascade of care could be used as a viable framework for people with epilepsy. In this model, the targets of success include (1) ensuring 90% of all people with epilepsy are aware of their diagnosis as a brain disorder, (2) starting 90% of people with epilepsy on quality controlled, appropriately chosen and well stocked antiepileptic drugs, and (3) achieving seizure freedom in 70% of those treated. At least 90% of all people with epilepsy must also be linked to and retained in appropriate care.Although the precise numbers may be debated, this cascade of care approach will assist in deconstructing the barriers to epilepsy care in populations better than the more familiar concept of the epilepsy treatment gap. These reflect concrete goals for health systems for epilepsy care that, if achieved, could lead to seizure freedom for the many people in lower income countries living with poorly controlled epilepsy.
Highlights
Epilepsy is an important cause of chronic disability and a preventable cause of early mortality in low- and middle-income countries (LMICs)
Epilepsy is an exemplary disease for health systems planning for brain disorders
Efforts to improve epilepsy care require more than appropriate metrics
Summary
Epilepsy is an important cause of chronic disability and a preventable cause of early mortality in low- and middle-income countries (LMICs). A reasonable goal of 70% of all PWE achieving seizure control should be targeted This provides a fair comparison for services across higher and lower income settings and may reflect, like in HIV/ AIDS, that lower income countries are better able to implement cascades of care for more of their population. These precise numbers may be debated by the global community, they are goals that reflect actual processes of epilepsy care. Newer medications may be efficacious to older medications, minimization of side effects and improving the range of options in locations without laboratory capacity can be important
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