Epilepsy care in six Indian cities: a multicenter study on management and service

Background: Epilepsy care in developing countries is lagging behind than in the developed countries. Precise data on delivery of neurological services for epilepsy is essential to optimize the medical services for epilepsy ca re with limited resources. Objective: This study was carried out in order t o examine the management practices and utilization of various medical servi ces for epilepsy in different parts of India. Methodology: University cente rs with epilepsy clinics, one each from six states of India, had participat ed in this study. Demographic data, clinical details, and data on epilepsy care were collected simultaneously on standard proforma. Results: Data on 2 85 patients with epilepsy (generalized epilepsy: 49.1%, localization-relate d epilepsy: 49.9%, others: 1%) were included. Mean age of onset of epilepsy was 14.8 + 11.1 years. Mean delay in diagnosis was 1.5 +/- 4 years. Mean d istance from place of residence to the consulting neurologist was 70 +/- 82 kin. Medical consultations before referral to epilepsy center included gen eral practitioners (54.1%) and specialists (43.3%). Very few patients recei ved services from clinical psychologist or social worker. Investigations in cluded, EEG (63.2%), CT Scan (36.2%). MRI brain (8.5%) and video EEG (2.1%) were limited to a few. Nearly 75.5% were on monotherapy. Newer Anti-Epilep tic Drugs (AEDs) were used only in less than 5% patients. Conclusion: The s ervices for epilepsy are urban-based and there is underutilization of servi ces, general practitioners and specialists. Newer AEDs (although expensive) are gradually emerging in Indian market. Facilities for epilepsy surgery, therapeutic drug monitoring and services of clinical psychologist or medica l social workers are limited. (C) 2001 Elsevier Science B.V. All rights res erved.