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Abstract Details

Decreasing the Epilepsy Treatment Gap in the Developing World: The Epilepsy Medical Mission to the Amazon Rain Forest in Tena, Ecuador Report 2009-2012
Global Health
P04 - (-)
230
BACKGROUND: In the Ecuador-Amazon region, it is estimated that over 70% of patients with epilepsy do not receive appropriate treatment due to lack of access to neurological diagnosis and care. The city of Tena, located in the Napo-Province in the rural Amazon region of Ecuador, is 200 kilometers away from the nearest facility with neurological services. We introduced an epilepsy clinic in this region and created a system locally to sustain it.
DESIGN/METHODS: We organized annual epilepsy clinics with a local team. Quarterly visits by a smaller team are accomplished with telemedicine. Local internists and pediatricians interested in the mission were trained and a consultation model was initiated with local practitioners from the local hospital. Since 2009, a multidisciplinary team examined patients in consultation with the staff of the hospital. Spanish/Quichua translation is available. Continuous anti-epileptic-drugs supply are provided by the Ministry of Health at no charge. Members of the team lecture local physicians, residents, medical students, first responders and the community on a variety of topics in epilepsy.
RESULTS: Since 2009, we evaluated a total of 1293 patients with neurological complaints. Of the total number of patients evaluated, 520 had epilepsy, 61% were children. A total of 261 EEGs were performed during 4 years of the program. The rate of abnormal EEG findings in the epilepsy patients was 65%. A total of 92 CT scans and 15 MRIs were performed. The calculated epilepsy treatment gap (patients evaluated with epilepsy not receiving treatment) was estimated to be 77% -80%.
CONCLUSIONS: Since 2009 we have been able provide neurological/epilepsy care to a community where there are no neurologists. Our program shows that ongoing collaboration with local health practitioners in the Ecuador-Amazon rainforest can help reduce the epilepsy treatment gap in this region.
Authors/Disclosures
Patricio S. Espinosa, MD, MPH, FAAN (The Espinosa Neuroscience Institute)
PRESENTER 		Dr. Espinosa has nothing to disclose.
No disclosure on file
Dominic B. Fee, MD, FAAN (Medical College of Wisconsin) An immediate family member of Dr. Fee has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for The Spine Journal. The institution of Dr. Fee has received research support from ALS Association. The institution of an immediate family member of Dr. Fee has received research support from Veterans Administration.
No disclosure on file
Patricio H. Espinosa Del Pozo, MD (Universidad Central Del Ecuador) No disclosure on file
Gavin Giovannoni, MD (QMUL) Dr. Giovannoni has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Giovannoni has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi. Dr. Giovannoni has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Merck KGaA. Dr. Giovannoni has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Roche-Genentech. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Moderna. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sandoz. Dr. Giovannoni has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Astoria Biologica. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Zenas. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Giovannoni has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Medscape.
Stephen J. Ryan, MD (UK Neurology) No disclosure on file
Ikuko Laccheo, MD (Nuvasive Clinical Service/American Neuromonitoring Associates) Dr. Laccheo has nothing to disclose.
Aaron L. Berkowitz, MD, PhD, FAAN Dr. Berkowitz has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN. Dr. Berkowitz has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for McGraw-Hill 好色先生. Dr. Berkowitz has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for various law firms. Dr. Berkowitz has received publishing royalties from a publication relating to health care. Dr. Berkowitz has received publishing royalties from a publication relating to health care. Dr. Berkowitz has received publishing royalties from a publication relating to health care. Dr. Berkowitz has received publishing royalties from a publication relating to health care. Dr. Berkowitz has received publishing royalties from a publication relating to health care. Dr. Berkowitz has received personal compensation in the range of $500-$4,999 for serving as a Content creator with Clinical problem Solvers. Dr. Berkowitz has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant with Thieme Publisher.
Alcy Torres, MD (Boston Medical Center) Dr. Torres has nothing to disclose.
No disclosure on file
Alexander Paciorkowski, MD The institution of Dr. Paciorkowski has received research support from University of Rochester.
Sydney Cash, MD (Massachusetts General Hospital) Dr. Cash has received stock or an ownership interest from Beacon Biosignals.
No disclosure on file
No disclosure on file
No disclosure on file
Joshua P. Klein, MD, PhD, FANA, FAAN (Brigham and Women's Hospital) Dr. Klein has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for SAGE Publishers. Dr. Klein has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for McGraw-Hill Publishers. Dr. Klein has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Oakstone Publishers. Dr. Klein has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wolters Kluwer Publishers. Dr. Klein has received personal compensation in the range of $100,000-$499,999 for serving as an Expert Witness for various law firms. Dr. Klein has received publishing royalties from a publication relating to health care.
Jennifer Lyons, MD (Brigham and Women's Hospital) Dr. Lyons has received personal compensation for serving as an employee of Biogen. Dr. Lyons has received stock or an ownership interest from Biogen.
Sarah Wahlster, MD Dr. Wahlster has nothing to disclose.
Franca Cambi, MD (Pittsburgh VA Medical Center) The institution of Dr. Cambi has received research support from NIH.
Blanca R. Vazquez, MD Dr. Vazquez has nothing to disclose.
Robert J. Baumann, MD, FAAN (University of Kentucky - Dept of Neuro) Dr. Baumann has nothing to disclose.
Barbara A. Dworetzky, MD, FAAN (Brigham and Women's Hospital) Dr. Dworetzky has received publishing royalties from a publication relating to health care.