Abstracts

An important treatment gap for epilepsy in developing countries has been reported in association with economic and sociocultural factors. The objectives of our nationwide survey in Honduras, a developing Latin American country, were to assess the treatment gap, treatment compliance and treatment practices for epilepsy. After completing an IRB approved pilot study at the University Hospital at Tegucigalpa, Honduras, a 28-question questionnaire was used countrywide. Practitioners selected to participate had been previously trained in administering epilepsy surveys at the University Hospital and they were doing follow-up of epilepsy patients in 3 private and 10 public clinics in urban and rural areas of the country between March 2002 and July 2003. We interviewed 217 patients (83 male, 134 female) averaging 31.1 years of age (range 3 to 79 years). They came from 13 of 18 Honduran counties; 102 lived in urban areas and 115 in rural regions. Average age at seizure onset was 16.9 years (range birth to 71 years). Average duration of seizure history was 12.6 years (range 0.1 to 61 years). In 89% of cases (n=193) seizures were partial with or without secondary generalization and 11% (n=24) were clinically suspected to be primary generalized seizures. Thirty percent of patients knew about the etiology of their seizures (mainly cysticercosis and head trauma). The majority of patients (92%) reportedly were currently taking drugs for their seizures when they were seen, but 43% reported stopping treatment in the past, most commonly because it was unavailable in the public clinics or because they could not afford treatment. However, the state paid for some or all treatment in 86% of the patients. Fifty-two percent of patients had used alternative treatments and 32% were using them at the time they were interviewed. The most popular alternative treatments were praying (n=70) and taking herbs or potions (n=61). Our nationwide survey indicates that no matter the age of onset, type, or etiology, there is widespread treatment non-compliance throughout the country. The use of alternative therapies is common even when taking standard AEDs. Novel initiatives to address the economic and sociocultural causes of non-compliance should help close the epilepsy treatment gap that exists in the Honduran population. (Supported by Neurology Training Program, National Autonomous University of Honduras and Honduran Neurological Association)