Authors :
Presenting Author: Sally Shaaban, MD, PhD – Faculty of Medicine, Mansoura University
Ruba Al-Ramadhani, MD – Children's Hospital of Pittsburgh, UPMC
Daniah Kurdi, MD – King Saud University
Bader Almasaad, MD – Farwaniya hospital, Amiri hospital
Abas Tilako, MD – Shar Teaching Hospital, University of Sulaimani
Rihab Ben Dhia, MD – Fattouma Bourguiba Hospita
Christelle NDERBE MELOM, MD – Mother and Child University Hospital of N’Djamena
Wafaa Al Shehhi, MD – Royal Hospital
Ahmed Abdulrahman, MD – Aden University
Ali Ibrahim, MD – Damascus Hospital
Hamda AK Albastaki, MD – Rashid Hospital
Mohamed AlKhaja, MD – King Hamad University Hospital
Leen Alkalbani, MD – Children's Hospital of Pittsburgh, UPMC
Nada Benkirane, MD – The Moroccan Neurology Society
Shorouk Mohsen, MD – Faculty of Medicine, Mansoura University
Rationale:
Epilepsy care in the Eastern Mediterranean Region (EMR) faces multifaceted challenges across diverse economic and healthcare contexts. Therefore, the Young Epilepsy Section (YES) of the International League Against Epilepsy (ILAE) EMR conducted the first regional study mapping barriers to epilepsy medication access.
Methods:
In May 2025, a cross-sectional survey was distributed across 12 EMR countries via ILAE chapters and professional networks. Eligible participants were physicians practicing in secondary or tertiary care with at least 5 years of experience managing epilepsy in at least 10 patients per month and postgraduate qualifications. Of 163 responses, 73 met inclusion criteria (55% exclusion rate). Countries were stratified by income into three groups: Group A (high-income: Saudi Arabia, UAE, Oman, Kuwait, Bahrain), Group B (high-middle-income: Egypt, Iraq, Morocco, Tunisia), and Group C (low-middle/low-income: Syria, Yemen, Chad). The survey assessed medication availability, affordability challenges, and their impact on clinical decision-making.
Results:
Income-based disparities were pronounced. Rescue medications access varied: Rectal diazepam was more accessible in high-income countries (Group A: 80%) compared to Groups B (63.6%) and C (66.7%); however, nasal midazolam/diazepam remained scarce, with nearly 10% availability reported across all groups. Parenteral lorazepam was accessible to 80% of Group A providers but was markedly lower in Groups B and C (15.9%, 11.1%, respectively; p < 0.001). Similarly, parenteral valproate was available to 100% of Group A providers, compared to only one-third in either Group B or C (p < 0.001). Notably, some antiseizure medications (ASMs) for refractory epilepsies were not universally available across all income groups, although disparities persisted: Group A reported the highest access (45%), followed by Group B (20%) and Group C (11.1%) (p = 0.058). In contrast, immune therapy, such as Intravenous Immunoglobulin (IVIG), was universally accessible in Groups A and B (100%), but limited in Group C (44.4%) (p < 0.001). Financial constraints of ASMs compelled 94.5% of providers to modify their treatment plans (p < 0.001).