Where there are no Neurologists: Decreasing the Epilepsy Treatment Gap in the Ecuador Amazon Patricio S. Espinosa, Nicole M. Falcone, Aaron L. Berkowitz, Kathleen and William Principe, Dominic B. Fee, Karin R. Swartz, Sydney S. Cash, Robert Baumann, Blanca R. Vasquez, and Barbara A. Dworetzky C I E N C I E N Introduction Methods Local pediatricians and general practitioners were actively recruited to train in the consultation and follow-up care of patients with epilepsy who are begun on treatment during the visits, and email contact and a telemedicine program for further follow-up are established. Radio and TV advertisements were used to recruit patients with seizures or epilepsy from local and remote areas. Interpreter services were arrange for patients and health care providers. Quishua – Spanish – English. Of nearly 50 million epilepsy cases worldwide, 80% may be in the developing world likely secondary to increased incidence of infectious causes (meningitis, neurocystercircosis, cerebral malaria, etc.), and poor perinatal care 1,2. As many as 90% of patients with epilepsy in the developing world may go untreated in part due to lack of access to neurological services in these regions. Pharmacologic treatment for epilepsy is cost-effective, and could result in a huge reduction of the burden of disability3 The city of Tena is located in Napo Province (pop. 90,000) in the rural Amazon region of Ecuador where the nearest facility with neurological services is located ~200 kilometers away. This distance and a substantial prevalence of poverty prevent patients from obtaining proper diagnosis and treatment of neurological conditions. Conclusions The Team 2010. The Ecuadorian Amazon has substantial need for sustainable epilepsy treatment that had not been met. Prior to our project, 1 in 4 patients in the cohort evaluated received adequate or appropriate AEDs. Need for local sustainable collaborations will increase access to Epilepsy care. This work is the beginning of the partnership between US and Latin American centers but more is needed to bring neurological care to areas where there has been none. Objectives To develop a sustained collaboration with a hospital in the rural Amazon region of Ecuador with aim to reduce the epilepsy treatment gap. Methods References: We established relationship with staff and physicians of the local public Hospital Jose Maria Velasco Ibarra in Tena. Since April 2009, a team of several neurologists, internists, pediatricians, electroencephalography (EEG) technicians, physical therapists and volunteers (medical students, nurses, and translators both from Ecuador, and the US) have seen patients in consultation with the local hospital. Two portable EEG machines were donated. Antiepileptic drugs (Carbamazepine, Phenytoin, Valproic Acid) are continuously supplied by the Ministry of Health free of charge. Members of the team fluent in Spanish gave educational talks on epilepsy management to local physicians and medical students, as well as workshops on seizure first aid and stigma reduction to the local community, students, and first responders. Results Scott RA, Lhatoo SD, Sander JWAS (2001) The Treatment of epilepsy in developing countries: where do we go from here? Bulletin of the WHO 79(4): 344-351. Meinardi, H. et al (2001). ILAE Commission Report: The treatment gap in epilepsy: the current situation and ways forward. Epilepsia 42(1) 136-149 . Chisholm D (2005). Cost effectiveness of first line antiepileptic drug treatments in the developing world: a population level analysis. Epilepsia 46 (5): 751-759. Since April 2009, we evaluated over 900 patients with neurological complaints. Most were from urban and rural areas of the Napo Province, some travelled over 600 Km for evaluation About 300 patients had epilepsy, 1/3 with active seizures yet not on any treatment. 43% of the 180 EEGs were epileptiform. Developed the first epilepsy clinic in this region with support from the local hospital. Acknowledgments ILAE: Partnering Epilepsy Centers in the Americas (PECA) Program Brigham and Women's Hospital - Harvard Medical School Centro Internacional en Neurociencias – CIEN Pedihabilidad Tena , Ecuador Hospital Jose Maria Velasco Ibarra Tena – Ecuador Dirección Provincial de Salud del Tena