Document Download: Epilepsy: Global Issues for the Practicing Neurologist

Preface

Epilepsy is one of the most common serious primary brain disorders, affecting 40 million people worldwide. According to the World Health Organization (WHO), epilepsy accounts for 1% of the Global Burden of Disease, equivalent to lung cancer in men and to breast cancer in women. It is not surprising, therefore, that 10 to 20 textbooks on epilepsy are published annually. These texts contain the very latest information on the diagnosis and treatment of various aspects of epilepsy; however, approximately 80% of people with epilepsy in the world live in developing countries, where modern diagnostic and treatment approaches do not exist. Upwards of 90% of people with epilepsy in these areas receive no treatment at all. It is surprising, therefore, that no textbook on epilepsy addresses the issues faced by neurologists who must deliver care with limited resources, often in a setting of tropical diseases and malnutrition that characterizes practice in developing countries. This text is specifically designed for this purpose.

The World Federation of Neurology has recognized the unmet need of neurologists who must practice medicine without many of the advantages that are often taken for granted in the industrialized world, and has undertaken the task of creating a series of textbooks on neurologic subspecialty topics, in an effort to address issues important for neurologists in developing countries, but which are not covered in standard textbooks. This is the first in the series specifically intended to achieve this goal. At this point, the book is a work in progress, because the authors' experience is limited to only a few areas of the extensive developing regions of the world, and undoubtedly, many important problems remain to be identified and addressed. Consequently, we will appreciate feedback from our colleagues who use this text to help us make it more comprehensive in future editions.

Although I, as chief editor, practice at the University of California in Los Angeles, with all the advantages available to neurologists in the industrialized world, my familiarity with the problems of people with epilepsy in developing countries has increased since 1993, when I served first as treasurer, then president, of the International League against Epilepsy (ILAE), and most recently as co-chair of the joint ILAE/International Bureau for Epilepsy (IBE)/WHO Global Campaign against Epilepsy. My personal lack of hands-on experience is complemented by the coauthors of this book, all of whom are neurologists practicing in developing countries. Gretchen Birbeck is a neurologist in a general medical clinic in rural Zambia, and she has written a handbook on epilepsy for healthcare workers in similar environments. Amadou Gallo Diop is a member of the neurology department at a medical college in Dakar, Senegal, and has been instrumental in organizing epilepsy programs for the WHO and the ILAE in Sub- Saharan Africa. Satish Jain heads an epilepsy center in New Delhi, India, and has been active in programs of the Southeast Asian region of the WHO. André Palmini is the scientific director of an epilepsy center at a university hospital in Porto Alegre, Brazil, and was chair of the ILAE Commission on Latin American Affairs.

The authors are grateful to Martin Brodie from Glasgow, Scotland, an expert on the clinical pharmacology of antiepileptic drugs, who chaired the ILAE Commission on European Affairs and is currently a vice president of that organization; Olivier Dulac, a pediatric epileptologist in Paris, France, who has worked in various developing countries; J.A.W. Sander of London, who has organized epidemiologic studies throughout the developing world, and is currently treasurer of the ILAE, and C.T. Tan, a general neurologist in Kuala Lumpur, Malaysia, who chairs the ILAE Commission on Asian and Oceanian Affairs, for their review and critical comments on the manuscript.

Jerome Engel, Jr., MD, PhD
Los Angeles, California
September 2004