The primary focus of care for patients with epilepsy is the prevention of further seizures, which may, after all, lead to additional morbidity or even mortality (29). The goal of treatment should be the maintenance of a normal lifestyle, preferably free of seizures and with minimal side-effects of the medication. Up to 70% of people with epilepsy could become seizure free with AED treatment.
In 25-30% of people with epilepsy the seizures cannot be controlled with drugs. Epilepsy surgery is a safe and effective alternative treatment in selected cases. Investment in epilepsy surgery centres, even in the poorest regions, could greatly reduce the economic and human burden of epilepsy. There is a marked treatment gap with respect to epilepsy surgery, however, even in industrialized countries.
Attention to the psychosocial, cognitive, educational and vocational aspects is an important part of comprehensive epilepsy care (30). Epilepsy imposes an economic burden both on the affected individual and on society, e.g. the disorder commonly affects young people in the most productive years of their lives, often leading to avoidable unemployment.
Over the past years, it has become increasingly obvious that severe epilepsy-related difficulties can be seen in people who have become seizure free as well as in those with difficult-to-treat epilepsies. The outcome of rehabilitation programmes would be a better quality of life, improved general social functioning and better functioning in, for instance, performance at work and improved social contacts (31).
In 1990, WHO identified that the average cost of medication (phenobarbitone) could be as low as US$ 5 per person per year (32). From an economic point of view also, therefore, it is an urgent public health challenge to make effective epilepsy care available to all who need it, regardless of national and economic boundaries.
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