February 21, 2020

International League Against Epilepsy: Reducing the Epilepsy Treatment Gap in Pakistan

With a countrywide prevalence of 0.98%, more than 2.2 million people have epilepsy in Pakistan. A 1987 population-based study estimated Pakistan’s treatment gap at 72.5% in urban areas, and 98.1% in rural ones.

Clinicians in Pakistan have worked consistently, with strategies large and small, to chip away at the country’s epilepsy treatment gap. “We had been working sporadically since 1985,” remembered Zarine Mogal, president of the Pakistan ILAE chapter. “We started sustained activities in 2001, with a goal of reducing the treatment gap by 50%.”

To manage the activities, the Comprehensive Epilepsy Control Program of Pakistan was established—a non-governmental organization that includes the National Epilepsy Centre in Karachi, as well as Epilepsy Support Pakistan, which conducts public awareness and epilepsy education activities. The two parts work together, often overlapping.

After five years of sustained efforts, a population-based study found that in urban areas of Pakistan, the treatment gap had dropped from 72.5% to 25%. “That was beyond our expectations,” said Mogal.

Later, to bolster the survey findings, the group analyzed data on anti-seizure drug sales between 1998 and 2018. They found a 15.6% annual growth rate in sales, as well as significant growth in drug manufacturing.

In hindsight, the effort to reduce the treatment gap can appear painstakingly planned, like the blueprints for a shopping complex or a neighborhood. But the secret of Pakistan’s success is not rooted in elaborate planning. Nor did it rely on consistent, generous funding, or following designated steps. The secret is not much of a secret at all, really; it merely combined three components that predict success in almost any venture:

Start small. Be flexible. And never give up.

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