EFFECTIVE STRATEGIES TO STRENGTHEN EPILEPSY CARE IN INDIA AND LOW MIDDLE INCOME COUNTRIES STRENGTHENING EPILEPSY CARE IN INDIA AND LMICS

Epilepsy affects 50 million people globally, with nearly 80% living in low- and middle-income countries (LMICs). Many could be seizure-free with adequate treatment, yet treatment gaps often exceed 50-75% in LMICs. In India, 12 million people have epilepsy, comprising roughly one-sixth of the global burden. This review synthesizes evidence (2008-2026) on community- and facility-level interventions that reduce epilepsy treatment gaps in resource-poor settings. Key strategies include training community health workers (CHWs) with validated screening tools, home-based care by primary health teams, task-shifting under WHOs mhGAP protocols, telemedicine, and improving antiepileptic drug (AED) availability. In rural Rwanda, CHW-led door-to-door screening using a validated questionnaire increased case detection 14.2-fold (from 48 to 682 cases). In rural India and Africa, training local volunteers, traditional healers, and CHWs yielded >75% seizure freedom at one year. A recent Indian cluster trial showed home-based care (monthly nurse visits with free AED provision) significantly improved medication adherence (regression coeff=0.585, p=0.001) and reduced seizures (coeff-2.06, p=0.002) compared to clinic care. Telemedicine (accelerated by COVID-19) reached 50% of Indian patients in one study, with barriers of digital literacy and provider training identified[7].