Abstracts

Rationale: In the Ecuador Amazon region, it is estimated that over 70% of patients with epilepsy do not receive appropriate treatment due to lack of access to neurological diagnosis and care. The city of Tena, located in the Napo Province in the rural Amazon region of Ecuador, is ~200 kilometers away from the nearest facility with neurological services. We introduced an epilepsy clinic in this region 3 years ago and sought to create a system locally to sustain it. Methods: We organized annual epilepsy clinics with a local team in Tena 3 years ago. Quarterly visits by a smaller team was accomplished with email and skype contact for questions. A local internist interested in the mission was trained and a consultation model was initiated with local practitioners from the Jose Maria Velasco Ibarra Hospital. In April 2011, a team of 2 adult neurologists, 1 pediatric neurologist, 1 neurosurgeon, 2 electroencephalography (EEG) technicians, 1 physical therapist and over 20 volunteers (residents, medical students, nurses, and translators both from Ecuador, and the U.S.) examined patients in consultation with the internal medicine and pediatric staff of the hospital. Spanish and Quichua translation was available. Anti-epileptic drugs supply was continued by requests to the Ministry of Health at no charge. Members of the team lectured to local physicians, residents, medical students, first responders and the community on a variety of topics in epilepsy. This study was sponsored by the ILAE Partnering Epilepsy Centers in the Americas (PECA) grant.Results: In 3 working days in 2011, we evaluated a total of 253 patients with neurological complaints. Of the total number of patients evaluated, 102 had epilepsy, 61% were children. A total of 54 EEGs were performed, 26 were normal, 17 showed generalized epileptiform discharges, and 12 with focal epileptiform discharges. Approximately 60% of the patients were repeat visitors. The local doctors were very receptive to the consultants; they evaluated and treated the patients in conjunction. In this way appropriate follow up was assured. Conclusions: This 3 year ongoing project with a rural hospital in the Ecuador Amazon region includes local practitioners working together with epileptologists in order to sustain a collaboration between Latin America and North America. While only a small project, we are aiming to decrease the epilepsy treatment gap and increase knowledge about epilepsy as a treatable illness in this previously underserved region.