Abstracts

Rationale: In the Ecuador Amazon region, it is estimated that 70% of patients with epilepsy do not receive appropriate treatment due to lack of access to neurological diagnosis and care. The city of Tena is located in Napo in the rural Amazon region of Ecuador where the nearest facility with neurological services is located ~200 kilometers away. This distance and a substantial prevalence of poverty prevent patients from obtaining proper diagnosis and treatment of neurological conditions. Methods: We have a sustained collaboration with staff and physicians of the local public Hospital Jose Maria Velasco Ibarra in Tena. We organized annual and quarterly epilepsy clinics. In April 2010, a team of 4 neurologists, 1 general practitioner, 1 electroencephalography (EEG) technician, 1 physical therapist and over 20 volunteers (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 are supplied by the Ministry of Health free of charge. Members of the team lectured to local physicians, residents, medical students, first responders and the community on a variety of topics in epilepsy. Results: In 3 working days, we evaluated a total of 350 patients with neurological complaints. Most of the patients were from urban and rural areas of the Napo Province, however some of them travel over 600 Km to be evaluated. Of the total number of patients evaluated, 122 had epilepsy, 54 % were children, 76 were new patients and 46 were follow-ups. Of the new patients with epilepsy, 43 had uncontrolled seizures and were receiving no treatment. A total of 36 EEGs were performed, 18 were normal, 10 with generalized epileptiform discharges, 5 with focal epileptiform discharges, and 3 with diffuse slowing. In response to the need for care of the patients with epilepsy, the hospital in collaboration with us created the first epilepsy clinic in this region, this will assure that patients with epilepsy will have continuity and follow up care. Conclusions: A sustained ongoing collaboration with a rural hospital in the Ecuador Amazon region is decreasing the epilepsy treatment gap in this region. This ongoing project will continue to increase the access to epilepsy care in the developing world. Future efforts will aim at telemedicine consultation and educating local health providers in continuity of care for these patients with epilepsy.