Abstracts

Rationale: The WHO estimates that 80% of world’s 50 million persons with epilepsy (PWE) live in resource-poor countries. These countries account for >50% of global burden of disease but less than 2% of health care costs. The recent COVID-19 pandemic disrupted care delivery globally. We hypothesized that the impact of the pandemic would have deleterious effects on epilepsy care in countries with already stretched resources. The aim of this study was to evaluate changes in patterns of care for PWE living in poorly resourced settings during the pandemic.

Methods: We conducted a cross-sectional, online survey among healthcare providers (HCPs) caring for PWE in resource-poor countries. A link to access the questionnaire (Spanish and English versions) was sent to country representatives for local distribution. The Bhapkar test for marginal homogeneity was used to test the equality of the distributions of percentages of PWE seen in the outpatient setting per week pre- and post-COVID.

Results: The survey was available from May 19 to August 25, 2021. A total of 250 HCPs from 22 countries (smallest population Antigua’s 97,000 to largest China’s 1.398 billion) representing four regions (Africa 5.6%; Asia 31.2%; Caribbean 12.4%; Latin America 50.8%) responded to the questionnaire. Most provider practices were located in low- and middle-income countries (LMICs), as classified by World Bank Ranking (WBR). (92%). HCPs from multiple disciplines were represented, with the majority being pediatric and adult neurologists (39 and 22.5% respectively). Most responders worked in public settings (83.2%) and were located in Urban regions (97.1%). EEG was the most restricted diagnostic service. Table 1 describes details by WBR and diagnostic services that were limited during COVID-19. Table 2 displays pre-COVID and post-COVID overall patient percentages and comparisons by WBR.

Conclusions: This study demonstrates that epilepsy care in multiple countries is delivered by a variety of HCPs with different training backgrounds, with most of them practicing in urban areas. The pandemic clearly altered patterns of healthcare delivery for PWE. Overall, in-person epilepsy visits were reduced and telephone visits were used as the main alternative. Access to EEG, lab work and imaging were significantly curtailed. These factors produce a negative impact in an already resource-challenged system. A previous pediatric study showed limitations in epilepsy care (Wirrell, 2020). Our study explored patterns of epilepsy care in both adult and pediatric patients. Lack of dietary and surgical management in LMICs limited our exploration of these therapeutic options. One could hypothesize an even larger impact on rural citizenry with an already limited number of providers. This study focused on LMICs. The WBR system negates intra-comparisons between high-income countries due to significant gross national income (GNI) differences (e.g., $14,460 GNI is $14,460 in Barbados versus $65,910 in the USA). Therefore, we decided to include 3 highly ranked, but not optimally resourced, Island States.

Funding: Please list any funding that was received in support of this abstract.: None.