Abstracts

Rationale: There is an estimated median treatment gap, defined as the number of individuals with epilepsy who remain untreated with anticonvulsant medications, of nearly 50% for epilepsy care across Africa1. Persons with epilepsy in developing countries have at least double the mortality rate of the general population, and having the disease can have significant social consequences, such as negatively affecting employment and marriage prospects2. This disparity in care may be due to many factors, including the limited availability and prohibitive costs of specialists, treatment modalities and diagnostic tools1. One of the major technologies that is essential in the diagnosis and treatment of epilepsy is the electroencephalogram (EEG). Methods: The Foundation for African Medicine and Education (FAME) has established a clinic in Karatu, Tanzania, and provides specialized neurologic care in collaboration with the Hospital of the University of Pennsylvania. In October 2015, EEG was made available at FAME. An EEG machine was donated and local nurses were trained to administer the test. Additional EEG studies were ordered and performed by the local practitioners after the departure of the visiting neurology team from Karatu. Through telemedicine, consultations with the Hospital of the University of Pennsylvania Neurology Department were utilized for interpretation. Results: Several EEGs were done while the neurology team was present for their subspecialty clinic, including one case illustrative of management changes due to EEG findings. A 17-year-old girl with a several year history of recurrent seizures, previously described by family as a head turn to the left and bilateral shaking, presented for follow up to the neurology clinic. She had tried several medications and was on carbamazepine monotherapy with worsened confusional episodes and myoclonic jerks. Her management was complicated by the patient's mother's belief that these episodes were psychogenic, as well as the stigma of epilepsy causing difficulties for the patient at school. Interictal EEG demonstrated generalized frontally-predominant polyspike-and-wave discharges (Figure 1). The patient was successfully transitioned to levetiracetam and achieved seizure freedom after two weeks. Additional EEG studies ordered and performed by the local practitioners were successful in diagnosing primary generalized epilepsy, localization-related epilepsy, infantile spasms, and Lennox-Gastaut syndrome. Conclusions: The FAME clinic EEG program has shown itself to be sustainable in the absence of neurologists with the education of local primary providers in administering the test and the use of telemedicine for interpretation. References 1. Mbuba CK, Ngugi AK, Newton CR, et al. The epilepsy treatment gap in developing countries: A systematic review of the magnitude, causes, and intervention strategies. Epilepsia. 2008;49(9):1491-1503. 2. Wilmshurst JM, Kakooza-Mwesige A, Newton CR. The challenges of managing children with epilepsy in Africa. Semin Pediatr Neurol. 2014;21(1):36-41. Funding: None