Epilepsy treatment gap: prevalence and associated factors in Southeast Nigeria.

OBJECTIVES: The treatment gap of epilepsy in developing countries is high, and data on the magnitude and causes of epilepsy treatment gap in Africa are sparse. We aimed to determine the prevalence and causes of epilepsy treatment gap among people with epilepsy in a Suburban community in Southeast Nigeria. MATERIALS AND METHODS: The direct method was used to determine epilepsy treatment gap in a two-phase cross-sectional study. Those with probable epilepsy were identified in a door-to-door survey using a modification of World Health Organization (WHO) protocol in the first phase. In the second phase, an epilepsy-specific questionnaire that was further designed to determine the magnitude and causes of epilepsy treatment gap was used. RESULTS: The overall treatment gap of epilepsy was 76% (n = 22/29). The major contributors to the overall treatment gap were people who were never diagnosed accounting for a diagnostic gap of 38% (n = 11/29) and those who were diagnosed but discontinued antiepileptic drug (AED) treatment of their own volition accounting for a therapeutic gap of 38% (n = 11/29). CONCLUSIONS: Epilepsy treatment gap in Southeast Nigeria is comparable to that in many developing countries. Fifty percent of the overall treatment gap was caused by patients discontinuing AED treatment of their own volition despite continuing fits. This result may indicate that perhaps with appropriate education on the need to adhere to therapy, the treatment gap in the community may be narrowed.