Surgical Treatment for Epilepsy in Developing Countries

To the Editor: In their Clinical Crossroads article, Drs Schomer and Black¹ reviewed surgery for intractable seizures. It is notable that none of the references in this article appear to have originated from a developing country. This does not represent a bias in reference selection; it reflects the scarcity of such studies on patients with epilepsy in the developing world. Yet, of more than 50 million people with epilepsy, 80% live in developing countries, 90% of whom do not receive appropriate treatment.² In the context of large and rapidly increasing populations in these countries, epilepsy remains a significant health and socioeconomic burden, and these patients experience the psychosocial consequences of stigma, discrimination, and underemployment.³ The cost of surgery compared with the gross domestic product per capita may be relatively low in developing countries,⁴ and epilepsy surgery has been shown to be feasible in these areas.⁵ However, many of these countries lack neurologists and neurosurgeons who can perform this surgery.