Abstracts

Rationale: Jamaica is an island in the English-speaking Caribbean with a population of about 2.8 million and limited resources. Jamaica has 0.41 physicians per 1000 (U.S.A.: 2.42) and even fewer neurologists available. Neither epilepsy surgery nor other non-pharmacological options, ex: Vagus Nerve Stimulator, are available in the island.Methods: We reviewed an epilepsy cohort (2007-2015) of the largest neurological practice in the country to compare the outcomes of patients who were managed according to accepted standard of care but with the limited resources available.Results: There were 52 patients with 17 males and 35 females. Seizure types included generalized seizures, complex partial seizures, unclassified and psychogenic non-epileptic seizures. Routine EEG was done on all the patients, with abnormal results suggesting epilepsy in 40 patients; MRI Brain was done on 45 patients (abnormal results in 20 patients). Video-EEG was performed in only 10 patients due to limited availability (abnormal in 8 patients). Anti-seizure agents used were a mixture of first and second-generation medications, although Oxcarbazepine and Phenobarbital were used less compared to the other agents noted. 65% of women of childbearing age were on Folic acid, in keeping with the guidelines. Overall, 39 patients were seizure-free on single or a combination of anti seizure agents. 8 patients were seizure-free (at least one year) on single agent; 20 patients were seizure-free on 2 agents and 11 patients needed multiple (more than 2) agents to attain seizure-freedom. 13 patients were refractory to multiple medications and most of these patients had seizure duration of 10 – 40 years. Some, if not many, of these patients would benefit from further evaluation and be potential candidates for surgical management or options such as VNS or Responsive Neuro Stimulator (RNS, Neuropace).Conclusions: In general, although accepted guidelines are being followed in managing the patients with seizures in Jamaica with fair outcomes (75% of patients in the cohort are seizure-free), the lack of resources, particularly further investigative and surgical options, may represent a significant limitation to achieving optimal care.