Abstracts

Rationale: Ninety percent of people with epilepsy live in less developed countries and more than three-fourths of affected people in developing countries do not get the treatment they need. In India, there are less than 2000 practicing neurologists for a population greater than 1.15 billion people, most of these neurologists practice predominantly in urban areas. In 2009, Dr. Mamta Singh established a mobile epilepsy clinic, as part of the Lifeline Express (LE) medical train, where she and colleagues travel to rural areas and see epilepsy patients for a single visit, recognizing a follow-up visit is impractical in a majority of cases. This approach raises the question of whether a one-time mobile clinic can be a feasible and effective model for the chronic treatment of epilepsy in rural India. This could be evaluated by measuring continued medication adherence in patients at greater than 6 months after the visit. Methods: The researchers developed an interview tool composed of demographics and primarily close-ended questions, with limited open-ended questions. Two LE stop locations in different areas of northern India were chosen, Babrala and Morena, due to similar characteristics (seen 7-9 months previously and similar proximity to Delhi). Patients who had been seen at the LE clinic were contacted for an in-person interview where possible; otherwise the survey was completed over the phone. Data was then coded and summarized. Results: Of the 334 patients originally seen during the clinics at Babrala and Morena, 36 were excluded for various reasons (non-epileptic spells, no medications given, death, or refusal to participate), leaving 298 eligible patients, 142 of which were interviewed (47.7%). Of those patients contacted, 72.5% of patients were still taking medications; the non-respondents (52.3%) had an unknown adherence status. Patients who were more likely to be adherent included those who were already being treated when they were seen at the LE epilepsy clinic (93.7%), who had previously seen a doctor regarding their seizures (81%), who believed epilepsy was a treatable condition (79.1%), who had the perception that medications improved their seizures (86.8%), and who reported fewer seizures over the preceding month (82.8%). There were no significant differences due to age, sex, marital status, education level, employment status, type of epilepsy, length of time with epilepsy, or frequency of seizures at the time of visit. Conclusions: Most of the contacted patients seen on the Lifeline Express were still taking medications between 6-9 months after a one-time visit with a neurologist. Those patients who had previously been treated for epilepsy and who had the perception that epilepsy could be treated and that medications improved seizures were more likely to be adherent. This one-time clinic appears to be an effective model of treating epilepsy, and could be a model for epilepsy care in other countries.