Packages of Care for Epilepsy in Low- and Middle-Income Countries 英文参考文献.docVIP

NeglectedDiseases 1 PackagesofCareforEpilepsyinLow-andMiddle-Income Countries CarolineK.Mbuba1,CharlesR.Newton1,2,3* 1TheCentreforGeographicMedicineResearch(Coast),KEMRI,Kilifi,Kenya,2ClinicalResearchUnit,LondonSchoolofHygieneandTropicalMedicine,London,United Kingdom,3NeurosciencesUnit,InstituteofChildHealth,UniversityCollegeLondon,London,UnitedKingdom This is the second in a series of articles highlighting the delivery of ‘‘packages of care’’ for mental health disorders in low- and middle- incomecountries.Packagesofcarearecombinationsoftreatmentsaimed at improving the recognition and management of conditions to achieve optimaloutcomes. disorders,psychoses,andpersonalitydisorders[12,13].Psychiatric comorbidity appears to be particularly common in some LMICs [14]. Stigma poses a major burden to PWE and their families, interferingwiththeopportunitiesthatPWEhaveforemployment andmarriage[15].Finally,womenwithepilepsyareparticularly vulnerable to sexual exploitation, physical abuse, and extreme poverty[16]. In this article, we focus on the management of epilepsy in LMICs. We review the evidence from LMICs on the efficacy of treatmentsanddeliveryofinterventions.Becausethatevidenceis often limited, we also refer to systematic reviews, meta-analyses, andkeytrialsfromHICswhereappropriate.Onthebasisofthis review, we propose a package of care—a combination of interventions aimed at improving the recognition and manage- mentofconditionstoachieveoptimaloutcomes—forepilepsy. Introduction Epilepsy is one of the most common and widespread neurological disorders. Recent estimates suggest that it accounts for 1% of the global burden of disease [1] and affects over 65 millionpeople[2].Inaddition,becausetherelativesandfriendsof peoplewithepilepsy(PWE)alsobeartheburdenofthiscondition, more than 500 million people are indirectly affected by epilepsy [3]. Thus, epilepsy imposes a large economic burden on global healthcaresystemsandisamajorpublichealthprobleminlow- andmiddle-incomec