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May 6, 2009

Surgical Treatment for Epilepsy in Developing Countries

JAMA. 2009;301(17):1769-1770. doi:10.1001/jama.2009.583

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.

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