The burden and pharmacoeconomics of epilepsy in India

t Sir, Epilepsy affects 40 million people worldwide, threequarters of whom remain untreated. About 75% of the 40 million people with epilepsy worldover are in developing countries. However, with early diagnosis and treatment, epilepsy can be controlled in three-quarters of those affected1. Since the prevalence rate of active epilepsy in India is 5.5/1000, the number of active epilepsy patients in India will amount to 5.4 million, i.e. one-eighth of the total epilepsy patients in the world2. A recent meta-analysis, conducted by Sreedharan and Murthy3, estimated that the number of people with epilepsy by the year 2001 will be 5.5 million and the number of new cases of epilepsy every year as approximately half a million. Since 74% of the Indian population live in rural areas, the number of rural epilepsy patients would be∼ 4.1 million, out of which∼ 3.0 million will not be getting any treatment for epilepsy! The above statistics clearly shows the enormous burden of epilepsy for a developing country, like India, where the Gross National Product (GNP) per capita income is only US$ 390 (US$ 1= Indian Rupees 43.0), whereas, the GNP per capita for United Kingdom (UK) and the United States of America (USA) are US$ 20 710 and 28 740 respectively4. Hence, there is an emergent need for an appropriate choice of antiepileptic drug (AED) for each epilepsy syndrome. Moreover, the emphasis should be on the choice of inexpensive AEDs like phenobarbital (PB) and phenytoin (DPH) over carbamazepine (CBZ) wherever possible, starting as monotherapy, based on the International League Against Epilepsy (ILAE) classification5. Intractable epilepsy is most often the result of missed opportunities for therapy6. Sub-optimal use of antiepileptic drugs, non-compliance, inappropriate selection of AEDs, wrong AED for a wrong diagnosis, polypharmacy etc. can result in escalation of cost and intractability. Following the era of widespread polytherapy for the treatment of epilepsy, it is now uniformly accepted that most cases of newly diagnosed epilepsy in children or adults can be controlled with a single AED7–10. Evidence has accumulated in the literature that the correct