Comprehensive management of severe epilepsies in small countries with limited resources

Abstract

High professional expertise organized in multidisciplinaryteams is needed to provide comprehensive epilepsy care. InEurope, 54 million people live in 24 countries with a populationof less than 5 million and 12.5 millions live in countrieswith a population of less than 3 million. Adjusted solutionsare needed for severely aff ected people with epilepsy insmall health systems.Living with epilepsy in a small country is a unique challengefor the patient, and so is implementing comprehensive carefor people with epilepsy by health providers. Small populationsrequire adjusted systems of care, often hard to realizedue to limitations in economy and politics. Small populationalso means fewer patients referred and limited professionalexpertise that may adversely aff ect the quality of care.National languages spoken by small populations make useof foreign facilities diffi cult. Linguistic issue becomes evenmore important when neuropsychological and psychiatricproblems are dealt with outside the area exclusively dependingon one language. There is also a risk to neglect patientsaff ected by rare syndromes requiring specifi c treatments.Comparing models of practice may be a useful exercise:systems of care extrapolated from large to smallpopulations may not be most appropriate. Models eff ectivein small health systems may at times be applicable to largerpopulations.