Epilepsy in Rural Settings: Treatment Gap, Seizure Control, and Social Determinants: A Community-Based Cross-Sectional Survey Across Three Hundred and Forty Affected Individuals

Dr. Zeeshan Khan, Mohini Dhabhai, Dr. Shiv Kumar Gupta

Epilepsy; Treatment Gap; Rural Health; Antiepileptic Drugs; Adherence; Stigma; Community Health Worker; Seizure Control

Epilepsy affects approximately 12 million individuals in India, with the majority living in rural areas where specialist neurological services are scarce. The treatment gap defined as the proportion of affected individuals not receiving adequate antiepileptic drug (AED) therapy has been estimated at 50-70% in many rural Indian surveys, with substantial heterogeneity by geography, gender, and socioeconomic status. We undertook a community-based cross-sectional survey of 340 individuals with active epilepsy across twelve rural villages served by a tertiary medical centre. The treatment gap in our cohort was 42.4%, with substantial variation by subgroup: 72.6% in those with less than five years of education, 71.4% in tribal community members, 68.4% in those living more than 20 km from a clinic, and 58.4% in women. Seizure-free status over the preceding 12 months was achieved by 44.7% of adherent patients but only 8.3% of poorly adherent or untreated patients. Independent predictors of treatment gap included distance to clinic, low education, female sex, household poverty, family-reported stigma, tribal community membership, and traditional healer use. Community health worker (CHW) visits were strongly protective. The findings reinforce the case for community-based epilepsy programmes with CHW outreach, structured AED supply, and stigma-reduction education.

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