S. Shaaban, R. Al-Ramadhani, L. Alkalbani, D. Kurdi, B. Almasaad, A. Tilako, RB. Dhia, C. Nderbe Melom, W. Al Shehhi, M. AlKhaja, HAK. Albastaki, A. Abdulrahman, A. Ibrahim, N. Benkirane, et al. (2026). Challenges in epilepsy management in the Eastern Mediterranean (Part I): Disparities in pharmacological treatment and ketogenic diet access. Epileptic disorders : international epilepsy journal with videotape, 28(3), 832-845. https://doi.org/10.1002/epd2.70225

PubMed 41891746

[Abstract]
OBJECTIVE: To assess disparities in access to antiseizure medications (ASMs) and ketogenic diet (KD) therapy across Middle Eastern countries with different income levels, and to identify barriers to epilepsy care in resource-limited settings.

METHODS: A cross-sectional survey was distributed to epilepsy healthcare professionals in high-, middle-, and low-income countries (HICs, MICs, and LICs) in the Middle East. Of 206 responses, 93 experts met inclusion criteria. The survey assessed the availability of rescue medications, parenteral status epilepticus treatments, first- and second-line ASMs, immune therapies, and KD resources. Barriers to access and affordability were analyzed using descriptive statistics.

RESULTS: Significant disparities were found across income groups. Access to parenteral lorazepam was 76% in HICs versus 10.7% in MICs and 8.3% in LICs (p < .001). Second-line ASM coverage was 77.8% in HICs versus 66.7% in MICs and 22.2% in LICs (p < .001). High medication cost was a primary barrier for 80.4% of MIC and 83.3% of LIC providers, compared to 44% in HICs (p = .002). Government funding for KD was available to 83.3% in HICs but only 24%-25% in LMICs (p = .04).

SIGNIFICANCE: This study reveals critical gaps in epilepsy care in lower-income Middle Eastern countries, particularly in access to emergency and second-line treatments. The findings demonstrate that barriers extend beyond cost to include regulatory and health system structures, providing crucial evidence to inform health policy and advocacy efforts aimed at reducing the global epilepsy treatment gap.