Availability of antiepileptic drugs: Politicians' roles.

To the Editors: Recently, Baftiu et al. published a very nice and important paper entitled: “Availability of antiepileptic drugs across Europe.” In their study, they observed that the main reasons for poor access to antiepileptic drugs (AEDs) in European countries were lack of regulatory approval, high prices, and reimbursement restrictions. There were large gaps in AED availability across European countries, especially between high-income countries and the others. The newest AEDs were not available in lower-income countries. These authors concluded that their findings raise major concerns about the quality of epilepsy care in many European countries. Findings in the study of Baftiu et al. are important and valid. In fact, the dramatic situation in the world is the presence of even a more strikingly huge gap in epilepsy care between high-income countries and poor nations. In a recent study from the Democratic Republic of Congo, only 33% of the people with epilepsy had received any AEDs, indicating a treatment gap of 67%. In a systematic review investigating global disparities in the epilepsy treatment gap, the authors concluded that the gap was >75% in low-income countries, whereas many highincome countries had gaps of <10%. During the past decade or so, many health care professionals and physicians around the world have developed or proposed creative ways to overcome the challenges and to provide better care for patients with epilepsy in resource-limited settings. These kinds of actions have often resulted in significant changes regionally. However, poor income, lack of resources, regulatory approval, and high prices are apparently not the only factors that play significant roles in lack of access to AEDs and appropriate epilepsy care. In a recent study, we observed that the hardship by the international economic sanctions imposed on the Iranian people in the past few years caused poor access to AEDs in some patients with epilepsy. Compared to the period before the intensification of sanctions, the price of some AEDs (e.g., levetiracetam) increased up to 300% after intensification of the international economic sanctions. In addition, some other AEDs were not available (e.g., zonisamide and nitrazepam) or were difficult to access (e.g., clobazam, vigabatrin and oxcarbazepine) after intensification of the sanctions. None of the newest AEDs (i.e., lacosamide, perampanel, and rufinamide) have become available in Iran. In brief, physicians, researchers, and other health care professionals around the world will continue their endeavor to provide the best care possible for all patients including those with epilepsy, but from a patient care perspective, it is necessary that politicians facilitate decisions that make the life, health, and well-being of ordinary people more affordable and without hardship.