Field notes: Doctors drawn to build epilepsy program in Peru

LIMA, Peru – He is a neurologist in Canada’s largest epilepsy program, and yet Dr. Jorge Burneo comes from a country with no specialized medical help, and a higher-than-average incidence for this serious neurological disorder. “I’m from Peru, so of course, I feel an obligation to help,” he says.

Burneo and neurosurgeon Dr. David Steven, both associate professors in the Department of Clinical Neurological Sciences at the Schulich School of Medicine & Dentistry, recently returned from a trip to Lima, Peru, where they trained physicians to diagnose and treat epilepsy. In Canada, the prevalence of epilepsy is 4-5 incidents per 1,000 people, but in Latin America, 18 per 1,000 are affected.

“At best, they may see their family doctor who only knows of one or two medications to prescribe,” Burneo says. “Many people in Peru just learn to live with the seizures, even though epilepsy is treatable for three-quarters of patients.”

Their commitment to help Peru establish an epilepsy program goes back to 2008 with the launch Partnering Epilepsy Centers in the Americas (PECA). The idea was to pair a centre in North America with a centre in Latin America or the Caribbean for mentoring.

In August of that year, Burneo travelled to Lima, the capital of Peru, to the largest neurological hospital in the public health system to give a workshop to neurologists on video-EEG (electroencephalogram), which measures electrical activity along the scalp to help diagnose seizures. By the end of the following year, they were running their own video-EEG units. The mentorship has grown, with doctors from Peru coming to London Health Sciences Centre for observerships, and return trips to Lima for Burneo.

This was Steven’s first trip, trying to help take its fledgling epilepsy program to the next level to include surgery. He conducted workshops and delivered lectures at the National Institute of Neurological Sciences, to the Department of Neurosurgery at the Hospital Edgardo Rebagliati Marins, the largest hospital in Peru, and to the Peruvian Neurology and Neurosurgery Societies.

Setting up an epilepsy surgery program represents a big challenge. It requires a multidisciplinary team as well as skilled surgeons. “We recommend a year of fellowship training to learn the specialized techniques on top of the basic neurosurgery training, and that can be difficult to arrange because of the language barrier,” Steven says. “I was impressed though, by how genuinely motivated people are there. It’s not an easy enterprise to start an epilepsy program.”

To help Peruvian patients and their families, as well as physicians, Burneo has launched a Spanish website, epilepsiaperu.com, with questions and answers about epilepsy, all delivered in easily understood terms.

Both feel there are lessons to be learned from international experiences like this.

“I learned there are ways we can make things work even without all the equipment and technology that we have here in London,” Burneo says.

Steven sees the flip side. “It makes you realize how much we have here and how fortunate we are to have our health-care system and all the latest technology.”

The collaboration has also produced research opportunities with Dr. Hugo Garcia, who holds a multi-million grant from the Bill and Melinda Gates Foundation, to study cysticercosis, a diseases caused by parasites in which cysts may enter the brain and cause seizures. Neurocysticercosis is actually the leading cause of seizure worldwide.

Burneo has also started collaboration with Garcia and other centers in Latin America (Ecuador, Honduras, Brazil and Mexico) and the United States to study the relationship between cysticercosis and epilepsy, a collaboration that has already been recognized by the American Epilepsy Society with a research infrastructure grant.

As for the future, Burneo and Steven plan to return to Lima in 2012 to assess the progress being made on Peru’s epilepsy program.