{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T09:51:17Z","timestamp":1781776277313,"version":"3.54.5"},"reference-count":21,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epileptic Disorders"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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\u2010limited settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross\u2010sectional survey was distributed to epilepsy healthcare professionals in high\u2010, middle\u2010, and low\u2010income 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\u2010 and second\u2010line ASMs, immune therapies, and KD resources. Barriers to access and affordability were analyzed using descriptive statistics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001). Second\u2010line ASM coverage was 77.8% in HICs versus 66.7% in MICs and 22.2% in LICs (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001). High medication cost was a primary barrier for 80.4% of MIC and 83.3% of LIC providers, compared to 44% in HICs (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.002). Government funding for KD was available to 83.3% in HICs but only 24%\u201325% in LMICs (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.04).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>This study reveals critical gaps in epilepsy care in lower\u2010income Middle Eastern countries, particularly in access to emergency and second\u2010line 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epd2.70225","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T13:11:14Z","timestamp":1774617074000},"page":"832-845","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Challenges in epilepsy management in the Eastern Mediterranean (Part I): Disparities in pharmacological treatment and ketogenic diet access"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5881-9607","authenticated-orcid":false,"given":"Sally","family":"Shaaban","sequence":"first","affiliation":[{"name":"YES\u2010EMR, a Regional Chapter of the Young Epilepsy Section of the International League Against Epilepsy (ILAE\u2010YES) in the Eastern Mediterranean Region"},{"name":"Neurology Department Faculty of Medicine, Mansoura University  Mansoura Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7799-9268","authenticated-orcid":false,"given":"Ruba","family":"Al\u2010Ramadhani","sequence":"additional","affiliation":[{"name":"YES\u2010EMR, a Regional Chapter of the Young Epilepsy Section of the International League Against Epilepsy (ILAE\u2010YES) in the Eastern Mediterranean Region"},{"name":"Division of Child Neurology, Department of Pediatrics Children's Hospital of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3951-6093","authenticated-orcid":false,"given":"Leen","family":"Alkalbani","sequence":"additional","affiliation":[{"name":"YES\u2010EMR, a Regional Chapter of the Young Epilepsy Section of the International League Against Epilepsy (ILAE\u2010YES) in the Eastern Mediterranean Region"},{"name":"Division of Child Neurology, Department of Pediatrics Children's Hospital of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniah","family":"Kurdi","sequence":"additional","affiliation":[{"name":"YES\u2010EMR, a Regional Chapter of the Young Epilepsy Section of the International League Against Epilepsy (ILAE\u2010YES) in the Eastern Mediterranean Region"},{"name":"Department of Pediatrics King Saud University  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bader","family":"Almasaad","sequence":"additional","affiliation":[{"name":"YES\u2010EMR, a Regional Chapter of the Young Epilepsy Section of the International League Against Epilepsy (ILAE\u2010YES) in the Eastern Mediterranean Region"},{"name":"Neurology Department Farwaniya Hospital  Kuwait 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Epilepsy Section of the International League Against Epilepsy (ILAE\u2010YES) in the Eastern Mediterranean Region"},{"name":"Department of Pediatrics Mother and Child University Hospital of N'Djamena  N'Djamena Chad"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wafaa","family":"Al Shehhi","sequence":"additional","affiliation":[{"name":"YES\u2010EMR, a Regional Chapter of the Young Epilepsy Section of the International League Against Epilepsy (ILAE\u2010YES) in the Eastern Mediterranean Region"},{"name":"Department of Pediatrics Royal Hospital, Ministry of Health  Muscat Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4480-525X","authenticated-orcid":false,"given":"Mohamed","family":"AlKhaja","sequence":"additional","affiliation":[{"name":"YES\u2010EMR, a Regional Chapter of the Young Epilepsy Section of the International League Against Epilepsy (ILAE\u2010YES) in the Eastern Mediterranean Region"},{"name":"Internal Medicine Department King Hamad University Hospital  Busaiteen Bahrain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamda A. K.","family":"Albastaki","sequence":"additional","affiliation":[{"name":"YES\u2010EMR, a Regional Chapter of the Young Epilepsy Section of the International League Against Epilepsy (ILAE\u2010YES) in the Eastern Mediterranean Region"},{"name":"Neurology Department Rashid Hospital  Dubai UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4921-8847","authenticated-orcid":false,"given":"Ahmed","family":"Abdulrahman","sequence":"additional","affiliation":[{"name":"YES\u2010EMR, a Regional Chapter of the Young Epilepsy Section of the International League Against Epilepsy (ILAE\u2010YES) in the Eastern Mediterranean Region"},{"name":"Department of Neurology, Faculty of Medicine Aden University  Aden Yemen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"YES\u2010EMR, a Regional Chapter of the Young Epilepsy Section of the International League Against Epilepsy (ILAE\u2010YES) in the Eastern Mediterranean Region"},{"name":"Department of Neurology Damascus Hospital  Damascus Syria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nada","family":"Benkirane","sequence":"additional","affiliation":[{"name":"YES\u2010EMR, a Regional Chapter of the Young Epilepsy Section of the International League Against Epilepsy (ILAE\u2010YES) in the Eastern Mediterranean Region"},{"name":"Moroccan Society of Neurology (SMN)  Rabat Morocco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shorouk","family":"Mohsen","sequence":"additional","affiliation":[{"name":"YES\u2010EMR, a Regional Chapter of the Young Epilepsy Section of the International League Against Epilepsy (ILAE\u2010YES) in the Eastern Mediterranean Region"},{"name":"Public Health and Community Department Faculty of Medicine, Mansoura University  Mansoura Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"Epilepsy.https:\/\/www.who.int\/news\u2010room\/fact\u2010sheets\/detail\/epilepsy. 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