Epilepsy Pioneers in Georgia and Current Educational Programs in Georgia

Two famous Georgian scientists Ivane Beritashvili and Petre Sarajishvili established the electroencephalography (EEG) Laboratory in the Department of Neurophysiology at the Ivane Javakhishvili Tbilisi State University, and the first human EEG investigation was performed in Georgia in 1949. In 1958, P. Sarajisvili promoted the establishment of an Institute of Neurology in Georgia that was renamed “P. Sarajishvili Institute of Neurology and Neurosurgery” in 1987. In this institution, the first electrophysiological department headed by Prof. Tina Geladze was established and since then electrophysiology and epileptology became the priorities. From 1960s till the collapse of the Soviet System, the Institute of Neurology was leading in performing scientific clinical and experimental investigations in the field of epilepsy. In the rest of the Soviet Union (S.U.), epilepsy was categorized under psychiatric care, but in Georgia it was an exception and epilepsy was managed only by neurologists.

The first and best monography about epilepsy in S.U., based on western literature and its achievements, was issued in 1979 by Profs. Sarajishvili and Geladze. The first Epilepsy Department in Georgia was opened in 1980 and was acknowledged as a scientific and practical center for epilepsy in the whole territory of the former S.U. The center was equipped with modern EEG, video-EEG, ambulatory-EEG, polysomnography, computed tomography (CT), and magnetic resonance imaging (MRI). The P. Sarajishvili Institute of Neurology had clinical, experimental, and epilepsy surgery departments and all clinical trials of anti-epileptic drugs (AEDs) were performed there.

In 1980s, first steps for an epilepsy service were took and intensive epidemiological studies started. In fact, between 1987 and 1992 in four regions of Georgia with a population of 350,000 door-to-door investigations were performed, and 10,966 persons were interviewed. High-risk patients were studied by a group of epileptologists (11 persons) for EEG investigations. It was shown that in 1,000 people the prevalence of active epilepsy varied from 5 to 12 in several regions (mean: 8.5 per 1,000).

In the Soviet health care system, all investigations were supported by the government, as well as outpatient and inpatient treatment and provision with antiepileptic drugs. The availability of epilepsy service was equal for any patient.

Fig. 1 Prof. Tina Geladze at the 22nd International Epilepsy Congress, Dublin, 1997.

In 1997, Prof. Geladze founded the Georgian League against Epilepsy (GLAE) and became the first president of GLAE until 2012. On the 22nd International Epilepsy congress in Dublin (1997), GLAE officially became a member of International League against Epilepsy (ILAE) ([Fig. 1]).

In 2001, the P. Sarajishvili Institute of Neurology and Neurosurgery in Georgia was destroyed and epilepsy was totally removed from the health care system. Visits to doctors and investigations became chargeable and costly; patients on AEDs had to pay for themselves and only urgent cases were supported by the government (status epilepticus). Hence, epileptic treatment became no longer available for the majority of patients. Moreover, due to the serious economic crisis, most of the staff had to change profession. Despite the Georgian chapter of ILAE still functioning at the time, former employees of the epilepsy center and epilepsy patients were left careless, and enthusiasm from the side of doctors was not enough for elementary epilepsy service provision. The big army of primary health care doctors and neurologists was not able to advice patients due to the low educational level in epilepsy. They chose to ignore the problem completely. This led to unfortunate cases of self-treatment, use of herbal medicines, admittance to fortune-tellers, mullahs, etc. As a result, outpatient admittance drastically reduced. For example, in 2002, in a country with a total population of 4.5 million, only 7,828 patients with epilepsy were registered. As a result, inadequate treatment, treatment gaps, status epilepticus, inadequate prescriptions, epilepsy stigmatization, and mortality were dramatically raised.

In 2005, Ltd. “Research-Practical Center for Prevention and Control of Epilepsy” (now Ltd. “Institute of Neurology and Neuropsychology” [INN] since 2010) was founded. In 2005, INN created the project for stage-by-stage formation and cost-effective functioning of epileptological service in Georgia, and was submitted for review to the Parliament Committee of Health Care and Social Affairs and Georgian Ministry of Health. On the basis of this project, the Georgian Government developed the first longstanding State Program on epilepsy–“Prevention and early Diagnosis of Epilepsy” (for primary and secondary health care level). As a result, since then epilepsy has been recognized as one of the more important social and health care problems in Georgia.

Within the framework of this state program, an electronic version of “National Epilepsy Registry” was created and this launched the formation of a database. The epilepsy registry is the official statistical base of the Georgian Government in the field of epilepsy. Nowadays, more than 50% of people with epilepsy living in Georgia are registered. All persons registered in the “epilepsy registry” are multidisciplinary investigated in INN, including registration of all dates of demographical, neurological/epileptological, standard EEG, neuropsychological testing, and MRI investigations. A model for cost-effective management of epilepsy at primary and secondary levels of epileptic care was developed and introduced.

The principles of a biopsychosocial approach for the treatment of epilepsy (including neuropsychologists, clinical psychologists, and psychiatrists) were implemented. National Guidelines and Protocols on Prevention, Diagnostic, Management, and Care of Epilepsy (was approved by Georgian MoH in March 19, 2007, revised in 2014 and in 2017) were developed and implemented in medical practice. The epilepsy–antistigma activity to support Global Campaign “epilepsy out of shadows” (ILAE/International Bureau of Epilepsy [IBE]/World Health Organizations [WHO]) started in Georgia in an effort to fight the stigma of epilepsy—there were 7 textbooks published on epilepsy for professionals, more than 30 booklets for public education, 2 books for school teachers with recommendations on first aid of epileptic seizures, 6 posters about medical and psychosocial problems of epilepsy which were directed to professionals, patients and their family members, school teachers, and broad society. Since 2011, “epilepsy day” is systematically organized in Georgia for supporting people with epilepsy.

Georgia with Armenia in partnership with ILAE, played a major role in establishing Regional Caucasian Summer Schools on Clinical Epileptology. Since 2008 till nowadays, seven schools were organized and eighth is on the way, with more than 500 participants. Four of them were organized in different regions of Georgia. GLAE and the Georgian Association of Pediatric Neurology (GACNN) with the help of their collaborators are permanently organizing several teaching courses with famous international experts, such as Wolf P., Janz D., Vigevano F., Nevill B., Bialer M., Tomson T., Perucca E., Cross H., Korinthenberg R., Guekht A., Beniczky S., Sander JW., Sperling M., Pennell P., Engel J., and Speccio N.

From 2012 till 2018, GLAE was led by Prof. Nana Nino Tatishvili. For the promotion of knowledge in the field of epilepsy in the Caucasus Region, the president of GLAE, Prof. Tatishvili was awarded with the European Educational Award at the European Congress of Epilepsy in 2015 in Prague ([Fig. 2]).

Fig. 2 Prof. Nana Nino Tatishvili.

The great majority of neurologists have been retrained in leading clinics of European countries and in the U.S.A. in the fields of neurology, pediatric neurology, developmental pediatrics, epileptology, clinical electrophysiology, and sleep medicine by longstanding fellowship programs (Donors Georgian Scientific foundation, EFNS, ESRS, IBRO, Marie Curie Project), distance education courses of ILAE–Virtual Epilepsy Academy (VIREPA), ILAE/ILAE-Europe short-term intensive training courses, and the process is still continuing.

Under the global campaign “epilepsy out of the shadow,” WHO, the ILAE and IBE in collaboration with the Georgian Chapter of ILAE and IBE, recently conducted a demonstration project on epilepsy in Georgia.

GLAE has performed various scientific projects on the epidemiology of epilepsy, on epidemiology of pharmacologically resistant epilepsy, on the late results of AEDs in children suffering from fetal-anticonvulsants exposure, on rare epilepsy syndromes, epilepsy mortality study, and the health-related quality of life of patients with epilepsy.

Georgia is included in international registries of EURAP (European registry on antiepileptic drugs and pregnancy), “EpiNet” (international epilepsy network), and EEG SCORE.

In 2015 teaching course, “clinical electrophysiology and electroencephalography” was approved as a subspecialty by the Ministry of Health of Georgia and seven specialists were certified. In 2016, with active support of German epileptologists (Gloveli T., Holtkamp M., et al) the development of an epilepsy monitoring unit (EMU) and an epilepsy surgery service started in Georgia.

In 2018, during the repetitive elections of GLAE, Prof. Sofia Kasradze, founder of the Institute of Neurology and Neuropsychology, became the new president of the GLAE ([Fig. 3]).

Fig. 3 Prof. Sofia Kasradze.