Impact of the Western China epilepsy initiative on epilepsy care capacity in underserved regions: a nationwide cross-sectional survey.

BACKGROUND: China has approximately 10 million people with epilepsy, with western and rural regions facing substantial treatment gaps. The China Association Against Epilepsy launched the Western China Epilepsy Initiative (WCEI) in 2013 to improve epilepsy care in underserved hospitals. OBJECTIVE: To evaluate the impact of the WCEI on epilepsy care capacity at assisted hospitals and professional development of participating experts. METHODS: A nationwide cross-sectional survey was conducted targeting 115 hospitals that received WCEI assistance (2013-2025) and 96 expert team members. The hospital survey collected data on epilepsy center establishment, workforce certification, equipment, patient volumes, surgical capacity, and the use of unauthorized therapies. An interrupted time series analysis using linear mixed-effects models assessed pre- versus post-intervention trends on four key indicators. RESULTS: Among the 115 assisted hospitals, 49 (42.6%) were in western China. A total of 54 hospitals (47.0%) had established formal epilepsy centers, of which 43 (79.6%) were established after WCEI participation. Significant post-intervention acceleration was observed in EEG technician certifications (β2 = 10.2%/year, p = 0.007), epileptologist certifications (β2 = 14.9%/year, p < 0.001), and epilepsy patient visits (β2 = 4.7%/year, p = 0.001). Among 101 hospitals (87.8%) reporting a decline in the use of unauthorized therapies, the median decline was 15% (IQR 8-25%). Over 90% of expert respondents reported gains in clinical competence and professional fulfillment. CONCLUSIONS: The WCEI may have contributed to improvements in epilepsy care capacity in underserved Chinese hospitals, demonstrating a replicable model that can serve as a feasible strategy for narrowing the epilepsy treatment gap.