On 1 December 2025, the University of Oxford’s Oxford Martin School hosted a hybrid panel discussion titled “Integrating Epilepsy into Maternal Health Systems: Lessons from Nepal and Global Insights.” The session featured a framing talk by Ms Deepesha Silpakar, Visiting Fellow with the Programme on Global Epilepsy, and a panel comprising Dr Mahesh Kumar Maskey, Founding Chair and Executive Chief of the Nepal Public Health Foundation; Professor Jane Hirst, Chair of Global Women’s Health at Imperial College London; and Professor Arjune Sen, Professor of Global Epilepsy at Oxford. Together, they explored the epidemiology of epilepsy in pregnancy, system-level barriers in Nepal, and strategies for integrating neurological care into maternal health services in resource-limited settings.

Framing Epilepsy as a Maternal Health Priority

Ms Deepesha Silpakar opened by sharing her personal and professional journey—from early field visits in Nepal to her visiting fellowship at Oxford—using photographs to illustrate both the country’s diversity and its deep health inequities. She outlined Nepal’s geography, governance structure, and maternal health achievements alongside persistent challenges: a maternal mortality ratio of 151 per 100 000 live births and profound stigma around neurological conditions. Silpakar then described the global burden of epilepsy—50 million affected, 80% of whom live in low- and middle-income countries, with a 75% treatment gap—and highlighted the lack of current data on epilepsy in pregnancy in Nepal. Drawing on a tertiary hospital’s records (10 cases per 22 400 pregnancies in 2023–24), she argued that underdiagnosis and underreporting conceal a far larger “iceberg” of unmet need.

Mapping System and Policy Gaps

Silpakar reviewed existing policies: epilepsy features in Nepal’s Basic Healthcare Service Package, the Social Health Security Scheme, and WHO’s mhGAP intervention guide, yet no national or hospital-level protocols address epilepsy specifically during pregnancy. Key system-level barriers include insufficient diagnostic facilities, scarce specialist workforce, poor supply chains for antiseizure medications, and entrenched social stigma that drives many women to traditional healers or prevents them from seeking care at all.

Theory of Change for Integrated Care

Presenting her theory of change model, Silpakar emphasized four pillars—human resources, governance, multisectoral collaboration, and community engagement—to strengthen epilepsy care across the maternal health pathway. Proposed activities range from scaling up mhGAP training for primary healthcare workers and developing context-specific clinical guidelines to enhancing community awareness and refining supply chain management. Short-term outcomes include improved detection and referral; mid-term outcomes target reduced treatment gaps and formal inclusion of epilepsy in routine maternal services; long-term impact envisions sustained reductions in maternal complications, enhanced neonatal outcomes, and diminished stigma.

Insights from Panel Experts

Dr Mahesh Kumar Maskey highlighted Nepal’s experience with community-based data collection methods—such as the “motherhood method” for maternal mortality—that could be adapted to uncover hidden epilepsy cases. He stressed leveraging existing WHO mhGAP initiatives in selected districts to pilot integrated models and generate evidence for national scale-up.

Professor Jane Hirst underscored the necessity of mixed-methods evaluation, combining robust quantitative surveillance (akin to UKOSS for rare obstetric events) with in-depth qualitative research to understand lived experience and stigma. She cautioned against overburdening frontline workers and advocated for carefully scoped task-sharing, ongoing iterative training, and appropriate incentives for both paid and volunteer cadres.

Professor Arjune Sen described Oxford’s development of portable EEG headsets designed for low-resource, hard-to-reach settings. Used alongside digital decision-support tools, such devices can streamline diagnosis and referral, ensuring that pregnant women with suspected epilepsy are rapidly connected to specialist care.

Pathways Forward

Panelists agreed on the urgency of establishing a nationally endorsed, context-specific guideline for epilepsy in pregnancy; implementing sentinel surveillance to capture true prevalence; and engaging civil society—including epilepsy associations and traditional healers—as allies in destigmatization and referral. They called for pilot projects in willing districts, rigorous monitoring and evaluation, and continuous engagement with policymakers to embed epilepsy care within Nepal’s broader maternal health agenda.

As the session closed, speakers and attendees committed to sustaining collaborations between Oxford, Nepal Public Health Foundation, and global health networks—transforming research insights into actionable policies and practices to safeguard the lives of women living with epilepsy.

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