Overcoming the Disease

Today is the World Epilepsy Day and there are some facts which are to be known regarding epilepsy. Epilepsy is a treatable disease and not caused by evil spirits or super natural factors which is still believed in the rural areas.

It is the second most common neurological disorder but is poorly understood even today Historically, epilepsy has received little public health attention despite poor health outcome and potentially devastating social consequences from untreated disease.

It affects more than 5/1000 people and there are approximately 50 million persons with epilepsy worldwide and 80 per cent of them are in developing countries.

In India the incidence of epilepsy is 0.5 to 1.7 per cent in the general population and there are approximately 10-15 million epileptics in our country. Epilepsy can occur in any age group but it is more common in children and young adults.

Epilepsy is not a disease but a sign or symptom of underlying neurological disorder. Epilepsy means the tendency to have “seizures” Epilepsy is the oldest known brain disorder. On the other hand seizures are short episode of symptoms caused by a burst of abnormal electrical activity in the brain. When the electrical activity involves a small area of brain it produces minor seizure (Partial) and if large area is involved a major seizure results (Generalized). Typically a seizure lasts from a few seconds to a few minutes.

Causes of epilepsy

There is no single cause of Epilepsy. Many factors can injure the nerve cell in the brain.

The following are some of the most frequently identifiable causes:-

Head injury that causes damage to the brain tissue.

Trauma at birth, or high fever.

Certain drugs or toxic substances when administered in large, doses.

Interruption of blood flow to the brain caused by stroke or certain cardiovascular problems.

Diseases which alter the balance of blood or its chemical structure, or diseases that damage the nerve cells in the brain.

Infections, Viral, N.C.C, Tuberculosis, Bacterial etc.

However in some cases Epilepsy could also be due to some unidentified disorders and in 75% of cases there is no known cause & this is known as idiopathic epilepsy.

There are certain factors which trigger seizures like lack of sleep, high fever, loud noise, stressful conditions, increased excitement, flashing lights, drug withdrawal etc.

Misconceptions

The failures in understanding and treating properly epilepsy, has resulted in resistant chronic seizures, which is due to socio-economic problems and prejudices, since majority of people in our country wants to hide the disease.

Precautions

Keep calm, you cannot stop a seizure once it has started. Let the seizure run its own course. Do not try to overpower the person.

Ease the person to the floor and loosen clothing.

Try to remove any hard, sharp, or hot objects that might injure the person. It may be necessary to place a cushion or soft item under their head.

Turn the patient to one side to drain saliva from the mouth.

Let the patient rest or sleep for sometime after the convulsion.

In case of a child having seizure, contact his/her parents or guardian.

If the person undergoes a series of convulsions, with each successive one occurring before he or she has fully recovered consciousness, or a single seizure lasting longer than 10 minutes, you should immediately consult a neurologist.

Do not force or insert anything in the mouth of the patient.

Do not restrain the convulsive movements while holding or protecting the patents from injury.

Do not crowd around the patient, allow free air circulation.

Do not offer anything to eat or drink till he/she is fully conscious.

Indian Scenario

As per estimates nearly 95 per cent people with epilepsy in India don't receive any treatment. Anti-epileptic drugs are not available to almost 50 per cent patients in the public sector with less than 40 per cent actually receiving generic medicines instead of the expensive branded ones.

Neurocysticercosis (parasitic disease of the nervous system) is responsible for about 30 per cent of seizure disorders in the Indian subcontinent. Epilepsy is often associated with substantial stigma, with most people with epilepsy less likely to be sent to school, find employment or marry.

It is estimated that more than 85 per cent of the global burden of epilepsy occurs in low-income countries including India.

In rural parts of India, epilepsy faces serious social stigma because of which majority of people do not reach out for treatment. Epilepsy is quite a serious problem in India. While 60 per cent of people in urban India consult a doctor after suffering a seizure, only 10 per cent in rural India would do so. Also, epilepsy treatment is long term and can take around two years time. Compliance to medications therefore is very poor with only half adhering to the regimen. Once patients are seizure free for a few days, they stop medication until they suffer another episode.

The most common cause of epilepsy in the 15-50 age group is neurocysticercosis caused by infected pork or underground vegetables not washed properly. In every 10 patients I see, 5 suffer from neurocysticercosis. However majority of them are treated in 2-3 years time.

Inputs from Dr. Gopal Poduval, Consultant Neurologist, Global Hospitals Hyderabad