EPILEPSY: Controlling the storm in your mind

By Sola Ogundipe

Epilepsy is one of the world’s oldest recognized conditions.   It is one of the most common neurological diseases globally. Fear, misunderstanding, discrimination and social stigma have surrounded the disease for centuries. This stigma continues today and can impact on the quality of life for people with the disorder and their families.

Epilepsy is a chronic disorder of the brain characterized by recurrent seizures, which are brief episodes of involuntary movement that may involve a part of the body (partial) or the entire body (generalized), and are sometimes accompanied by loss of consciousness and control of bowel or bladder function. There are around 180,000 new cases of epilepsy each year. About 30 per cent occur in children. Children and elderly adults are the ones most often affected.

Seizures & convulsions

Epilepsy can cause convulsions — sudden, uncontrolled movements. But seizures can trigger a wide range of other symptoms, from staring to falling to fumbling with clothes.

Seizure episodes are a result of excessive electrical discharges in a group of brain cells. Different parts of the brain can be the site of such discharges. Seizures can vary from the briefest lapses of attention or muscle jerks to severe and prolonged convulsions. Seizures can also vary in frequency, from less than 1 per year to several per day. One seizure does not signify epilepsy (up to 1 in 10 people worldwide have one seizure during their lifetime). Epilepsy is defined as having 2 or more unprovoked seizures.

Signs and symptoms

Characteristics of seizures vary and depend on where in the brain the disturbance first starts, and how far it spreads. Temporary symptoms occur, such as loss of awareness or consciousness, and disturbances of movement, sensation (including vision, hearing and taste), mood, or other cognitive functions.

People with seizures tend to have more physical problems (such as fractures and bruising from injuries related to seizures), as well as higher rates of psychological conditions, including anxiety and depression.

Similarly, the risk of premature death in people with epilepsy is up to three times higher than the general population. A great proportion of the causes of death related to epilepsy are potentially preventable, such as falls, drowning, burns and prolonged seizures.

Rates of disease

The estimated proportion of the general population with active epilepsy (i.e. continuing seizures or with the need for treatment) at a given time is between 4 and 10 per 1000 people. However, some studies suggest that the proportion is much higher, between 7 and 14 per 1000 people.

Annual new cases of epilepsy are between 60 -100 per 100 000 people in the general population in low- and middle-income countries. This is likely due to the increased risk of endemic conditions such as malaria or neurocysticercosis; the higher incidence of road traffic injuries; birth-related injuries; and variations in medical infrastructure, availability of preventative health programmes and accessible care.

Causes

Epilepsy is not contagious. The most common type of epilepsy, which affects 6 out of 10 people with the disorder, is called idiopathic epilepsy and has no identifiable cause.

Epilepsy with a known cause is called secondary epilepsy, or symptomatic epilepsy. The causes could be due to brain damage from prenatal or perinatal injuries (e.g. a loss of oxygen or trauma during birth, low birth weight); congenital abnormalities or genetic conditions with associated brain malformations; a severe head injury; a stroke that restricts the amount of oxygen to the brain; an infection of the brain such as  meningitis, encephalitis,  neurocysticercosis;  certain genetic syndromes or a brain tumour.

Diagnosis: EEG

A doctor will review the description of the seizures and medical history, then examine the patient. He’ll give   a test called an electroencephalogram — EEG — to confirm a diagnosis and get more information about the seizures. It’s a painless procedure that records the brain’s electrical activity as wavy lines. The pattern changes during a seizure and may show which part of the brain is affected. That can help guide treatment.

Brain scan

Detailed images of your brain from tests like CT or MRI scans can help doctors rule out some things as causes, like a change in the structure of your brain, bleeding, or masses. A CT scan is a powerful type of X-ray, and an MRI uses magnets and radio waves to make pictures. This information will help your doctor come up with the best treatment plan for you.

Treatment

Epilepsy can be treated easily and affordably with inexpensive daily medication that costs as little as N2,500 per year. Anti-seizure drugs are the most common epilepsy treatment. If a medication doesn’t work, your doctor may adjust the dose or switch you to a different drug. About two-thirds of people with the brain disorder become seizure-free by taking their meds as prescribed.

Recent studies   have shown that up to 70 per cent of children and adults with epilepsy can be successfully treated (i.e. their seizures completely controlled) with anti-epileptic drugs (AEDs). Furthermore, after 2 to 5 years of successful treatment and being seizure-free, drugs can be withdrawn in about 70 per cent of children and 60 per cent of adults without subsequent relapse.

 Treatment gap

People with epilepsy respond to treatment approximately 70 per cent of the time although 75 per cent of patients living in low- and middle- income countries do not get the treatment they need. The average availability of generic antiepileptic medicines in the public sector of low- and middle-income countries is less than 50 per cent. This may act as a barrier to accessing treatment.

It is possible to diagnose and treat most people with epilepsy at the primary health- care level without the use of sophisticated equipment.   The lack of trained health-care providers can act as a barrier to treatment for people with epilepsy. Surgical therapy might be beneficial to patients who respond poorly to drug treatments.

Prevention

Idiopathic epilepsy is not preventable. However, preventive measures can be applied to the known causes of secondary epilepsy. Preventing head injury is the most effective way to prevent post-traumatic epilepsy.

Adequate perinatal care can reduce new cases of epilepsy caused by birth injury. The use of drugs and other methods to lower the body temperature of a feverish child can reduce the chance of febrile seizures.

Central nervous system infections are common causes of epilepsy, elimination of parasites and education on how to avoid infections can be effective ways to reduce epilepsy for example those cases due to  neurocysticercosis.

Social and economic impact

Epilepsy accounts for 0.6 per cent of the global burden of disease, a time-based measure that combines years of life lost due to premature mortality and time lived in less than full health. Epilepsy has significant economic implications in terms of health care needs, premature death and lost work productivity.

Three years ago, the cost per patient of epilepsy treatment was as high as 88.2 per cent of an affected country’s per capita Gross National Product (GNP), and epilepsy-related costs, which included medical costs, travel, and lost work time, exceeded $2.6 billion/year.

Although the social effects vary from country to country, the discrimination and social stigma that surround epilepsy worldwide are often more difficult to overcome than the seizures themselves. People living with epilepsy can be targets of prejudice. The stigma of the disorder can discourage people from seeking treatment for symptoms, so as to avoid becoming identified with the disorder.

Living with Epilepsy

You can enjoy a full, active life. Taking your medication on schedule may stop your seizures. If not, you can get other kinds of help. A specialist can come up with ways to curb the condition’s impact on your life.

First Aid for seizures

Here are some tips if you or someone you love has epilepsy –

• Always carry medical identification. If an emergency happens, knowledge of your seizure disorder can help the people around you keep you safe and provide the appropriate treatment.

*Make sure your family, friends, and co-workers know what to do if you have a seizure.

*Avoid potential dangers of high places or moving machinery at home, school, or work if you have active seizures.

*Avoid contact sports, but if your seizures are well controlled, you can lead a normal life. Have another person with you who knows you have seizures and what to do if you have one.

*Be alert to the risks of possible drug interactions between your anticonvulsant drugs and other medications you may take, including over-the-counter drugs.

*Always call your doctor or pharmacist if you are not sure what interactions could occur before taking any medication.

*Avoid alcohol, as it can interfere with the effectiveness of your medication and may lower the brain’s seizure threshold.

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