Facts, sometimes, are scarier than science fiction. According to the World Health Organization (WHO) reports, around 50 million people the world over are afflicted by epilepsy, of which nearly 80% live in low and middle-income countries.
More importantly, an estimated 12 million patients live in India. And nearly 60% of Persons with Epilepsy (PWE) have the onset of the disease in their childhood.
To put these numbers in perspective, one out of every five PWE lives in India! In other words, just as Australia is called as the cancer capital of the world, India could well qualify for the title of epilepsy capital
A major reason for the high seizure burden among PWE in India is attributed to the lack of awareness and stigma attached to the disease. Therefore, there is an urgent need to increase public awareness to help improve the quality of life of PWE.
Epilepsy is a common disease that can occur in any age group, though the incidence is more pronounced among children below 5 years of age. Children diagnosed with epilepsy very early in life, in the neonatal or infantile period (less than 2 years) experience a heavy burden of cognitive and behavioural symptoms. Comorbidities are more frequent among children who develop drug-resistant seizures and those with a high seizure burden.
Seizures occur due to abnormally increased activation of neurons. When 2 or more unprovoked seizures occur at more than 24 hours’ interval, it qualifies for a diagnosis of epilepsy. It has to be treated by a neurologist/epilepsy specialist with appropriate medications. A correct syndromic diagnosis based on the age of onset of seizures, seizure types, EEG and MRI findings can help initiate appropriate anti-seizure medications. Some drug-resistant epilepsies can be treated with surgery as well.
How do you identify a seizure?
Contrary to the general notion, one should understand that epilepsy can occur in varied forms. Neonatal seizures occur as subtle events which may be eyelid blinking, oral sucking, pedalling, bicycling leg movements or apnoeic spells which are difficult to identify mainly because it can occur as normal behaviour in neonates and it is often difficult to assess the level of consciousness during these episodes. Other manifestations include myoclonic jerks (sudden jerks involving limbs/ body), tonic seizures (stiffening of limbs/ trunk or eye deviation and head adversion), clonic seizures (jerks involving mostly distal limbs), absence seizures (sudden stoppage of ongoing activity and stare) alone or in combination by the part of the brain where the type of seizure is determined by the part of the brain where the abnormal activity starts and where it spreads. A focal (or a minor seizure as common people call it) is generated from a part of the brain on one side whereas a generalized (major seizure) results from abnormal activation of extensive neuronal circuits bilaterally.
What should you do if you witness a seizure?
The immediate step to be taken if one starts throwing a seizure is to stabilize or revive the patient. These include laying the patient in a lateral position and avoiding injuries. Any doubtful seizure activity should be carefully observed from the onset till termination. The best way is to video-record the event focusing on limbs, eyes and head. The patient should be taken at the earliest to a nearby hospital where an epilepsy specialist is available. Strict compliance with anti-seizure medications prescribed by doctors should be followed. Sleep deprivation, fasting, light sensitivity and pattern sensitivity are the common triggers which if identified are to be avoided.
Need a change in mindset
Stigma refers to shame, prejudice, or discrimination towards people with some illness or health condition. It affects everything from interpersonal relationships to social norms.
Modern medicine has all the tools to diagnose, treat and cure epilepsy, but there should be no space for the stigma long attached to the ailment as well.
(Dr Soumya V.C is neurologist at Lourdes Hospitals, Kochi)