Epilepsy is a common disease affecting around 50 million people wide. About two third of these patients are in low and middle-income countries. Patients with epilepsy suffer from recurrent episodes of seizures due to abnormal electrical activity in their brain. Over the decades' knowledge, awareness and practices in epilepsy have changed considerably for the good. Diagnostic and treatment methods have undergone a paradigm shift. Close to two-thirds of patients with epilepsy can attain sustained seizure freedom through the use of appropriate treatment methods. More importantly, the field of epileptology is growing rapidly and newer forms of treatment are fast emerging adding a promise to hope. Having said that we continue to battle some challenges which are not new but remnants of the old. Most of these arise from stubborn and sometimes enigmatic mindsets which need to be remedied.
Fear and apprehension about medications:
Modern medicine has the greatest potential to treat all kinds of epileptic conditions more than any other systems of medicine. The diagnosis and treatment are based on scientific evidence and tailored according to patient profile. Factors like age, sex, body weight, epilepsy subtype and so many other variables are taken into consideration before initiating a particular medicine or combination of medicines. Each medication has a stipulated dose which is slowly titrated to avoid any type of adverse effects. With newer medications, side effects are rare and non-significant in most cases. It is very rare that a serious reaction occurs. The deleterious effects of ongoing seizures are a thousand times more hazardous than this one remote side effect you are afraid of.
The multitude of counsellors
In our society, unsolicited advice is freely and widely available. The provider of such authoritative advice can be a well-meaning friend, neighbour, family member, any random person and of course “google baba” . They will suggest alternative methods of treatment, sound an alarm about the damage caused by prolonged medication use, so on and so forth. It is advisable to discuss about your health problems only with your doctor and close family. Remember medical advice is given after years of rigorous medical training.
Man-made barriers and the marriage puzzle
Years of ignorance have created certain barriers for epilepsy patients preventing them from leading a purpose-driven and full life. There is no hindrance for children with epilepsy to play with others. Most of them do not require constant supervision by parents. They can also actively pursue any form of education or vocation. Their dreams are meant to be pursued and fulfilled.
The majority of patients with epilepsy can marry and have children. Nevertheless, it is very important to disclose the illness before entering into marriage to avoid problems in the future. This can be done with the help of your treating doctor. With increasing awareness in society and an understanding young generation, this hurdle is slowly getting out of the way
The paradox of easily treatable epilepsy
It is ironical that at times patients with severe forms of epilepsy are often well controlled than milder forms because of their strict adherence to medications and lifestyle. This is often because of a complacent and casual approach to instructions about medication timings, gadget use and a systematic daily routine. These patients and their families are also unsatisfied and unhappy about a single medication that they are advised to take for a long period of time. They often attempt medication stoppage without medical advice and resort to unscientific methods of treatment.
Obstacles to achieving seizure freedom
Seizure freedom is the most important endpoint of treating patients with epilepsy. This is possible through medications in most cases but some patients need to undergo detailed evaluation when they fail. Video EEG is a test commonly undertaken in such cases where the patient’s seizures are recorded along with the EEG. This is usually followed by other investigations like epilepsy protocol MRI Brain and PET study of the brain. After careful analysis, many of these patients can be considered for epilepsy surgery where the abnormal seizure focus is resected or separated from the normal brain. Despite the ever-present hope of seizure freedom, there is a prevailing reluctance to pursue or embrace it. The mandate of a good epilepsy centre is to propagate and practice this message of total seizure freedom whenever possible.
(Dr Sachin Sureshbabu is Sr Consultant & Head of Neurology, Centre of Neurosciences, Meitra Hospital, Kozhikode.)