Epilepsy-Let's join hands TODAY for a better future TOMORROW!
Have you seen in movies how a person suddenly drops down to the floor, violently shaking and sometimes frothing through their mouths and wondered what disease they were trying to portray?
What if I say that even a child who might be seeming ‘absent-minded’ in class, gazing at the wall and losing your attention intermittently- is also suffering from a variant of the same disease.
By now you might have guessed it right-Seizure, fits or maybe more commonly mirgi, daura !
What is the difference between ‘seizure’ and ‘epilepsy’?
Different neurology articles and journals have defined ‘seizure’ as a paroxysmal alteration of neurologic function caused by the excessive, hypersynchronous discharge of neurons in the brain.
Whereas Epilepsy may be defined as: a chronic neurologic disorder characterized by two or more unprovoked seizures separated by more than 24 hours or one unprovoked seizure in an individual with a high risk of subsequent seizures (e.g. head trauma leading to some permanent structural damage,brain infections)
Epilepsy: Inside-Out!
Now the definition may make it sound like a disease which is more theoretical than a reality, but you would be surprised to know that nearly 50 million people worldwide have epilepsy, making it one of the most common neurological diseases globally.
It could be caused by various factors- depending on the age group. In children it could be due to genetic disorders, developmental anomalies or even complications during birth. Added to that we see Illicit drug abuse to be a major factor among adolescents. Among the adults and the older population we see more concerning causes like brain tumors, strokes, metabolic causes or even age related degenerative disorders.
With the above causes as the background there can be a myriad of triggers that could aggravate the chances of epilepsy like excessive physical exertion, alcohol consumption, fever, sleep deprivation, flashing lights, loud music or hormonal changes.
Depending upon the origin of the electrical activity in one/both hemispheres: seizures are generally divided into Focal (prev: Partial) and Generalized further categorized into many subtypes which is important not only for the diagnosis but it also aids in determination of specific line of treatment.
What are the symptoms? What should you be aware of?
The symptoms could range from serious ones like falling down unconscious with vigorous involuntary movements of the whole body, frothing from the mouth, upturning of the eyes, loss of contact with surroundings to as little as a sudden jerk of an arm or disturbance in vision, hearing, or could even involve mood disturbances.
The events could lead to serious complications like fractures, dislocation of shoulder joints which are very common, or could cause something more life threatening, especially in a person working in an industrial setting dealing with heavy machinery or even a pilot or a bus driver leading to accidents causing multiple casualties.
Is it Treatable? How can we prevent it?
As we can judge for ourselves how important it becomes to make sure that we seek medical care at the earliest.
WHO claims that 70% of Epilepsy patients can be seizure free with adequate treatments. But it is also sad that 7 out of 10 people in the world do not receive treatment for epilepsy. This is what we call EPILEPSY TREATMENT GAP and there can be various reasons for this, like:
- Cost of the antiepileptic drugs especially among low income families
- Availability of the medications, although with increasing awareness the production and availability of these have improved
- Long term treatment of 5-10 years or in some cases even life long → leading to recurrence with discontinuation →finally non compliance.
And this brings us to the most important aspect of this discussion:
Social Stigma associated with Epilepsy
Today in 2022, after dealing with a deadly pandemic for over 2 years one would expect that the general public would be more aware about healthcare and diseases but sadly even now the first person of contact of a patient with epilepsy in most part of our country are faith healers like tantriks and babas who claim they can get rid of these ‘evil spirits’ and inturn we lose valuable minutes especially in case of emergency cases like status epilepticus that might even lead to the patient either incurring permanent brain damage or even aspiration leading to death.
Some even consider these to be contagious which is why society ends up shunning not just the patients but also their families making them feel like outcasts.
Not only in the rural setting but also among the educated crowd we have seen myths about epilepsy saying it stems from internal psychological conflict with root cause of anxiety or depression leading to their lack of seeking proper medical care which only goes to show how education does not correlate to awareness.
Conclusion
Once a patient is subject to an epileptic fit, he/she lives in anxiety for the rest of their lives as to when they may have the next attack.
They are scared to start a family. Last week a patient came to our OPD for his regular follow up and his primary concern was if he should even consider having kids though he desperately wanted to but was quite apprehensive that his disorder might be passed on to his child.
Pregnant females discontinue their antiepileptics on their own fearing those would adversely affect their babies. It is true that it can't be guaranteed that there are no adverse effects however many drugs have come up that are relatively safer to be started in pregnancy and there is no denying the fact that having epileptic attacks during pregnancy is far more lethal for the baby In utero than some sporadic cases of teratogenic effects