BENGALURU: Epilepsy is defined as a disorder in which a person develops recurrent seizures due to a chronic underlying condition. The incidence of epilepsy is 0.3–0.5 percent in different populations throughout the world, and the prevalence of epilepsy has been estimated at 5–10 persons per 1000 in our country.
Epilepsy has always been associated with social taboos, and people with epilepsy have suffered over the ages by being ostracised. Untreated epilepsy can affect the development and scholastic ability of students, reduce occupational efficiency of adults and lead to a global decrease in productivity and quality of life of patients. Further, a large number of patients, especially in rural areas remain undiagnosed and are frequently treated for psychiatric ailments. Owing to the lack of public health education, these patients are considered ‘possessed’.
Fortunately 60-70 percent of epilepsy is amenable to complete control with medical treatment. They should be encouraged to meet a neurologist, get evaluated, and take treatment up to 3 to 5 years.
Some precautions to be followed during treatment, are to take the prescribed medications regularly, to avoid sleep deprivation, alcohol consumption, to avoid driving, swimming and other dangerous activities.
The remaining 25-30 percent of people with epilepsy, do not achieve control of epilepsy with drugs. These patients come under the diagnosis of Medically Refractory Epilepsy.
The problem with partially controlled or uncontrolled epilepsy is that these patients suffer from progressive brain damage due to seizures and also from the side effects of medicines. A child will show significant learning disability. An adult may show significant cognitive disorder and may have difficulty in getting or retaining jobs. Similarly getting married or staying married can prove troublesome. Cooking may prove to be a dangerous occupation if the person gets a major fit!
Epilepsy surgery should be considered for such patients. They need to be carefully evaluated by a neurologist first, to make the correct diagnosis of the type of epilepsy and the region of the brain from which it is arising. The neurologist will use MRI, Video EEG as basic tools to achieve the goal of identifying the region of brain causing epilepsy and then the neurosurgeon will operate to remove the region safely.
The demand for such a programme is high, as the load of patients in India is immense and the number of facilities currently providing the service is limited. Though the success story of curing medically refractory epilepsy spreads by word of mouth, it is necessary to raise the awareness among general public to seek appropriate remedy and not lose time. Studies published in medical literature have proven the efficacy of epilepsy surgery in medically refractory epilepsy. The gift of being seizure free should be every epileptic’s right!
Dr Ravi Mohan Rao is a Senior Consultant Neurosugeon, and Dr Sujit Kumar is a Consultant Neurologist and Epileptologist at Appolo Hospitals, Seshadripuram.