KOCHI: Epilepsy is the second-most common and frequently encountered neurological condition (next only to stroke) that imposes a heavy burden on individuals, families, and also on the healthcare system. It is estimated that more than 12 million people are affected with epilepsy in India, which accounts for nearly one-sixth of the global burden.
What is epilepsy?
Not all seizures are epilepsy. To diagnose a person with epilepsy, he should have had unprovoked seizures (fits) on two or more occasions, separated by 24 hours or more.
For example, a patient with a head injury developing seizures immediately cannot be diagnosed as an epilepsy patient. But if those seizures persist, they can be labelled as epilepsy.
What is the ‘burden of epilepsy’?
Epilepsy in itself presents with a myriad of problems, especially in children, with cognitive decline, behavioural disturbances, epileptic encephalopathy and sudden, unexpected death (SUDEP). Not to mention the adverse effects of anti-seizure medications.
Of children with epilepsy, 23-to-41% suffer from intellectual disability. Special education is needed by 30% of the children. The incidence of SUDEP is considerably higher in patients with chronic epilepsy and the highest rates occur in the 20-to-40 age group, but it is also recorded in children.
Epilepsy can be accompanied by changes in personality and behaviour. Depression is a common accompanying problem that is often unrecognised and untreated. Social aspects like unemployment and a general lack of confidence to do any tasks because of the fear of an impending seizure too add to the burden.
Patients with epilepsy are forbidden to operate heavy machinery, drive, etc. Young females remain unmarried due to the stigma associated with this disease. Needless to say, if any one member of the family has epilepsy; the entire family is affected by it.
How to diagnose?
Epilepsy is caused by various factors. It can be genetic, hereditary, developmental, environmental, metabolic, nutritional or structural (lesional epilepsy).
A comprehensive epilepsy workup is part of every successful epilepsy programme where the patient will be subjected to video EEG, MRI, PET scan and other tests. One of the most crucial tools added to this armamentarium is the seizure video which the attendees can take during an episode, thanks to mobile phones.
What is Drug Resistant Epilepsy?
Nearly 40% of all epilepsy patients are resistant to anti-epileptic drugs. There are clear-cut guidelines laid down as to what constitutes DRE. You must seek an epileptologist’s advice. If it’s confirmed that it is indeed a case of DRE, the patients are subjected to more evaluation tests and then identified as potential candidates for surgery.
Can surgery provide a cure?
Yes, many epilepsy cases in our community can be surgically treatable, but they remain undiagnosed or undertreated. The results of surgeries done have been excellent with most of the patients being completely off medications and returning to a relatively normal life.
Proper guidance and community support can go miles in reducing the burden of this dreadful disease. However, poor socio-economic status and also various myths and misconceptions surrounding epilepsy as well as its surgery, deter progress in the field.
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