New Delhi, Feb 11 (NVI) Around 50 million people worldwide are afflicted with Epilepsy, a chronic noncommunicable disease of the brain characterized by recurrent seizures, and close to 80 per cent of them live in low and middle-income countries, according to the World Health Organisation (WHO).
A great proportion of the causes of death related to epilepsy, especially in low- and middle-income countries, are potentially preventable, such as falls, drowning, burns and prolonged seizures, it says.
The seizures are brief episodes of involuntary movement that may involve a part of the body (partial) or the entire body (generalized) and are sometimes accompanied by loss of consciousness and control of bowel or bladder function.
Seizure episodes are a result of excessive electrical discharges in a group of brain cells and different parts of the brain can be the site of such discharges.
Seizures can vary from the briefest lapses of attention or muscle jerks to severe and prolonged convulsions. Seizures can also vary in frequency, from less than one per year to several per day.
One seizure does not signify epilepsy, the WHO says, while noting that up to 10 of people worldwide have one seizure during their lifetime.
“Epilepsy is defined as having two or more unprovoked seizures,” it says.
Epilepsy is one of the world’s oldest recognized conditions, with written records dating back to 4000 BCE. Fear, misunderstanding, discrimination and social stigma have surrounded epilepsy for centuries. This stigma continues in many countries today and can impact on the quality of life for people with the disease and their families.
Characteristics of seizures vary and depend on where in the brain the disturbance first starts, and how far it spreads, the WHO says.
Temporary symptoms occur, such as loss of awareness or consciousness, and disturbances of movement, sensation (including vision, hearing and taste), mood, or other cognitive functions.
“People with epilepsy tend to have more physical problems (such as fractures and bruising from injuries related to seizures), as well as higher rates of psychological conditions, including anxiety and depression.
“Similarly, the risk of premature death in people with epilepsy is up to three times higher than in the general population, with the highest rates of premature mortality found in low- and middle-income countries and in rural areas,” according to the global health body.
As Epilepsy affects around 50 million people worldwide, the estimated proportion of the general population with active epilepsy (i.e. continuing seizures or with the need for treatment) at a given time is between 4 and 10 per 1000 people, the WHO says.
In high-income countries, there are estimated to be 49 per 100 000 people diagnosed with epilepsy each year.
In low- and middle-income countries, this figure can be as high as 139 per 100 000.
This is likely due to the increased risk of endemic conditions such as malaria or neurocysticercosis; the higher incidence of road traffic injuries; birth-related injuries; and variations in medical infrastructure, the availability of preventive health programmes and accessible care.
Epilepsy is not contagious. Although many underlying disease mechanisms can lead to epilepsy, the cause of the disease is still unknown in about 50% of cases globally, the WHO says.
The causes of epilepsy are divided into the following categories: Structural, Genetic, Infectious, Metabolic, Immune and Unknown.
For example, brain damage from prenatal or perinatal causes (like loss of oxygen or trauma during birth, low birth weight); congenital abnormalities or genetic conditions with associated brain malformations; a severe head injury; a stroke that restricts the amount of oxygen to the brain; an infection of the brain such as meningitis, encephalitis or neurocysticercosis, certain genetic syndromes; and a brain tumour.
Seizures can be controlled. Up to 70% of people living with epilepsy could become seizure free with appropriate use of antiseizure medicines. Discontinuing antiseizure medicine can be considered after 2 years without seizures and should take into account relevant clinical, social and personal factors. A documented etiology of the seizure and an abnormal electroencephalography (EEG) pattern are the two most consistent predictors of seizure recurrence.
In low-income countries, about three quarters of people with epilepsy may not receive the treatment they need. This is called the “treatment gap”.
In many low- and middle-income countries, there is low availability of antiseizure medicines. A recent study found the average availability of generic antiseizure medicines in the public sector of low- and middle-income countries to be less than 50%. This may act as a barrier to accessing treatment.
It is possible to diagnose and treat most people with epilepsy at the primary health-care level without the use of sophisticated equipment.
WHO pilot projects have indicated that training primary health-care providers to diagnose and treat epilepsy can effectively reduce the epilepsy treatment gap.
Surgery might be beneficial to patients who respond poorly to drug treatments. (NVI)
