Epilepsy

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Epilepsy

A medical disease with social stigmata

Headache
Qaiser Toqeer MPH MD

A Diplomat of the American Board of Psychiatry and Neurology, Inc., a Member of the American Board of Medical Specialties.

Novant Health Inc. Dept. of Neurology

Epilepsy is the 4th most common neurological disorder that affects approximately 2.5 million Americans. Worldwide approximately 65 million people are affected by this condition and seek treatment. Epilepsy affects mostly young children and older people however it can be diagnosed at any age. Epilepsy is a disease defined as one or more seizure with high likelihood of recurrence. Seizure can be described as episodic symptoms of abnormal movement, sensation or vision due to excessive cerebral cortical activity. In other words it’s the abnormal electrical activity of brain leading to cessation of some of the brain functions such as movement, sensation, vision and consciousness. There are various reasons for a brain to have a seizure. Some etiologies of seizures are due to primary neurological disorder whereas others are due to non-neurological disorders. Patients with epilepsy can go into a more serious condition known as status epilepticus in which brain continuously seizes. This complication of epilepsy carries a high mortality rate. It is a disease that carries a significant social stigmata in certain cultures.

In children this disease is common due to birth defects as well as traumatic injuries to brain. In older individuals common reason is stroke, infections and brain tumors. Regardless of the etiology the medical treatment remains the same. First line of treatment typically involves use of anti-epileptic medications. If anti-epileptics do not effectively control seizures then surgical resection of diseased area of the brain is considered after series of tests and mapping of the brain. Recently there are now devices that can be implanted under the skin of the head with wires inside the brain that can detect an initiation of a seizure and aborts it with small electrical shocks. Epilepsy was thought to be a non-curable disease however in recent advances in medicine and surgical procedures approximately 50% of patients can be cured and many other require only 1-2 seizure medications.

 In medieval times this disease was believed to be a demonic possession and was treated with only exorcism. This practice has led to many deaths of children and adults especially if patient went into status epilepticus and stops breathing. Unfortunately many cultures including Muslim countries still practice spiritual treatments which has a great social and medical impact.

Currently, in many parts of the world epilepsy is poorly understood and typically patient goes through many trials and tribulation before medical treatment is sought. I had the opportunity to visit Pakistan in Nov 2015 during which I learned many different beliefs that people have about epilepsy. Surprisingly many still believe that it’s demonic possession. Others believe its “Nazar” meaning evil eye which has  to be treated by religious people. Several individuals are scared and fearful to provide assistance when a patient is having a seizure. People quarantine individuals who suffer from epilepsy thinking they will contract the evil soul if they came in contact with the patient. Female patients are isolated due to embarrassment associated with the disease. Medical treatment is sought late in disease when usually its difficulty to control seizures. Furthermore, many areas in Pakistan are not equipped with technology or Neurologist to treat epilepsy. People travel hundreds of miles to see a Neurologist and compliance seems to be poor for various reasons.

In summary, epilepsy is a complex disease which is associated with social and cultural implications. It is poorly understood in many different cultures despite significant advances in medical treatment. If treated, this condition can be cured however it requires not only medical support but support from family members and community as a whole. Many patients and families are still living in the shade and lack awareness of this disease. Education is the key to success here.

References

“Epilepsy Center: Symptoms, Seizures, Treatments, Causes, and Tests.” WebMD. WebMD, 17 Jan. 2017. Web. 17 June 2017.

Shafer, Patricia O., RN. “Epilepsy Foundation.” Epilepsy Foundation. N.p., n.d. Web. 17 June 2017.

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