All you need to know: about EPILEPSY

This article was prompted by 3 stories.

A man came off an Okada bike in Lagos. He then started having a seizure where upon some people got sticks and stones and started beating him up. Because, according to them, he must have offended the gods!

Secondly, I heard about a chap who suffers from epilepsy and has been drinking cows’ urine for years. He still has epilepsy!!

Finally, a mother whose child had a convulsion was asked by ‘well meaning neighbours’ to give her own urine to the baby, as a cure for the convulsion!!!

What is epilepsy?

The medical definition of epilepsy is ‘repeated seizures or convulsions (or fits) due to a brain problem’. Epilepsy is a manifestation of a problem with the brain. It is due to something irritating the brain.

How does epilepsy occur?
The brain is made up of billions of nerve cells and connections. The normal brain is constantly producing electrical rhythms in an orderly way. However, a short circuiting of the wiring (nerves) can lead to overloading of the brain causing it to stop functioning correctly and everything becomes jumbled up. This misfiring can last a few seconds or be prolonged and is called a convulsion, seizure or fit.

What causes epilepsy?

Anything which can cause irritation or scarring in the brain and therefore a break in the connection of nerve cells to each other can cause epilepsy. The disorder can be congenital (a baby is born with it) or acquired (a person develops it after birth). It can have an obvious direct cause such as a brain tumour, head injury, stroke, and brain infection; or have no clear cause. In fact for up to 50% of patients, there is no obvious cause. It is important to know that an isolated, single seizure does not mean a person has epilepsy. Many people can have a one-time seizure because they were very dehydrated, or had abnormal levels of substances in the blood (e.g. glucose, magnesium, calcium). 

Defining Epilepsy: a disease or a disorder?

Epilepsy is not a disease. It is a disorder. A frequently used diagnostic criterion for epilepsy is two or more seizures within a year. A seizure is a symptom or sign of this disorder rather than the diagnosis. It just means something has gone wrong inside the brain. Doctors will try and make a diagnosis of the underlying cause of the seizure disorder.

Different seizures in different age groups?

The most likely problem in the brain in epilepsy varies with the age when the seizures start, e.g. congenital abnormalities (abnormal brain development that a baby was born with) and brain infections occur more in infancy, whereas trauma (head injury) occurs more in adolescence, and in old age, brain tumors and stroke are more frequent. Children born with normal brains can develop epilepsy due to lack of oxygen, fever, jaundice, infections such as malaria, meningitis and other insults on their young brain. Febrile complex seizures at age 6 months to 5 years and lasting more than 10 minutes are associated with the development of epilepsy in later life, in some patients.

What types of people have seizures?

Anyone can have a seizure. It is something that is happening to the brain of the person and can be caused by many things. It can happen to the rich, poor, educated or illiterate and people of all ages. It happens in all countries in the World and affects white, yellow, red and black people. It is no more common here in Nigeria than anywhere else in the World.

What does a seizure (epileptic fit) look like?

There are 3 common types. There is the simple partial type in which a part of the brain is occasionally disrupted, manifesting in repeated movements of a part of the body, but the person does not lose consciousness and is fully aware of what is going on. Then there is the complex partial type, in which a part of the brain is occasionally disrupted, manifesting in the form of decreased awareness with or without repeated movements of a part of the body. Finally, there is the generalized type, in which the entire brain is disrupted at once and these patients lose consciousness frequently accompanied by jerking around, foaming at the mouth, and involuntarily urinating on themselves.

About 90% of seizures are self-limiting lasting seconds to no more than 5 minutes. After a complex or generalized seizure has ended, patients can be disoriented or sleepy for several minutes thereafter. If a seizure lasts for more than 10 minutes, that is unusual and is a reason to take the patient to the hospital as quickly as possible. Self-limiting seizures do not cause brain damage, but prolonged seizures certainly can, and so it is important for the patient to get to the hospital where drugs can be administered to arrest the seizure promptly.

How should people treat someone having a seizure?

Make sure they do not injure themselves during the period of loss of consciousness. Move objects that can harm the person, out of the way. If possible, place a pillow under the person’s head so that the head doesn’t bang against the floor causing injury. Keep calm and try not to panic. Let the seizure run its course and do not hold them down. If possible move them to a comfortable place and let them sleep or at least have a good rest once the seizure is over. Please check to make sure they are breathing well.

What you should NOT do?

Please do not pour anything into the mouth of someone having a convulsion, not even tablets. Since, they may be unconscious they can choke on drugs and concoctions. Urine, whether from a mother or a cow is also not the treatment for epilepsy! Also, please do not burn someone having epilepsy with fire as treatment. This can damage them for life.

How is epilepsy diagnosed?

The doctor needs to talk to the patient, relatives and any eye witness and get a full story of the condition. The doctor also orders blood tests. Two important investigations are a brain scan (CT or MRI scan) and an EEG (electro encephalogram). The brain scan shows the exact pattern and structure of the brain and can detect abnormal areas. The EEG shows the electrical activity of the brain and can detect where the electrical signals are getting jumbled up. It can also show whether the electrical problem is located in a specific part of the brain alone or all over the brain.

Who cannot help the patient?

Churches, mosques, herbalists and traditional healers cannot diagnose or treat epilepsy. This is a fact. Many pastors and traditional healers prey on patients and thrive on the misery of the family. Avoid these people.

What are the treatment options available to patients?

Epilepsy can be treated, controlled and rarely, cured. Epilepsy can be well controlled by medications. There are up to 20 different types of drugs used to treat epilepsy. The doctor needs to find the perfect drug for the patient and then prescribe it based on the age and weight to get optimum control of the seizures.

Can epilepsy be cured?

Epilepsy can be cured depending on the cause. For example, if it is due to a brain tumour or stroke, it may be treated and cured once the stroke or tumour has been removed from the brain. Most types of epilepsy however, can only be treated and controlled, not cured. Let us repeat one statement: Seizures can be controlled if you take your medications regularly and combine that with prayers.

 

Are patients treated well in Nigeria?

A doctor has to choose the drug best for the particular type of seizure the patient has. The drug must then be given in the right format and dose for the person. Too often, the dosage is low and so the person continues to have fits. Of course, some patients stop taking their drugs or miss a dose here and there. Others also visit churches and mosques, traditional healers and spiritual herbalists. They either stop medication or mix their drugs with other concoctions which lead to poor seizure control. 

Are the drugs within reach and what are the cost implications?

The main drugs often used (Carbamazepine, Sodium Valproate, Phenytoin, Phenobarbitone) are available and may cost up to N300 per day for effective treatment. More expensive drugs (Gabapentin, Topiramate, Leveteracipam) may be necessary, if control is not adequate. Other ways to treat epilepsy include surgery. Treating the cause by removing the abnormality (e.g. scar or brain tumour) may lead to cure.

What are the myths and misconceptions about epilepsy?

• Many people think that epilepsy is due to a spiritual attack and that the demon must be cast out of the patient. This is incorrect.
• Some say that epilepsy is contagious and can spread from one person to another. This is also not correct.  
• Epilepsy is also not a mental illness. Seizures are mainly a symptom that there is a physical problem, like a scar, on the brain. Some people with epilepsy are extremely clever, others are of average intelligence and some have learning difficulties.
• Epilepsy is not a bar to success in life. Many people with epilepsy enjoy highly successful lives. The problem is often other people who put them down.
• Epilepsy is not generally an inherited condition. Although, there can be a genetic predisposition, more often than not, there is no family history of epilepsy.

The famous question: Is epilepsy contagious?

Epilepsy is not contagious. That is a fact. Epilepsy is also not a disease. It is the symptom of other things that is wrong with the brain.  Medications work to control the seizures if used properly. The choice of drug and the dosage must be correct. Find a doctor who knows.

Finally, add prayers BUT please do not stop the treatment. 

THE 'PREYING' MANTIS

As published in BLUEPRINT NEWSPAPER 21st June 2012

Black like night,

Beautiful as day,

As tall as the Eiffel Tower,

Bright like diamonds,

As sharp as a knife,

She was none of these things.

What she was, was pretty, petite, shy and introverted. Really, she was just a normal 16 year old Nigerian girl with a seizure disorder. Her story was engaging, her nature saddening as she told a story of seizures which has blighted her life from the age of 13 years. No warning. But, then she did have a bout of Malaria for which she was treated with Chloroquine for a whole month! Don’t ask me why. The seizures make her stiffen up, lose consciousness, fall down and jerk like a fish out of water. Two minutes later, all quietens and she drowns in a deep sleep, to wake up later, none the wiser of her ordeal. 

Her mother took up the story. She has taken Beatrice (not her real name!) everywhere for treatment and the elusive cure. She has been to herbalists and numerous churches. She has drunk gallons of concoctions and performed many rituals, yet the seizures continue. In fact, it happened the morning of our consultation. “What investigations have been performed”, I asked? “Investigations?” she replied. “Is she on any medications now”, I asked. “Nothing o”, she replied. “I am tired of the problem”, she said. “It has drained me completely”, she added and started crying.

Beatrice, the daughter, rummaged in her small hand bag and dug up a handkerchief which she gave to her mother, to use in wiping away the tears. I was touched by the simple act of kindness and love. Yet, she was actually the victim here.

The mother carried on. Beatrice has not been properly diagnosed or treated. They did see a doctor once who showed keen interest in her problem and prescribed medications for her. It seems he also prescribed sex; for once, he invited her to a hotel to have fun. When she refused his advances, the treatment stopped.

The same prescription was offered by one of the pastors in the church. The mother had left her with the pastor for prayers and the ubiquitous olive oil anointing. She stayed overnight in the church. In the morning, on her way to the bathroom, the pastor appeared, naked, with the required ‘stick’ with which to drive out the evil spirits causing the epilepsy. Once again, Beatrice refused and she was tossed out of the church. Obviously, this one cannot be cured!

Preying on the weak in our society

I was truly overwhelmed with the story and remembered the praying mantis. This tall, graceful insect with a big stomach has some of the fastest moves among insects. Praying mantis is highly predacious and feed on a variety of insects, including crickets and grasshoppers. They lie in wait with the front legs in an upraised position intently watching and stalking their prey. They will eat each other and often the adult female will eat the male after or during mating.

But, the real issue is about pastors, preachers and charlatans who prey on the vulnerable in our society. Many of these fake people cannot cure epilepsy but they promise cure, “so long as you do as I say, not as I do”. The means of cure can be spiritual or even physical as demonstrated here. Mrs Angela Asemota (Angie Epilepsy Foundation, Benin) chipped in that she herself had been propositioned by men in position of power when she goes out soliciting support for the foundation. An offer of help either materially or financially is conditional upon her satisfying this type of base and animalistic urge for domination. While talking about convulsions, all the men think about is convulsing with pleasure in return for their small charity. These “charity rapists” should be reported to the police and thrown in jail upon conviction. The best way to get evidence is by recording the conversation and getting the police to conduct a sting operation to trap the perpetrator.

Epilepsy

Epilepsy is not due to a spiritual attack and so pastors do not have to cast evil spirits out of the patient. Epilepsy is also not a mental illness but many sufferers are hidden away by families and friends in a warped protective manner. Seizures are mainly a symptom that there is a physical problem, like a scar, on the brain. Some people with epilepsy are extremely clever, others are of average intelligence and some have learning difficulties. Big deal! Many people in Nigerian politics are actually like this as well. Epilepsy is therefore not a bar to success in life but the fact that many children do not go to school is what ends up blighting their future.

I keep saying and impressing on people that epilepsy can affect anyone and we need to be more compassionate to sufferers. For as long as we are still alive, we all still have a risk of developing seizures in our lifetime. Secondly, people suffering from this disorder are highly stigmatised, dehumanised and ostracised. It knocks their self confidence and destroys their self worth. They feel cursed and abandoned even by God. Many have committed suicide because of the shame and the dent in their potential. Beatrice does not go to school though she is highly sensitive and perhaps even very intelligent.

Epilepsy can be treated, controlled and rarely cured.

In over 50% of cases of epilepsy, we do not have a credible diagnosis and do not see any structural abnormality on the brain of the sufferer. In these types of cases, cure is also elusive and long term medical treatment is crucial. Doctors also have so much to offer with up to 20 different drugs available for patients with epilepsy. The right drug for the right patient and at the right dose for the individual is what is important. Sometimes, it is even possible to tail off a medication and then stop completely once the person is seizure free. The Government (You and I, the people) must use Nigeria’s economic clout (all 160 million of it) to get drug manufacturers to make these drugs easily available and affordable for our people (remember, it maybe them today, it could be you tomorrow). Epilepsy due to an accessible, abnormal area of the brain such as a brain tumour may be amenable to surgical intervention by a neurosurgeon and possible cure. If we all do our job to the best of our limits and skills, then it is possible to keep patients seizure free and off the clutches of nasty people.

Attitudes need to change to make life a bit more bearable for sufferers. They are not and should not be seen as cannon fodder by pastors and even doctors. We have to actively protect sufferers from predators by providing affordable and effective treatment centres. A nation that devours its young and the vulnerable is completely inhuman. How much humanity are we losing as a nation?

No blind faith, please

A man decided to test his faith when his town got flooded. A rescue boat comes along but he denies their help. "My God will save me" he told them. So they went away. The waters rose, so next along comes a large lifeboat. Again the man says "my God will save me" and sends them away. The floodwaters rose up to his roof and a helicopter appeared. For the third time, the man sent them away stating "my God will save me". Having then drowned, the man's angry soul got up to heaven and upon meeting God asked "so why didn't you save me then?" God replied "What are you on about; I sent you two boats and a helicopter".

We have to help ourselves!

The “well” elderly

As published in Blueprint Thursday 7th June 2012

The life expectancy of Nigerians at birth today is 52 years on average. Compare this with that of a Japanese child born today, who is expected to live up to 85 years of age.

Britain's oldest student recently graduated from university aged 91- and is still planning to go on and do a PHD. Bertie Gladwin, 91, said that he had "a lot of laughs" with students less than a third of his age. Bertie, a former civil servant graduated with distinction in Masters in intelligence history. Despite him being more than 60 years older than his course mates.

My father does not know his age. But, he knows he is about or over 80 years of age. The most important aspect of his life however, is good health and an absence of any serious disease. Mr Olowookere, 90, is one of my patients and he has had a few health challenges. He walks into my office slowly but engages me in bright and stimulating conversation. Actually, talking to him enriches me. They are some of the few, very lucky, well, elderly people in Nigeria who are living to a ripe old age and in relative good health. These are the “wellderly” according to the Independent On Sunday newspaper. What most have in common are education and a good dose of intelligence.

You should interpret this story on the back ground of other people (younger) who are developing arthritis, hypertension, diabetes, strokes, memory failure and early senile dementia. Some of my patients have recently started complaining about difficulties remembering things, which is impacting on their lives. These are young middle age men and women (40 to 65 years) who are slowly falling apart in the mental and physical department. Some Nigerians do live till a ripe old age but it is difficult to know who will and, more importantly, if, YOU, will grow old. What are you going to do?

It is all a matter of making the right life style choices

Before that, let me tell you about the human brain and the concept of brain plasticity. The brain is in two halves each connected to each other by a thick bridge of nerves in the centre. This way the left half of the brain can control the muscles on the right side of the body through the nerves in the bridge (and vice versa). Of course, because of the connection, the two halves know what the other is doing. Did you get that? Ok. Now stimulating both sides of the brain, for example, in people who can use both hands effectively, leads to better connectivity through the bridge. The bridge is thicker in ambidextrous people. Similarly, since different parts of the brain do different things, being a jack of all trades, actually allows your whole brain to develop immensely. Plasticity means the ability of a part of the brain to perform functions it was not originally designed for: through education.

This is where education comes into play

One key concept implies that education improves health. Through education, individuals gain the ability to be effective agents in their own lives. Education improves physical functioning and enables a healthy lifestyle. (1) Education enables people to coalesce health-producing behaviours into a coherent lifestyle, (2) gives a sense of control over outcomes in one's own life, and (3) educated parents inspire a healthy lifestyle in their children. These lifestyle changes brought on by education is important as there are diseases with natural histories that include conscious exposure to certain health-compromising or risk factors. An example is heart disease associated with cigarette smoking, poor dietary habits, lack of exercise, and sustained un-buffered stress. Are your children developing into healthy adults, simply by your example?

Mental health is also very important and cuts across educational ability, status and economic power. One in four people in the UK will suffer a mental health problem in the course of a year. One in five Nigerians is said to suffer from depression. Having low levels of education, a low income, being unemployed, living in poor housing, and membership of low socio economic classes are all associated with a greater risk of experiencing a mental health problem. People without a degree are almost twice as likely to experience depression as those with a degree.

This is where intelligence comes into play

Large studies of almost an entire population in Scotland found that intelligence in childhood predict substantial differences in adult morbidity and mortality, including deaths from cancers and cardiovascular diseases. These relations remain significant after controlling for socioeconomic variables. One possible, partial explanation of these results is that intelligence enhances individuals' care of their own health because it represents learning, reasoning, and problem-solving skills useful in preventing chronic disease and accidental injury and in adhering to complex treatment regimens. Intelligence prevents you from running across a busy motor way in the belief that you are smart enough to avoid the speeding cars, all the time. Intelligence allows a Government to plan ahead for population growth: 25-50 years ahead when allocating resources, building structures or planning cities.  

Intelligence, emotional Intelligence (EQ) this time, is the ability to perceive, understand and reflectively manage one's own emotions and those of others. There is a relationship between a measure of EQ and subjective stress, distress, general health, morale, quality of working life and management performance. For example, managers who scored higher in EQ suffered less subjective stress, experienced better health and well-being, and demonstrated better management performance. Mindfulness is a mind-body approach to life that helps people to relate differently to experiences. It involves paying attention to thoughts, feelings and body sensations in a way that increases our ability to manage difficult experiences and make wise choices. It is a protective mechanism to mind your own body.

You have to make wise choices

Almost all diseases including cancer are preventable if you make wise life style choices. When last did you dance or laugh with reckless abandon, without someone telling you off? Does your wife say you are behaving like a teenager and do you not know your age? When was the last time you did any house work or tidy the garden and wash the car? Do you go for walks or even jog (exercise improves brain power and memory)? Do you eat just enough to keep body and soul together and or eat like there is no tomorrow? Do you eat the biggest meat in the pot and the choicest, richest meals: because you can afford it? You like alcohol and cigarettes? Is it fun to have sex with as many women as come through your office? How many wives are enough? Or is life too short that you have to pack it like a suitcase on an ARIK flight? Do you read and understand what you read, digest and discuss it intelligently? Do you travel to different places, explore new ideas, do things out of your particular area of interest? 

Studies have pointed to many likely reasons why one may not live to a ripe old age. Some of these are limited access to healthcare and other resources, poorer living conditions, chronic stress and higher rates of lifestyle risk factors like smoking. Note as well that the top five heart disease risk factors are cigarette smoking, low intelligence, low income, high blood pressure, and low physical activity. Lower IQ scores could raise the risk of heart disease -- in particular a person's approach to "healthy behaviour." Those who ignored or failed to understand advice about the risks of smoking or benefits of good diet and exercise for health would be more likely to be at higher risk of hypertension, diabetes, obesity, arthritis and stroke. 

Do we have to make this ‘simpler’ for you?

You can and you should train your brain, and challenge yourself to achieve more: be intelligent. This behavioural change will increase your life span. Low level of intelligence could kill you! Remember the joke: Alzheimer’s or Parkinson’s....which one would you, rather have? Parkinson’s, of course! Better to spill half your drink than forget where you put it!