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.