EPILEPSY: The “Falling Sickness”

EPILEPSY: The “Falling Sickness”


Epilepsy was defined by WHO as a chronic noncommunicable disease of the brain that affects around 50 million people worldwide. It is characterized by recurrent seizures, which 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.

Epilepsy was known as a “falling sickness” because of the rapidity episodes which a patient with epilepsy falls to the ground when has either minor or major fit. It is Central nervous system disorder known for thousands of years in which brain activity becomes abnormal causing seizures, sensations and sometimes loss of awareness. This disorder is one of the diseases viewed with horror and terror by lay people, some even think it’s communicable and always run away from patient when they have convulsions.
Epilepsy may be characterized by attacks of unconsciousness which may be accompanied with or without convulsion. Epilepsy often begins as infantile convulsions, and persistent infantile convulsions and should be managed at early stage. Epilepsy is hereditary which may sometimes affect several members of one generation.
When convulsions are present it’s described as a major fit but when the attack is a very short one, unaccompanied by convulsion, it’s a minor fit.

Seizure, a paroxysmal behavioral event due to abnormal, excessive, hypersynchronous discharges from an aggregate of cortical neurons, may be either generalized or partial. Generalized epilepsy may take the form of tonic-clonic or absence seizures. In tonic-clonic (or major) seizures (formerly called grand mal), the patient falls to the ground unconscious with the muscles in a state of spasm. The lack of any respiratory movement may result in a bluish discoloration of the skin and lips (cyanosis). This – the tonic phase – is replaced by convulsive movements (the clonic phase) when the tongue may be bitten and urinary incontinence may occur. Movements gradually cease and the patient may rouse in a state of confusion, complaining of headache, or may fall asleep. Absence seizures (formerly called petit mal in children) consist of brief spells of unconsciousness lasting for a few seconds, during which posture and balance are maintained. The eyes stare blankly and there may be fluttering movements of the lids and momentary twitching of the fingers and mouth. The electroencephalogram characteristically shows bisynchronous spike and wave discharges (3 per second) during the seizures and at other times. Attacks are sometimes provoked by over breathing or intermittent photic stimulation. As the stream of thought is completely interrupted, children with frequent seizures may have learning difficulties. This form of epilepsy seldom appears before the age of three or after adolescence. It often subsides spontaneously in adult life, but it may be followed by the onset of major or partial epilepsy.
However, one seizure does not necessarily signify epilepsy (up to 10% of people worldwide have one seizure during their lifetime). Epilepsy is defined as having two or more unprovoked seizures. Epilepsy is one of the world’s oldest recognized conditions, with written records dating back to 4000 BC. 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.

 

EPIDEMIOLOGY:
• Around 50 million people worldwide have epilepsy, making it one of the most common neurological diseases globally.
• Nearly 80% of people with epilepsy live in low- and middle-income countries.
• It is estimated that up to 70% of people living with epilepsy could live seizure- free if properly diagnosed and treated.
• About one third of all cases begin before the age of ten and three quarters before the age of twenty.
• It affects both male and female
• It’s common to all races
• It’s hereditary
• In some part of Nigeria, there is a stereotype that epilepsy is secondary to ingestion of Lizard and victim should not be touched for it can be transmitted.

 

Causes
Epilepsy has no identifiable cause but common causes include:
• Head trauma
• Brain conditions
• Prenatal injury
• Developmental disorder
• Genetic influence
• Infectious Diseases

 

Risk factors
Certain factors may increase your risk of epilepsy:
• Age
• Hereditary
• Head injuries
• Cerebrovascular diseases such as stroke
• Brain infections
• Dementia
• Fetal Seizure

 

Symptoms
Because epilepsy is caused by abnormal activity in the brain, seizures can affect any process your brain coordinates. Seizure signs and symptoms may include:

• Temporary confusion
• Hallucinations of smell
• Hallucinations of taste
• Hallucination of sight
• Hallucination of hearing
• Paroxysmal disorders of memory
• Automatism
• A staring spell
• Uncontrollable jerking movements of the arms and legs
• Loss of consciousness or awareness

 

TREATMENT:
Seizures or epilepsy can be controlled. World Health Organization, put forward the following management for Epilepsy Patient.
• 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 medication. 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.