The ‘ World Epilepsy Day’ was observed recently and spotlight was on Epilepsy, a health issue which though common is still not understood by many, on The Sunday Observer spoke to Consultant Neurologist at District General Hospital, Hambantota, Dr Kishara Gooneratne to explain more about this condition to our readers .
Excerpts.
Q. Tell us what is Epilepsy ?
A. Epilepsy is one of the most common neurological diseases in the world. It affects approximately 1% of adults and between 0.4 – 0.8% of children. This is a condition which affects the brain and causes frequent seizures or commonly called fits in an individual.
Q. Is it contagious?
A. Epilepsy is not contagious and therefore the World Health Organization (WHO) has identified Epilepsy as a “chronic non communicable disease of the brain that affects people of all ages”.
Q. What are the main trigger factors?
A. Triggers for each patient with epilepsy can be different. However, missed medication, lack of sleep, stress, alcohol, and menstruation are some of the most common triggers. There are many more depending on the type of epilepsy. Flashing lights can cause seizures in certain people with certain types of epilepsy.
Q. How long does each seizure last in general?
A. Majority of seizures last from 30 seconds to two minutes. If a given seizure lasts for 5 minutes or more especially if it is a type of seizure called a tonic-clonic seizure or sometimes called a grand mal seizure, then it is advisable for patients to go to hospital as these patients may need urgent intravenous medication.
Q. What happens after an attack?
A. This is often called a “post ictal state”. This state is an altered state of consciousness and usually lasts between 5 and 30 minutes, but sometimes longer in the case of larger or more severe seizures. It is often characterised by drowsiness, confusion, nausea and headache.
Q. Today we are living amidst a Covid-19 pandemic with the added threat of foreign variants also entering the country which reportedly spread faster and are more dangerous than the existing type. Are those who suffer from epilepsy more vulnerable to be affected by the pandemic ?
A. In general there is no evidence that people with epilepsy alone have a weakened immune system. Therefore, in the majority of individuals with epilepsy, epilepsy per se does not increase the risk of getting Covid-19 and does not increase the severity of Covid-19. Some people with epilepsy can have other health conditions that put them at higher risk from Covid-19. Some may be taking medicines to control seizures that also affect their immune system such as steroids. Some people may have other neurological or developmental issues that affect their immunity. People with epilepsy may have other medical problems such as diabetes and lung problems. Such individuals are at a higher risk for Covid-19.
Q. Is injury possible during an attack?
A. Yes, especially in the case of a tonic clonic or grand mal seizures there is a risk of injury. Fractures, joint dislocations, accidental burns and road traffic accidents are some of the injuries that one can sustain during a seizure. Of course an individual should not be driving if he or she has uncontrolled epilepsy.
Q. It was recently reported that a cook in the North had fallen into a large cauldron of steaming salmon he was preparing when he suddenly got an epileptic seizure and had died before admission to the hospital. What is your advice to all managers out there when hiring employees to engage in the future to prevent such tragedies?
A. . I would advise anyone who wishes to employ someone with epilepsy for a job that can be deemed dangerous if one loses consciousness, to obtain a recommendation from the treating physician or doctor. Risk factors for injuries associated with epilepsy are dependent on seizure frequency, type of seizure, and the use of anti-epileptic medicines.
Uncontrolled epilepsy can put individuals at risk especially in cases of operating heavy machinery in which an individual can get seriously injured, in cases of operating over an open fire in which a person can get seriously burned or in cases of driving heavy vehicles or public transport vehicles in which a person can put themselves as well as others in harms’ way. Excluding such restrictions, the majority of individuals with epilepsy are largely employable.
Q. Is there an age limit or can anyone get Epilepsy? Do you have any data on how many people globally suffer from epilepsy? If so who are the most vulnerable groups at risk ?
A. Epilepsy can develop in any person at any age. However, it is more common in young children and older people. According to the WHO, approximately 50 million people are afflicted with epilepsy globally.
Q. Is it a common condition in Sri Lanka? Have you any recent data on the number of epileptics in Sri Lanka?
A. Unfortunately, data from large population based studies are lacking. There is some data, for instance a recent study done in the Ampara district estimated nearly 6 children out of a 1000 to have epilepsy.
Another study from the Kandy district done some time ago estimated 9 individuals out of 1000 to have epilepsy. All in all, a rough national estimate would be 1% of the population to have epilepsy.
Q. If a close relative has epilepsy what are the chances of a person in the same family inheriting it?
A. There is a slightly higher chance of first degree relatives (parents, siblings, children) to have epilepsy, especially with certain types of epilepsies. Often this risk is less than 5%.
Q. Does stress at work and at school and the increasing pressures of life contribute to epilepsy?
A. Increasing stress and pressures at school and work is not a cause for epilepsy. However it can certainly be a trigger for seizures for an individual already suffering from epilepsy.
Q. How about having allergies ?
A. Having allergies does not increase the risk for epilepsy.
Q. What are the usual symptoms to look out for?
A. Seizures can affect people in different ways, depending on which part of the brain is involved.
Possible symptoms include: uncontrollable jerking and shaking, losing awareness and staring blankly into space, becoming stiff, sensations, such as a ‘rising’ feeling in the stomach, unusual smells or tastes, and a tingling feeling in the arms or legs and sudden collapsing.
Q. Are they the same for all epileptics?
A. No. There are a variety of epilepsies and seizure types. Thus the symptoms an individual would experience would depend largely on the area of the brain that is affected.
Q. Can the symptoms be mistaken for some other condition?
A. Yes, common mimics of seizures include faints, migraine, minor strokes and symptoms that come about as a result of various psychological stressors.
Q. Treatment wise, who treats epilepsy? What are the methods used and drugs?
A. A variety of medical practitioners treat patients with epilepsy and include neurologists, paediatric neurologists, specialist general physicians, paediatricians and general practitioners.
Treatment of epilepsy can help most patients with epilepsy to have fewer seizures, or stop having seizures completely. Such patients are commonly treated with medicines called anti-epileptic drugs.
They help control seizures in around 7 out of 10 of people. These medicines work by changing the levels of chemicals in the brain. They do not cure epilepsy, but can stop or control seizures from occurring.
Q. What are the factors you take into account before deciding on the drugs to prescribe?
A. Several factors are considered before one is started on anti-seizure medication and they include: age, type of epilepsy, possible side effects of the medicines, other medical problems the patient may have and individual circumstances of the patient such as employment status and the nature of employment.
Q. What happens to patients who don’t respond to anti epileptic drugs?
A. Approximately 30% of patients do not respond completely to medicines. In such cases other options for treatment are explored.
Such treatment options include surgery for epilepsy and special types of diets which includes a ketogenic diet especially for children with severe epilepsies.
In other countries certain devices which are much like pacemakers are used which involve transmitting electrical pulses to various parts of the brain periodically. Such devices may be a reality in Sri Lanka in the near future.
Q. What are the obstacles in detecting and treating patients e.g myths, wrong beliefs by parents ?
A. A fair number of people in Sri Lanka think that epilepsy is a disease given by the “gods”.
The stigma associated with this disease is enormous and thus a lot of people try to hide the fact that they have epilepsy and refrain from seeking treatment.
This can have dire consequences affecting the individual’s quality of life and even resulting in death. Such beliefs can be an obstacle not only for treatment but also for education, employment and marriage.
Q. The theme for this year’s Epilepsy Day? How relevant is it especially for our local population ?
A. Unfortunately this year the epilepsy day celebrations were affected by the pandemic and restrictions such as social distancing.
Thus the Epilepsy Association of Sri Lanka was only able to reach out to people through various educational activities through social media. I think the, ”new normal” allows us to connect to our patients through such technology which might further increase our capacity to reach out to more people.
Q. What do you see as shortcomings in care of epileptic patients in Sri Lanka?
A. Due to the belief system that is an inherent part of society, case detection of epilepsy may be found wanting. This often leads to what is called the treatment gap which is the difference that exists between the number of people who need care and those who receive care.
This needs to be addressed proactively through wider education and through active case detection in the field.
Q. What are the interventions made in recent years by the Sri Lanka Epileptic Association to rectify these shortcomings?
A. Over the years, the Epilepsy Association of Sri Lanka (EASL) has tried to quell the misconceptions and stigma associated with this disorder through various public awareness programs using different media.
Members of EASL (who mainly comprise medical professionals who treat patients with epilepsy and Carers of patients with epilepsy) use print media, electronic media such as television and radio, and social media to reach out to the community and spread awareness of this disease.
Recent examples of such programs include a national short film festival on epilepsy and an awareness campaign for public health midwives in the Galle district on the South coast of Sri Lanka which was well received as an example of how these s ‘Questions and answers’ session can reach out to the community in creating greater awareness of Epilepsy.
Q. Your message to all parents and persons with epilepsy ?
A. Epilepsy is an easily treatable disease. It is not contagious. If you have epilepsy, please contact a medical professional who will refer you for treatment.
There are lots of people with epilepsy who have gone on to have very successful and beautiful lives. So make your life a better one. Seek help now!