AKUH's 'Signs, Symptoms and Care' Programme

3-5 % Incidence of Epilepsy in Children

“Neurological disorders, especially epilepsy, are very common in Pakistan, and based on current data 1.38 million people are estimated to suffer from this disorder in Pakistan. Diagnosis requires highly specialised tests which are not easily available in Pakistan.” This was stated by Dr Mughis Sheerani, Assistant Professor at the Department of Medicine, Aga Khan University Hospital (AKUH). He was speaking at a seminar on the ‘Multi-disciplinary Approach to Management of Epilepsy’ held under the aegis of the Hospital’s ‘Signs, Symptons and Care’ programme.

Dr Sheerani apprised the audience on the Comprehensive Epilepsy Programme and Electroencephalography (EEG) services at AKUH, the objective is to provide the best possible diagnostic and therapeutic service. This programme has a specialised epilepsy clinic, with fully qualified Neurologists and highly-trained nursing staff. Cutting-edge video and facilities for intra-operative monitoring help distinguish epileptic from non-epileptic attacks. The programme also incorporates the ‘Epilepsy Group’, a multi-speciality team that meets regularly to discuss difficult cases and advise best possible options.

Dr Shehnaz Ibrahim, the University’s Associate Professor and Consultant Neurologist at the Department of Paediatrics, spoke on ‘Children and Epilepsy’: seizures or convulsions occur in three to five percent of children, and as in any chronic disorder this also has deep-rooted misgivings and fears. Most parents tend to fear the presence of a tumour in the brain and as these are to some extent valid, it is necessary for a child to be examined in detail by a specialist after a first episode of seizure.

Defining the condition, Dr Shehnaz explained that when the brain undergoes an “abnormal burst of electrical activity”, the visible physical result is a seizure: when this happens recurrently the person is said to suffer from Epilepsy. The condition unfortunately has great deal of social stigma and hence has major significance in the lives of concerned families. She informed that epilepsy in children can be broadly divided into two categories: focal or partial epilepsy, that affects only one part of the brain; and generalized epilepsy which affects a wider part. A particular type of the latter results in a very brief period of loss of activity or consciousness: parents often miss observing this and consequently consider the matter as one of ‘not working hard enough’ at school.

However all focal epilepsies, the most common of which is ‘temporal lobe epilepsy’ (or ‘complex partial epilepsy’) call for very detailed medical evaluation. The child may become confused, dizzy, and angry, ‘see’ spots before his eyes, or ‘hear’ ringing noises and may often not remember what has happened. This type of seizure may be mistaken for an emotional or a psychiatric problem. Though sometimes the child outgrows the condition, Dr Shehnaz re-emphasised the vital necessity for parents to have him or her be examined by a doctor. She also referred to traditional beliefs and practices wherein families believe that only an ‘occultist’ might ‘cure’ the condition.

Dr Saad Bashir, Consultant Neurosurgeon and Associate Professor, Department of Surgery underlined the key aspects considered in epilepsy surgery. The psychiatric aspect of epilepsy was expressed by Dr Ehsan Syed, Consultant Psychiatrist and Assistant Professor at the Department of Psychiatry.

Dr Ather Enam, Consultant Neurosurgeon, Associate Professor and Head of the Neurosurgery Section, explained the types of epilepsy surgery, while Dr Fowzia Siddiqui, Consultant Neurologist, spoke on ‘Women and Epilepsy’.

As part of its outreach programme and societal commitment to creating awareness of early diagnosis and timely treatment, AKUH has organised over 200 ‘Signs, Symptoms and Care’ programmes in Karachi, Hyderabad and the UAE, benefiting more than 40,000 people. Similarly, Aga Khan University Hospital’s Patient Welfare Programme offers financial assistance to those patients who are unable to afford the medical cost of treatment. In 2005, 74 per cent of all patients treated at AKUH were from low- to middle-income groups. Since the inception of this welfare programme in 1986, over Rs. 1.4 billion has been disbursed to more than 250,000 needy patients.