"Epilepsy is a commonly misunderstood condition which is often confused with magical, mystical or religious phenomena and can lead to epileptics being labelled as 'possessed'. Unfortunately, due to lack of education, these misconceptions are prevalent in our society. As physicians, we frequently hear horrifying stories of epileptics being tied up and beaten."
This was stated by Dr Mughis Sheerani, Assistant Professor and In-charge, Epilepsy Programme, Section of Neurology, Department of Medicine, Aga Khan University (AKU), while giving a presentation on 'Epilepsy: A Treatable Disease'. Dr Sheerani was speaking at 'Signs, Symptoms and Care', a public health awareness programme organised by Aga Khan University Hospital (AKUH) in Karachi on May 7, 2005.
Epilepsy is sometimes also confused with mental retardation, said Dr Sheerani. He clarified that epileptics are of normal intelligence and can be highly accomplished figures such as Socrates, Vladimir Lenin, Alexander the Great, Napoleon Bonaparte and Alfred Nobel, all of whom were epileptic.
"Epilepsy patients suffer recurrent seizures or fits due to a sudden alteration in the electrical activity of the brain," explained Dr Sheerani. Manifestations of this illness can be complex, "ranging from the well recognised jerking of limbs, rolling back of the eyes, and loss of urine and stool control - known as a 'tonic-clonic seizure' or 'generalised fit' - to just subtle changes in the mood or behaviour."
The cause remains unknown in the majority of epilepsy cases. "There could be a genetic basis or background and such patients have a better prognosis of 'growing out' of their seizure disorder. There is a two- to three-fold increased risk in relatives of patients with epilepsy of unknown cause," Dr Sheerani elaborated. "Seizures can also be triggered by many environmental or internal factors that may be hard to identify. The most common triggers include lack of sleep, stress, strong emotions, intense exercise, flashing lights (such as those in video games), fever or other illness, and menstrual cycle."
Rapid advances in the field of neurology and clinical neurophysiology have greatly facilitated the diagnosis and classification of epileptic disorders. For instance, electroencephalography (EEG) aids in unravelling the epicentre or focus of an epileptic attack. AKUH recently launched an Epilepsy Monitoring Unit - the first of its kind in Pakistan - which helps classify seizures and differentiates epileptic spells from non-epileptic episodes and can also diagnose certain sleep-related disorders, especially when combined with polysomonography (sleep study).
"Depending on the case, the physician may order other tests including magnetic resonance imaging (MRI), cerebrospinal fluid analysis and various blood tests. These tests help pinpoint the root cause of this illness," disclosed Dr Sheerani. He added that both medical and surgical treatments are available for treatment of epilepsy. "The number of epilepsy medications has increased exponentially in last few years. Intractable epilepsy, the condition where a combination of three medications cannot control seizures for one to two years, can be treated surgically."
As epilepsy is a chronic illness, patients and their families need proper counselling to acquire a better understanding of the disease, Dr Sheerani suggested. Close supervision is required when patients are handling inflammable material or engaged in potentially hazardous activities such as climbing ladders or swimming. Driving, he warned, is usually prohibited until seizures are fully controlled for several months. "If seizure occurs, do not panic or try to restrain the patient or force anything between the teeth. The patient should be turned to one side to prevent aspiration and any sharp objects in the vicinity must be removed," he added.
Drs Saad Shafqat, Shahid Masud Baig and Bhojo Asumal Khealani of the Section of Neurology, Department of Medicine, AKU, participated in the question-and-answer session that followed the presentation.
As part of its outreach programme and societal commitment of creating awareness of early diagnosis and timely treatment, AKUH has organised over 160 'Signs, Symptoms and Care' programmes in Karachi, Hyderabad and the UAE, reaching out to more than 35,000 people.
