Epilepsy is a chronic, non-communicable brain disease that affects approximately 50 million people worldwide. This seizure is a short bout of involuntary movements that may involve one part of the body (partial) or the whole body (whole body), and sometimes causes repeated attacks with loss of consciousness and control of bowel or bladder function. It is a feature.
A seizure episode is the result of excessive electrical discharge in a group of brain cells. Different parts of the brain can be the location of such discharges. Seizures can range from a very brief loss of attention or muscle spasms to severe, long-lasting spasms. The frequency of attacks also varies from less than once a year to several times a day.
One seizure does not mean epilepsy (up to 10% of people worldwide will experience one seizure in their lifetime). Epilepsy is defined as her having two or more unprovoked seizures. Epilepsy is one of the oldest recognized diseases in the world, with written records dating back to 4000 BC. For centuries, epilepsy has been surrounded by fear, misunderstanding, discrimination, and social stigma. This stigma continues in many countries today and can impact the quality of life of people with the disease and their families.
signs and symptoms
Seizure characteristics vary and depend on where in the brain the damage first begins and how far it spread. Temporary symptoms occur, such as loss of consciousness or awareness, and disturbances in motor, sensory (including vision, hearing, and taste), mood, and other cognitive functions.
People with epilepsy are more likely to have physical problems (such as broken bones or bruises from seizure-related injuries) and higher rates of psychological conditions such as anxiety and depression. Similarly, the risk of premature death in patients with epilepsy is up to three times higher than in the general population, with early mortality rates highest in low- and middle-income countries and rural areas.
Particularly in low- and middle-income countries, most epilepsy-related deaths, such as falls, drownings, burns, and long-term seizures, may be preventable.
Epilepsy accounts for a significant proportion of the world’s illnesses, affecting approximately 50 million people worldwide. The estimated proportion of the general population with active epilepsy (that is, epilepsy that continues to occur or requires treatment) at any given time is between 4 and 10 per 1000 people.
An estimated 5 million people worldwide are diagnosed with epilepsy each year. In high-income countries, it is estimated that 49 per 100,000 people are diagnosed with epilepsy each year. In low- and middle-income countries, this number can reach 139 per 100,000 people. This may be due to the increased risk of endemic diseases such as malaria and neurocysticercosis. The incidence of traffic accidents is high. Childbirth-related injuries. Changes in health care infrastructure, availability of preventive health programs, and more accessible care. Nearly 80% of patients with epilepsy live in low- and middle-income countries.
Epilepsy is not contagious. Many underlying disease mechanisms can cause epilepsy, but in approximately 50% of cases worldwide, the cause of the disease remains unknown. The causes of epilepsy are classified into structural, genetic, infectious, metabolic, immunological, and unknown categories. Examples include:
- Brain injury due to prenatal or perinatal causes (eg, oxygen deprivation or trauma at birth, low birth weight).
- A genetic condition with birth defects or associated brain malformations.
- Severe head injury.
- A stroke that limits the amount of oxygen to the brain.
- Brain infections such as meningitis, encephalitis, and neurocysticercosis;
- Certain genetic syndromes.and
- Brain tumor.
Seizures can be controlled. With proper use of antiepileptic drugs, up to 70% of people living with epilepsy can become seizure-free. Discontinuation of antiepileptic drugs can be considered after 2 years of seizure freedom, but relevant clinical, social, and personal factors should be considered. A documented seizure etiology and abnormal electroencephalogram (EEG) pattern are the most reliable predictors of seizure recurrence.
- In low-income countries, around three-quarters of people with epilepsy may not receive the treatment they need. This is called the “treatment gap.”
- Availability of antiepileptic drugs is low in many low- and middle-income countries. A recent study found that the average availability of generic antiepileptic drugs in the public sector in low- and middle-income countries is less than 50%. This can act as a barrier to receiving treatment.
- Most patients with epilepsy can be diagnosed and treated at the primary care level without the use of sophisticated equipment.
- A WHO pilot project has shown that training primary health care providers in the diagnosis and treatment of epilepsy can effectively reduce epilepsy treatment gaps.
- Surgery may be beneficial for patients who do not respond well to drug treatment.
An estimated 25% of epilepsy cases may be preventable.
- Preventing head injuries by reducing falls, traffic accidents, and sports injuries is the most effective way to prevent post-traumatic epilepsy.
- Proper perinatal care can reduce new cases of epilepsy caused by birth injuries.
- Using drugs and other methods to lower a child’s body temperature with a fever can reduce the chance of febrile seizures.
- Prevention of stroke-related epilepsy focuses on reducing cardiovascular risk factors, such as preventing or managing hypertension, diabetes, obesity, and avoiding tobacco and excessive alcohol consumption.
- Central nervous system infections are a common cause of epilepsy in tropical regions, where many low- and middle-income countries are concentrated. Education on how to eliminate parasites and avoid infections in such environments can be an effective way to reduce epilepsy worldwide, for example epilepsy due to neurocysticercosis.
Social and economic impact
Epilepsy accounts for more than 0.5% of the global disease burden, which is a time-based measure of years of life lost due to premature death and time spent short of full health. Epilepsy has significant economic consequences in terms of medical needs, premature mortality, and reduced work productivity.
Out-of-pocket costs and reduced productivity can place a significant strain on household budgets. The Economic Survey of India estimates that public financing for both primary and secondary treatment and other health care costs reduces the economic burden of epilepsy and is cost-effective.
The stigma and discrimination surrounding epilepsy around the world is often more difficult to overcome than the seizures themselves. People living with epilepsy and their families can be subject to stigma. The widespread belief that epilepsy is an incurable disease, a contagious disease, or the result of morally bad behavior can isolate people and discourage them from seeking treatment.
People with epilepsy may experience reduced educational opportunities, withheld opportunities to obtain a driver’s license, barriers to entering certain occupations, and reduced access to health and life insurance. Laws in many countries reflect centuries of misconceptions about epilepsy, such as laws that allow for the annulment of marriages on the basis of epilepsy and laws that allow people with seizures to stay in restaurants, theaters, recreation centers, and other public places. There are laws that deny entry to buildings.
Laws based on internationally recognized human rights standards can prevent discrimination and rights violations, improve access to health services and improve the quality of life for people with epilepsy.
The first global report on epilepsy, ‘Epilepsy: a public health emergency’, produced by WHO and key partners in 2019, sets out the available evidence on the burden of epilepsy and the evidence needed at global, regional and national levels. The public health response is emphasized.
The 75th WHA adopted a cross-cutting global plan of action on epilepsy and other neurological disorders for 2022-2031. The plan recognizes that preventive, pharmacological and psychosocial approaches shared between epilepsy and other neurological disorders serve as a valuable entry point for accelerating and strengthening services and support for epilepsy. It is being these conditions.
The WHO recently published a technical brief on epilepsy. This technical brief outlines actions for policy makers and health planners to reduce the burden of epilepsy in countries by identifying and prioritizing the most effective solutions across a wide range of societal sectors. .
WHO, the International League Against Epilepsy (ILAE), and the International Bureau for Epilepsy (IBE) are leading a global campaign against epilepsy to bring this disease out of the shadows, provide better information about epilepsy, and raise awareness about epilepsy. Raised awareness and strengthened public and private efforts. Improve care and reduce the impact of disease.
These efforts have contributed to the prioritization of epilepsy in many countries, reducing treatment disparities and morbidity for people with epilepsy, training and educating health professionals, eliminating stigma, and identifying and developing potential prevention strategies. A project has been carried out for this purpose. A model for integrating epilepsy care into local health systems. These projects, which combined several innovative strategies, showed that there are simple and cost-effective ways to treat epilepsy even in low-resource settings. WHO’s Epilepsy Treatment Gap Reduction Program and Mental Health Gap Action Program (mhGAP) have achieved these goals in Ghana, Mozambique, Myanmar and Vietnam, enabling an additional 6.5 million people to receive epilepsy treatment when they need it. became.