1EPILEPSYProf Faisal A.Latif Alnasir FPC, MICGP, FRCGP, PhDChair; Dept. of Family & Community MedicineEx-Vice PresidentArabian Gulf University
2EPILEPSYEPIDEMIOLOGY, ETIOLOGYAND PROGNOSISWhat is epilepsy?Greek word "epilambanein" which means, "to seize or attack".Seized by supernatural force.No geographical, racial or social boundaries.Occurs in men and women and can begin at any age.
31. Causes of epilepsy in many people cannot be identified.2. Epilepsy the result of an underlying brain disease.3. Theory “ imbalance of certain chemicals in the brain”(neurotransmitters) causing them to have a low convulsivethreshold.Etiology of epilepsy
44. Brain tumor, brain disease, or cerebrovascular disease.These are more common in older patients.5. Febrile illness of any kind can trigger seizures in young children.3% of children with febrile convulsions develop epilepsy in lateron.Etiology of epilepsy
56. Brain infection and trauma can cause epilepsy at any age.(Higher incidence of epilepsy in developing countries). In Latin America; neurocysticercosis cysts in the braincaused by tapeworm infection. In Africa; malaria and meningitis. In India; tuberculosis and neurocysticercosis.7. Children and adolescents are more likely to have epilepsy ofunknown or genetic origin.Etiology of epilepsy
6 • Prevalence of active epilepsy (i.e. continuing seizures or the needfor treatment) is approximately 8.2 per 1,000 of the generalpopulation ( underestimated). • In developing countries more than 10 per 1,000.• Around 50 million people in the world have epilepsy at any onetime. Prevalence
7 • In developed countries 50 per 100,000 annually.• In developing countries 100 per 100,000.• Up to 5%of the world population have single seizure at some timein their lives.Incidence
8- 70% of newly diagnosed can be successfully treated. - After 2-5 years of successful treatment, drugs can bewithdrawn in about 70% of children and 60% of adultswithout relapses.- 30% of people may not respond to drug therapy.- 3 out of 4 people with epilepsy do not receive treatment atall. Most of these people live in developing countries.Prognosis
9 Epilepsy is associated with an increased risk of mortalitydue to: An underlying brain disease, such as a tumor or infection Seizures in dangerous circumstances, leading todrowning, burns or head injury Status epilepticusMortality
10Mortality Sudden and unexplained causes such as respiratory orcardio-respiratory arrest during a seizure SuicideEpilepsy-related deaths in young adults in the UK are 3 timeshigher than standard age-related mortality rates.
11Fear, misunderstanding and the resulting social stigma anddiscrimination surrounding epilepsy often force people withthis disorder "into the shadows".Social consequences
12Misunderstanding and social stigmaSome examples of misunderstandings :• In Cameroon, inhabited by the devil• In China, epilepsy diminishes the prospect of marriage• In rural India, to exorcise evil spirits from people with epilepsy bytying, beating!• In Indonesia, a punishment from unknown dark forcesSocial consequences
13Social consequences In Liberia, witchcraft or evil spirits In Nepal, weakness, possession by an evil spirit In Swaziland, sorcery (witchcraft) as cause of epilepsy In Uganda, it is contagious In the Netherlands in 1996, a person was whipped andput into isolation because her seizures were thought toresult from magic
14LegislationDue to misunderstanding or fear:• In both China and India, prohibiting or annullingmarriages.• In the United Kingdom, a law-forbidding people withepilepsy to marry were repealed only in 1970.
15Legislation•In the United States of America;prohibited people with epilepsy from marrying (in manystates. Last state to repeal was in 1980).18 States provided eugenic sterilization of people withepilepsy until 1956.until 1970s, denied from access to restaurants, theaters,recreational centers and public buildings.
16Key points• Epilepsy is one of the most common neurological disorder andhas no age, racial, social, sexual or geographical boundaries.• Up to 5% of people in the world may have at least one seizure intheir lives.• At any one point in time, 50 million people have epilepsy,especially in childhood, adolescence and old age.• Epilepsy can have profound social, physical and psychologicalconsequences.
17• In up to 70% of people, epilepsy responds to treatment, but indeveloping countries, three-fourths of people with epilepsy maynot receive the treatment they need.• The cost and burden of epilepsy varies between countries.• The anti-epileptic drug “Phenobarbitone” can cost as little asUS $5/person/annum and can be used to treat many peoplewith epilepsy.• People with epilepsy continually face social stigma andexclusion.• Legislation which reinforces fear and discrimination must alsobe changed.Key points