The proclivity towards having repeated seizures may be indicative of or may mean epilepsy. It is a symptom of brain disease rather than a disease itself. A single seizure is not epilepsy. Never the less it requires investigation. The prevalence of epilepsy in European Countries is said to be by far lower than the prevalence rate in the developing countries. While that of the developed countries is said to be about 0.5%, that of the developing countries is up to five times higher than that of the developed countries.
The clinical events (seizures), the abnormal electrophysiology, the anatomical site of seizure genesis and the pathological cause of the problem, play a pivotal role in the classification of epilepsy. The following have been identified as trigger factors for seizures:
Alcohol (particularly withdrawal)
Recreational drug misuse
Physical and mental exhaustion
Flickering lights, including Tv and Computer screens (primary generalized epilepsies only)
Intercurrent infections and metabolic disturbances
Uncommonly; loud noises, music, reading, hot baths.
TYPES OF EPILEPSY
There are different types of epilepsy. These includes, absence seizures, atomic seizures, benign Rolandic epilepsy, childhood absence, clonic seizures, complex partial seizures Juvenile absence epilepsy, hot water disorders, simple partial seizures, secondary generalized seizures, photosensitive epilepsy, sensory seizures, subtle seizures, withdrawal seizures, nocturnal seizures, visual reflex seizures and motor seizures, etc.
The syndromes of epilepsy are divided into localization related epilepsies, generalized epilepsies, or epilepsies of unknown location.
The syndromes are categorized further on the basis of the presumptive cause: Idiopathic, symptomatic, and cryptogenic. Genetic abnormalities resulting in alteration of basic neuronal regulation, is said to precipitate idiopathic epilepsies. Symptomatic epilepsies are said to arise from the effects of an epileptic lesion, whether that lesion is focal, such as tumor, or a defect in metabolism causing widespread injury to the brain. Cryptogenic epilepsies deal with a presumptive lesion that is otherwise difficult or impossible to uncover during evaluation.
Very many precipitants have been implicated in the triggering of epileptic seizures in patients. Emotional stress, sleep deprivation, sleep itself, heat stress, alcohol and febrile illness have been found to be precipitants cited by a number of patients.
Different causes of epilepsy have been highlighted by many experts. The following have been identified as common in certain age groups.
Hypoxic-ischemic encephalopathy, CNS infections trauma, congenital CNS abnormalities, and metabolic disorders are said to be the common causes of epilepsy during neonatal period and early infancy.
In late infancy and early childhood, febrile seizures that may be caused by many things including such as CNS infections ad trauma, are implicated.
During childhood, well defined epilepsy syndromes are generally seen
During adolescence and adulthood, the causes are more likely to be secondary to any CNS lesion.
Cerebrocascular disease, CNS tumors, head trauma, dementia and other degenerative diseases are the common causes for epilepsy on older adults.
Mutations in genes have been linked to some types of epilepsy. Some genes that code for protein subunits of voltage-gated and ligand gated ion channels have been associated with forms of generalized epilepsy and infantile seizure syndromes.
A speculated mechanism for some forms of inherited epilepsy are mutations of the genes which code for sodium channel proteins; these defective stay open for too long thus making the neuron hyper-excitable. Glutamate, an excitatory neurotransmitter, may thereby be released from these neurons in large amounts which by binding with nearby glutamatergic neurons triggers excessive calcium (Ca2+) release in these postsynaptic cells. This could make such persons vulnerable to epileptic seizure.
EPILEPSY AS SACRED DISEASE:
Variously, epilepsy has been defined by different persons in many ways. It is perceived in some quarters as the consequence of an infraction of the laws of providence. To very many persons, the violation of the moral order upon which the Cosmos is predicated, is an invitation to the wrath of the Almighty Creator. Epilepsy is therefore seen by some as nature's way of dealing with those who are Fiendish in the conduct of their affairs on earth. Garretson talks about epilepsy as a Sacred Disease thus;
“This phrase, the sacred disease achieved immortality in the written sense with that utilization by Hippocrates. There have been descriptions of epileptic and epilepsy of one type or another for many years… In the New Testament in Mark 9:14-29, there was a man that came to Christ and said “I have brought to thee my son which hath a dumb spirit”. The concept of epilepsy being something from without, the term is being something that seizes a man from without himself, a Greek term has had a connotation and has been probably been encouraged by some people, perhaps Charlatans and other people who had something to gain from it by being possessed by a spirit , possessed by a god, hence, I think the use of the term The Sacred Disease”.
It is obvious that very early in time, those who suffered from epileptic fit were deemed as those under the sway of some negative spirits, it was either that they were paying for the wrongs which they have done, or were simply being witch hunted by forces that seek to render the lives of others miserable. The age and social status of those who get affected reflected the fact that no one was absolutely free.
The very high and the mighty had been held hostage by this disease. Such great men like Julius Caesar, who was said to have “the falling illness”, Hercules, Alexander the Great, Dickens and Alfred Nobel were all said to be epileptics. These great minds who impacted so wonderfully on the World they lived in, had epilepsy which could never have been the work of some evil and implacable spirits.
The belief that epilepsy was a Scared Disease was the reason why sufferers were not just majorly treated with utter barrenness and disdain, but accounted for the harshness which marked the treatment they got. There were violent purgatives and blood lettings as ways of treating those who were epileptic. Some victims are sometime mercilessly flogged under the varnish of seeking to set them free from the clutches of evil forces that torment them. Ligatures and amputation in some extreme cases have been used in dealing with patients. This method was always intended by those who applied it to treat seizure.
In our local environment in the past and even now, children who have suffered some form of seizure or the other, have had their feet put under fire to drive away the evil forces that are believed to be responsible for the seizure. This does not just mean inflicting more pains, but could lead to worse complications. Even in some religious setting persons suffering from epilepsy have been subjected to one form of blood letting and burning to force out the evil spirits. A lady was said to have come to Prophet Muhammad (SWA) and asked that he should pray that God takes away her epilepsy. The Prophet (SWA) informed her that her plight may be a source of blessings from God and therefore should never let that trouble her. The woman while accepting this position however asked that the Prophet should pray that her nudity should not be exposed whenever she suffered any seizure and falls down. The Prophet was said to have prayed for her against the exposure of her nudity whenever she had an attack.
The Prophet's (SWA) perception of the lady's problem was that the problem was never one caused because of a sinful life, or because some evil spirit was at work. It was basically an illness for which God's blessing could be earned should the victim continue to be God fearing.
The import of this is that epileptic sufferers do not need to suffer any denigration from others. They are neither evil persons nor those who are paying for a wrong that was committed in the past. In fact epileptic patients are not any the less religious and God fearing persons. Their capacity to live full and fulfilling lives is not in the least in doubt. Nevertheless this could be circumscribed if not aborted when they come under the monumental illusion that they are under a cause. This explains the need to deal with the psychological traumatization that flows as a natural corollary from this illness. It will be nothing less than regaling in prodigious duplicity if one were to suppose that dealing with this problem will be easy.
Most epileptic patients are either very depress or are withdrawn. They usually are overwhelmed with shame when they are in the company of others. The question they ask in their solitary moments had always been “why us”. There is obviously the need for us to begin to appreciate epilepsy for what is is a medical condition that requires efforts at mitigating it. While in very many instances it could bring about loss of consciousness for a time, it is certainly not a punishment from any evil forces.
HISTORY OF EPILEPSY
Epilepsy is the most common non-infectious disease in developing African countries, including Nigeria and it remains a major medical can social problem. Historically, epilepsy was believed to be a sacred disease that is the result of the invasion of the body by a god. It was thought that only a god could deprive a healthy man of his senses, throw him to the ground, convulse him and then rapidly restore him to his former self again, the word 'lunatic' was first applied to sufferers of epilepsy as gods were thought to heavenly spheres, one of which was the moon. In contrast, mad people were referred to as 'maniacs' whose madness was a result of invasion of the body by devils of evil spirits. In the Gospel according to Saint Mark, it was a foul spirit that was cast out of the young man with fits. The 'Dictator Perpetuus' of the Roman Empire, the great Julius Caesar likely had epilepsy n the basis of documented four attacks that were probably complex partial seizures. Also, it is possible that he had absence attacks as a child and as a teenager. His son, Caesarion, and his great-great-great grandnephews Caligula and Britannicus also had seizures. The etiology of epilepsy in this Julio-Claudia family is probably linked to inheritance.
This historical legacy has continued to influence public attitude to epilepsy making it a dreaded disease. These beliefs have resulted in patients with epilepsy (PWE) being ostracized and misunderstood. The social implications are serious. For instance, in Madagascar, patients with epilepsy are refused burial in the family grave. In many African countries, the PWE us an out-cast as Africans believe that the disease result from visitation of the devil, effect of witch-craft, the revenge of an aggrieved ancestral spirit of consumption of something harmful in utero. Suicide of attempted suicide is not uncommon among Nigerians who suffer from epilepsy. The patient with epilepsy is likely to drop out of school, lose his job, finds it impossible to marry, loses his wife of her husband, and be tormented to the extent of becoming a vagrant vagabond.
The remarkable issue raised by Hippocrates' famous treatise on the Sacred Disease' was the seat of the disease. In the latter half of the nineteenth century, Hughlings Jackspon defined epilepsy on the basis of a neuronal theory a disease of the brain. About three decades later, William Gowers observed a link between epilepsy and cognitive deterioration. He noted that defective memory, especially for recent acquisitions and weakened capacity for attention are frequently encountered cognitive impairments in epileptic patients. This observation was not novel as Tissot in 1770 in his 'Traite' de L'Epileptic' wrote that he had never seen a patient with epilepsy whose fits were not very rare not complaining, about a weakening of memory.
CAUSES OF EPILEPSY
The commonest cause of symptomatic epilepsy remains central nervous system infections, mainly bacterial and viral meningitis, encephalitis, neurosyphilis, brain abscess and tuberculosis. These infevtions accounted for 10% to 20% of cases of epilepsy reported in Africa. Most of the acute presentations of seizures in the tropics, where health facilities are lacking especially in the rural and suburban communities, are due to CNS infections. Incidentally, Human immunodeficiency virus infection (HIV) is increasing steadily in African with the recent WHO report stating that 11.3 million cases out of 17 million worldwide are found in Africa with South Africa, Uganda, Kenya and Nigeria leading other African Countries. It is now clear that HIV infection will ne, or already is, a much greater problem in developing tropical countries. It may lead to epilepsy by direct invasion of the brain, as in HIV encephalopathy, of as a consequence of opportunistic infections, as in toxoplasmosis.
Although there is a high incidence of parasitic infections in Nigeria, there is little evidence that these parasites commonly cause epilepsy locally. There are however, many reports from other parts of the world, especially other developing countries, incriminating parasites in the causation of epilepsu. Cysticercosis is the commonest cause of epilepsy in some parts of the world and epilepsy is the commonest presentation of neuro cysticercosis, frequently as an isolated clinical sign, to the extent that prevalence figures for idiopathic epilepsies in endemic regions cannot be accepted unless subjects have been examined with CT brain scab, this infection has been rarely reported in Nigeria unlike her neighbours, Cameroun and Togo, where cysticercosis was responsible for significant proportions of epilepsy cases.
Trauma and hypoxia are among the commonest causes of epilepsy in Nigeria. These factors may act alone or together in the parental period owing to poor obstetric care, or throughout life in acts of violence at home, work and in traffic accidents. Birth trauma can cause epilepsy following excessive molding of the scalp and asphyxia with subsequent damaging effects on the hippocampus and amygdale resulting in incisural sclerosis. It accounts for 1 2% of symptomatic epilepsies in Africa.
Cerebral tumours account for 3 10% of symptomatic epilepsies in Africa. With the introduction and installation of CT in some tertiary institutions in several African countries, more cases of epilepsy secondary to cerebral tumours are becoming obvious.
Vascular lesions account for 6 20% in Africa but lower incidence rate were obtained among Nigerian PWE. Seizures occur in 15% of patients with cerebral infarction and become chronic in less than 5%.
Metabolic derangements, such as pyridoxine deficiency which is associated with increased glutamic acid and reduced gamma aminobutyric acid (GABA) level in the brain, may result in seizures. Other metabolic causes on epilepsy include aminoaciduria, hypoglycemia, hypocalcaemia, hypomagnesaemia, uremia, alkalosis and water intoxication. Insulinoma, causing hypoglycemia may rarely present with epilepsy.
Generalized seizures have been reported in non-epileptic Nigerian subjects with normal EEGS after toxic doses of chloroquine, more rarely with therapeutic doses, and even during prophylactic treatment. Patients with epilepsy of low seizure threshold may be especially prone; which has prompted suggestions that the drug is contraindicated in such cases. The mechanism for these effects of antimalarial drugs is unclear.
Quality of life among patients with chronic epilepsy has been little study among Nigerians. Main aspect of life events affected from a study done in Ibadan was feeling of energy deficits. This was closely followed by memory, fear of experiencing the next seizure and work and social limitations. Cognitive impairments due either to the recurrent seizures or the anti-epileptic drugs contribute to disruption of life quality. The social problems encountered by the schoolchildren with epilepsy as a result of negative attitudes and believes are enormous. The school teachers' perception plays a significant role in the approach to care of the affected students. A study demonstrated that despite the fairly high level of education among the teachers in Nigeria the mean overall score for correct response for knowledge on epilepsy was 52.9% and majority of these teachers had negative attitudes and beliefs. There is an urgent need for public awareness and education with the objective of eradicating the stigma attached to epilepsy and getting the community and primary health care workers actively involved in the management of affected persons.
OTHER THINGS YOU NEED TO KNOW ABOUT EPILEPSY
Epilepsy is a condition which affect the central nervous system. And outbreak of Chaotic electrical activity in the brain leads to a seizure, which can be partial or result in loss of consciousness. There are many causes of epilepsy, including birth trauma, head injury, food sensitivity, flickering light, loud noise and fatigue, although often no specific cause is found. Most people with epilepsy take medication, but some prevent seizures by avoiding triggers, and complementary therapies can help by reducing stress. If you see someone have a seizure, lie them on their side, remove any nearby dangerous or breakable objects, loosen clothing at their neck and ensure that their airway is clear. Don not put anything in their mouth. If the seizure lasts longer than 3minutes, call an ambulance.
Dietary Advice For Epilepsy
Italian researchers examined 31 patients with epilepsy and found 24 had undiagnosed coliac disease (gluten intolerance). Gluten is found in wheat, oats, barley and rye, and following magnesium and calcium, and the amino acid taurine, can make seizures less likely . Some children with epilepsy are deficient in essential nutrients such as vitamins B1, B6, D, E, folic acid and selenium. However, it is unwise to self-supplement or radically change your diet if you have epilepsy, so see a qualified nutritional therapist. People with epilepsy should restrict stimulants such as coffee and alcohol.
Complimentary Remedies For Epilepsy
Dr. Tim Betts, at Queen Elizabeth Hospital in Birmingham, has been successfully using essential oils to reduce seizures in people with epilepsy. However, self-medicating with oils is not recommended. Certain oils, such as rosemary, sage, hyssop and fennel, may even trigger a seizure.
Relaxation exercises, meditation and cranial osteopathy can help reduce stress levels. Complementary treatments should be given by a qualified therapist and relaxation techniques learnt from an experienced teacher.
Chamomile tea helps relaxation. Use a tea bag, or 1tsp dried flowers, to a cup of boiling water, leave for 5 to 10 minutes, strain and drink. You can treat a child during a seizure by pressing an acupressure point in the furrow above the upper lip, just below the nose. Apply firm pressure to the point, pressing down towards the lips for up to 2 minutes.
In modern times, people with epilepsy were not allowed to marry or have children. In Nazi Germany and even in America in the 1920's, they were given an operation to prevent them from ever having children. Medicines such as potassium bromide and Phenobarbital were invented and helped people not have seizures. Bromides had bad side effects, but allowed some people with epilepsy to live normal lives. Phenobarbital was better, but it did not help everyone.
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