International Epilepsy Day: India holds up to over 12 million worldwide epilepsy cases.

Epilepsy

Epilepsy is a chronic, noncommunicable disease recognized by recurrent seizures. Seizures occur due to abnormal electrical activity in the brain, resulting in convulsions, loss of consciousness, and sensory disturbances. Nonetheless, no one who has a seizure does not have to have epilepsy, which can be a sign of other medical problems.?

Other Causes of Epilepsy:

• Genetics: Clinical studies suggest about 70% to 80% of idiopathic (genetic) epilepsy is linked to genetic factors.?
• Brain trauma: Traumatic brain injury (TBI) contributes to about 5% of all epilepsy cases.?
• Autoimmune diseases: Patients with any of the autoimmune diseases constitute about 17.5% of the total epilepsy population.
• Metabolic issues or infectious disease: According to the Scope of Metabolic Epilepsies, around 600 metabolic epilepsies have been detected, constituting nearly 37% of inherited metabolic diseases (IMDs).?
• HIV infection: Unprotected sex could carry a risk per exposure of up to 2.4%? in adults.?

4 Different Types of Epilepsy

The classification of epilepsy is done based on seizure type, cause, and affected brain region. Four main types of epilepsy:

• Generalized epilepsy (30-40% cases): Seizures occur in both hemispheres of the brain simultaneously. It starts in adolescence or childhood.?
• Focal epilepsy (60-70% cases): It arises from a specific part of the brain within the frontal lobe.?
• Combined generalized and focal epilepsy (5-10%): Individuals face symptoms of both epilepsy. Although rare, it is a life-long epilepsy caused by a mutation in the SCN1A gene.?
• Unknown epilepsy (5%): The onset of a seizure is unclear due to a lack of diagnostic clarity.?

Global Prevalence of Epilepsy from the WHO’s Eye!

According to the WHO, epilepsy is significantly contributing to the global burden of disease, with an estimated 13.9 million global disability-adjusted life years (DALYs).

The WHO website also reveals that close to 80% of the people living with epilepsy belong to low- and middle-income countries. Besides, it is also estimated that 70% of epilepsy patients could live a seizure-free life after getting treated.

In 2021, approximately 139,851 people worldwide died due to epilepsy, with an age-standardized mortality rate (ASMR) of 1.74 per 100,000 population.?

The annual cumulative incident rate of epilepsy is 67.77 per 100,000 population, indicating the detection of new cases every year.?

Global Targets:

International Epilepsy Day will implement the WHO’s 10-year intersectoral global plan of action (IGAP) and other neurological disorders (2022-2031). Achieving these global targets means people with epilepsy have better access to care, along with increased social inclusion across all sectors of society.?

• Global Target 1: By 2031, there will be a 50% increase in epilepsy coverage.?
• Global Target 2: By 2031, 80% of the countries will have updated their legislation to safeguard the human rights of epilepsy patients.?

The IGAP is making every effort to help people with seizures and their families. Support will strengthen accurate diagnosis, care and treatment, and prevention, thus improving quality of life. Additionally, equal opportunities will be provided for epilepsy patients and people with other neurological disorders worldwide.?

Epilepsy Impact in India

Epilepsy significantly affects millions in India. The country has to face unique challenges due to its socio-economic landscape.?

More than 12 million people with epilepsy (PWE) are living in India, which is about one-sixth of the global epilepsy population.?

Socioeconomic Impact

• Education and Employment

The disease adversely impacts education and employment opportunities. Lack of knowledge, misconception, and stigma create discrimination, restricting people's access to quality education and stable employment.

• Marriage Prospects

Epilepsy has a negative image, even from a marriage point of view. Individuals with epilepsy and their families may reject people with epilepsy and their families.?

• Economic Burden

The 2011 study reveals the country faced approximately an annual loss of Rs. 12.03 billion, with Rs. 2.22 billion from South India and Rs. 9.78 billion from North India due to neurocysticercosis-associated active epilepsy.?

Gaps in healthcare, quality, and treatment

• Rural-Urban Divide:?

The urban-rural disparity exists. Nearly 70% of the people live in rural areas, yet specialized epilepsy treatment centers are predominantly available in urban centers. Further, this leads to limited access to timely and accurate diagnosis for rural residents.

• Treatment Gap

Astonishingly, despite the medicines being available to treat epilepsy, the gap persists, ranging from 22% in urban middle-income areas to 90% in a sample of rural villages. Regretfully, many individuals do not receive adequate care due to a lack of knowledge, financial resources, and limited access to healthcare services. Otherwise, up to 70% of the people with epilepsy in India could get free from seizures with proper medication.?

Additionally, epilepsy-based surgery programs in India have shown over a 70% success rate in achieving seizure freedom.?

• Quality of Life?

The impact of epilepsy on life is not good owing to factors like age, gender, type of seizure, and duration of the condition. Older individuals, children, females, and patients with certain seizure types or simple partial seizures report lower quality of life scores.?

• Stigma and Misconception

Deep-rooted Indian cultural beliefs significantly contribute to the stigma of epilepsy. Misconceptions about epilepsy result in discrimination, careless attitudes towards seeking medical help, and social ostracism, further exacerbating the challenges faced by epilepsy patients.?

How can prevention put an end to the Epilepsy Number

Prevention can certainly help reduce epilepsy cases but may not eradicate the problem. It is because some cases are genetic or unavoidable. Below is an estimated breakdown of preventive measures for reducing epilepsy cases:?

• Preventing Head Injuries: BWe can prevent injuries by wearing helmets while riding bikes or playing contact sports such as basketball, reducing 30-40% of epilepsy.?
• Managing Prenatal and Perinatal Risks: Women with epilepsy (WWE) are suggested antiepileptic drugs (AED) during the gestation period. This can reduce up to 10-12% of fetal trauma associated with seizures. Additionally, they should avoid smoking, alcohol, and other harmful substances.?
• Controlling Infections: Various brain alterations occur during the latent phase between infection and the onset of epilepsy, which may contribute to epileptogenesis. Vaccinations such as meningitis and neurocysticercosis and early antibiotic or antiparasitic treatment can bring about a 10-12% reduction.?
• Avoiding Substance Abuse (alcohol, drugs): Avoiding alcohol and other harmful substances such as drugs can help reduce about 10-15% of epilepsy.?
• Preventing Stroke and Cardiovascular Issues: Eating a heart-healthy diet, exercising regularly, and monitoring cholesterol levels can reduce epilepsy by 10-15%.?
• Reducing Stress and Sleep Disorders: Lack of sleep and high-stress levels can worsen the condition. You can practice relaxation techniques and follow a good sleep regimen to reduce the condition by 5-10%.?
• Regular epilepsy screenings: Early detection can help a doctor identify the potential cause of epilepsy, allowing for timely treatment and preventing seizures from worsening.?