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Epilepsy: 'a disease once sacred'

Epilepsy: 'a disease once sacred'

Social stigma and exclusion have affected people with epilepsy for centuries. It was once referred to as 'the sacred disease', but what is epilepsy, what causes it and how is it treated?

In India, a person with epilepsy might be tied to a tree and have lemon juice squeezed onto their head, while in Nepal somebody having a seizure could be made to smell a leather shoe to rid them of evil spirits. In Uganda, epilepsy is thought to be contagious and so anybody with the condition is not permitted to use the communal food pot.

Just in case you think this sort of approach is confined to developing countries, consider the fact that the last state in the US to repeal a law forbidding people with epilepsy to marry did so as recently as 1980, and in the UK a similar law was repealed in 1970. And also until that time, somebody having an epileptic seizure could be banned from US restaurants and other public buildings.

Social stigma and exclusion, suspicion and misunderstanding have dogged epilepsy for centuries. It was once referred to as 'the sacred disease' because it was seen as a demonic attack. So what is epilepsy, what causes it, how common is it and how is it treated?

The causes of epilepsy
The condition of epilepsy – it is not referred to as a disease or mental illness – can be described as disturbances to the brain's normal electrical activity which causes recurring seizures or brief episodes of altered consciousness.

Anyone can develop epilepsy. It occurs at all ages, although it is often diagnosed under 20 and over 60 years of age, and has no link to race or social class.

There are many reasons why someone might have epilepsy, for example because of a head injury, but it can start for no apparent reason and its cause may never be found.

The most common causes of epilepsy include tumours and diseases in the brain, genetic or inherited conditions, and head injuries.

Epilepsy with a known cause is called symptomatic epilepsy; if there is a likely cause it is called cryptogenic; and, if there is no known cause, it is idiopathic.

How many people does epilepsy affect?
According to the World Health Organization, epilepsy affects about 50 million people around the world. A minimum of 250 million people will experience at least one seizure in their lifetime and at least 2.4 million new cases of epilepsy occur each year.

Reported figures vary widely, adds WHO. Generally, the incidence is taken to be 40-70 per 100,000 people per year in industrialised countries, with an estimated of 100-190 per 100,000 people per year in developing countries.

Types of seizure in epilepsy
There are about 40 different types of epileptic seizure, and it is possible for a person to have more than one type of seizure. Some people’s seizures follow a pattern – they can happen only at night, for example – and some may be mistaken for alcohol- or drug-related behaviour.

Most seizures are over in a few minutes and the person recovers quickly, but it can take a few days to feel back to normal. A common type of seizure is a general tonic-clonic seizure (formerly known as a 'grand mal'). These rarely last longer than a couple of minutes and follow a set pattern, often with an initial generalised tensing of muscles.

The next stage involves the rapid contraction of the muscles, which can lead to the person falling, often causing other injuries. During the next phase the legs and arms jerk uncontrollably. The jaw will be clamped shut and the tongue might be bitten. The severe muscle contractions during the seizure can significantly interfere with breathing. When this stage has passed the person is likely to be very drowsy and will probably fall asleep.

Partial seizure is a type of epilepsy caused by electrical abnormality in one part of the brain, which does not spread. Depending on which area of the brain is suffering, the symptoms can be spasms of the face or arm, or head jerks or twitching around the mouth. Most commonly these seizures are characterised by brief periods of confusion for which the person has little or no recollection. This is the most common type of seizure affecting adults.

When epileptic seizures follow in close succession, severe damage to the brain can occur. This condition is known as status epilepticus, a medical emergency which requires immediate emergency hospital treatment.

Absence seizure, formerly known as 'petit mal' is a form of generalised epilepsy found almost exclusively in children. Here, the child can lose all touch with the world for a few seconds but is unlikely to fall over or show outward signs associated with epilepsy. For this reason, these fits can pass unnoticed, but repeated fits can leave a child forgetful or inattentive.

Treatment for epilepsy
The usual treatment for epilepsy is medication, although no one drug is effective for everybody.

It is possible for people with epilepsy to lead relatively normal lives, although some treatments have side-effects such as drowsiness and skin rash.

Most medications for epilepsy are anticonvulsants, which minimise the shaking in some seizures. Effective treatment requires the right dose, drug or combination of drugs for each individual.