Let’s not ignore epilepsy condition

A fortnight ago, I came across a 17-year-old teenager who was referred from Kiteto hospital located in Manyara to the hospital I work at in Dodoma.

The doctors that examined her were astounded by her abnormal characteristics and features. For instance, the young girl made noises that resembled powerful hiccups, which she sometimes chocked on. She lost consciousness three to four times for about 30 minutes to four hours at intervals but sometime it could take up to eight hours in a span of 24-hours.

At times during such attack, she jerked her arms vigorously and arched her back to the extent of experiencing strong chest pain and headache. Worse of all, her discomfort could not be relieved by the medication that was given initially that includes antiepileptic medication.

What was the girl really suffering from? Both the patient and us [doctors] had crosses to bear as we strived to assuage the extent of her distress!

A battery of tests was done, which revealed she was a victim of epilepsy.

Despite the fact the tests showed that she had epilepsy, she could not get relief with the antiepileptic medication. But that did not thwart me from finding the treatment for her problem.

Not all seizures are convulsions

Let us talk a bit about epilepsy. Some doctors tag the condition as a seizure disorder.

Medically, epilepsy is a group of neurological disorder characterised by seizures. A person is diagnosed to have epilepsy when they have had two or more seizures. Seizure is a short change in a brain activity.

Epileptic seizures are episodes that can vary from brief to nearly undetectable long periods of vigorous shaking. So it’s said that an epilepsy seizure tend to recur and have no immediate underlying cause.

But mind you, not all seizures are convulsions [a seizure that results in abnormal movements of the limbs or body].

The late Dr Edward Ringo, who was the most renowned Neuropsychiatrist in Northern part of Tanzania with a vast experience in managing epilepsy/seizure disorder, described the condition in three words:

A sudden, abnormal and excessive neuronal discharge that is ‘brief, recurrent, and remitting.’

Dr Ringo insisted that a seizure disorder may present with anything ranging from, sensory to motor actions depending on the affected area, moreover, he used to make a note that it’s not necessary for it to present with convulsions. According to Dr Ringo, a seizure may present itself even with psychosis, and a patient may be confused after the attack.

Many people including health care providers are sometimes accustomed to believing that a person with epilepsy must present with convulsions.

In Swahili someone would call convulsions as degedege and epilepsy as kifafa. It is said that 40 per cent of seizures are non-convulsive type.

So it must be construed that seizure may present in different ways depending on the part of the brain involved and a person’s age. Some seizures can look like staring spells, others can cause a person to fall down, shake and lose consciousness.

Usually a seizure can last a few seconds to a few minutes but it depends on the type of seizure.

What causes epilepsy?

Some of the causes include brain injury, stroke, brain tumour, brain infections, tuberculosis, birth asphyxia, and genetic disorders such as Down’s syndrome or Alzheimer’s disease.

It is said that in 2 out of 3 people, the cause of epilepsy is unknown. Mind you seizures can happen because of other medical conditions such as high fever, low blood glucose in the body, alcohol or drugs withdrawal.

What can you do to manage epilepsy?

• Take your medicine on time

• Recognise your seizure triggers such as flashing or bright lights

• Keep a record of your seizures

• Get enough sleep

• Lower the stress

Challenges and myths

From my own experience of working at the two hospitals in Tanzania with routine epilepsy/psychiatry clinics and spending hours at the outpatient department in various private medical centers in Dar es salaam and Moshi, I can narrate some of the scenarios that I have personally grappled with.

• Many are of the perception that epilepsy must associate itself with convulsions and that’s why you would often hear, “hiki sio kifafa mbona sipati degedege.” Meaning, this is not epilepsy since I do not experience convulsions.

• There are many epilepsy patients being mismanaged since they do not present with convulsions hence they are treated symptomaticatically. Example: Someone with loss of consciousness is kept on oxygen.

• Since epilepsy/seizure disorder is self-limiting such that an individual recovers even without any intervention, relatives do not send such individuals to hospital. For instance, I’ve heard relatives saying, “huyu akipoteza fahamu huwa aazinduka mwenyewe.” Meaning, he actually regains consciousness even without any intervention.

• The patients who do not present with both convulsive and non-convulsive type of seizures are being sent to local healers or witch doctors for treatment either after or before seeking medical opinion.

• Many victims in Tanzania are eager to know prognosis of their condition and when to stop medication but sometimes they do not get genuine answers.

• Many epilepsy victim caretakers use their hands to control convulsions/ abnormal excessive shaking , which is not advised. However, you can give first aid by rolling a person onto their side into the recovery position that helps prevent fluid into getting in their lungs.

The author is a medical doctor based in Dodoma.