Developing countries are seeing rising rates of noncommunicable diseases such as diabetes, cancer and cardiovascular disease. But researchers say those countries already have a disproportionate number of epilepsy cases compared to richer nations.
Researchers say despite epilepsy being “one of the most cost-effective disorders to treat,” developing nations carry a “heavy burden.” Twice as many people with epilepsy live in low- and middle-income countries.
The findings appear in The Lancet
medical journal. The lead author, Oxford University Psychiatry Professor Charles Newton, spends much of his time in Kenya and Tanzania in the Wellcome Trust programs.
“Epilepsy is a condition in which there is an excessive neuronal or electrical discharge within the brain causing the person to develop abnormal movements or impaired consciousness or even in some cases abnormal sensations,” he said.
Epilepsy is an umbrella term for a condition that has many causes and can happen at any age.
“It can be inherited. It can have other genetic causes. It can be cause by infections, birth trauma, head injury and even such things as stroke and brain tumors,” he said.
Newton said that in Africa birth trauma often results from poor obstetrical care. And brain infections can result from such diseases as bacterial meningitis and malaria, among others. The disease also takes many forms.
“You can have people staring blankly into space very frequently during the day," he said. "People having funny sensations, such as hallucinations, or people who fall down completely unconscious, go stiff, and then start convulsing, shaking on the ground, often wetting themselves.”
Those with epilepsy can also have a much higher mortality rate. For example, a person having a seizure may become unconscious and be more vulnerable to falling, fires or work accidents.
Epilepsy is an age-old health problem. The Epilepsy Therapy Project says the Greek physician Hippocrates wrote the first book about it in 400 B.C. He attempted to dispel myths, describing it as a brain disorder. Despite that early insight, those with epilepsy have faced stigma and discrimination. The affliction, at times, has been described as being the result of witchcraft, not only in the past, but the present.
Newtown said stigma and discrimination give people with epilepsy less of a chance of getting an education, a job or even getting married. Their families are also often shunned. He said it doesn’t have to be that way.
“Epilepsy is controllable with relatively inexpensive drugs. So [for] between five and ten U.S. dollars a year one could control seizures or reduce the seizures in about 70 percent of the people with epilepsy,” he said.
The most common drug used to treat epilepsy in Africa in phenobarbital. It does have side effects, though, such as hyperactivity and skin rashes in children and drowsiness in adults. Newer drugs have been developed in recent years.
“The problem is that they’re all very expensive and they’re not really accessible to people living in poor areas. So I think that our emphasis in poor areas is trying to get access to the drugs which are well established and that are relatively inexpensive, and that we know what their side effects are,” he said.
But Newton and his colleagues said, besides making medicine more available, more should be done to educate and prevent epilepsy.
“The first thing,” he said, “is to sensitize communities in order to recognize that people who have epilepsy often don’t know that they have epilepsy - and if they do know that they have epilepsy, don’t know that it can actually be controlled by medical treatment.”
Newton said that if obstetric care were improved, if brain infections could be avoided through better sanitation and other efforts, if greater protection was used to avoid head trauma, up to 50 percent of epilepsy cases in parts of Africa could be prevented. He called on the United Nations to include epilepsy on its list of non-communicable diseases that demand more attention.
The World Health Organization reports that epilepsy "is the most common serious brain disorder worldwide with no age, racial, social class, national nor geographic boundaries." The WHO says, "There are over 50 million sufferers in the world today, 85 percent of whom live in developing countries." There are nearly two and a half million new cases each year.