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How to deal with epilepsy

By Vision Reporter

Added 17th July 2007 03:00 AM

EPILEPSY drugs are out of stock at the National Medical Stores (NMS), a situation the Epilepsy Support Association have called a disaster.
“Some of our clients depend only on drugs and a few are deteriorating into status epilepticus condition,” says the executive director, Augustine Mugarur

By Maureen Nakatudde and Jackie Nake

EPILEPSY drugs are out of stock at the National Medical Stores (NMS), a situation the Epilepsy Support Association have called a disaster.
“Some of our clients depend only on drugs and a few are deteriorating into status epilepticus condition,” says the executive director, Augustine Mugarura.

Status epilepticus is where an epileptic suffers continuous attacks without intervals of consciousness. It can lead to brain damage and death
Dr Ian Rwakaizi, a psychiatric officer at Butabika Hospital, explained epilepsy (ensimbu) as a group of common chronic neurological disorders that are characterised by recurrent unprovoked epileptic seizures.

Epilepsy is usually controlled, not cured, with medication, although surgery may be considered in difficult cases. Some epilepsy syndromes stop after childhood.

Mugarura says their organisation works as a community drug bank. “We buy drugs and send to groups whose members are registered with us,” he says.
“Each member contributes some money, the amount of which depends on where they hail from. People from Mbarara pay around sh2,000 per month.”

Anyone, including epileptics, their caretakers, relatives and friends can become a member. “Ask at your nearby hospital for your local branch,” Mugarura says. Their website is www.epilepsy.org.ug.

Causes of epilepsy
Rwakaizi said epilepsy can: Be genetic; result from any injury to the brain, say from a blow to the head, causing trauma or injury to a baby’s brain during birth, or while it is still in the womb if the pregnant mother gets an infection, does not eat properly, smokes or abuses drugs or alcohol; or during birth.

It can also result from environmental and occupational hazards, exposure to chemicals like lead and carbon monoxide, or due to sustained lack of sleep, stress, or hormonal changes and withdrawal from certain anti-depressant and anti-anxiety drugs.

Diseases like stroke, heart attacks and other conditions that affect the blood supply to the brain can also cause epilepsy. Others like meningitis, cerebral malaria, viral encephalitis, severe lowering of blood glucose levels, malfunctioning of the liver or kidneys, brain tumour and AIDS, are also causes.

How can you avoid it?
Be aware of certain triggers. According to the Medical Encyclopaedia, these include reading too much, hot water on the head, or flickering lights. Others are constipation, menstruation, stress or anxiety, alcohol consumption and physical trauma.
Rwakaizi advises that before anyone gets married, they should take a full historical chronology of the person’s family to check any epilepsy genes.

Other precautions include making sure that women deliver in hospitals and that disease is treated as early as possible.

Treatment
Epilepsy is usually treated with medication prescribed by a health worker. In some cases, a neurosurgical operation or a special diet can be helpful. Reducing the frequency or severity of seizures; or, in some patients, an operation can be curative.

Responding to a seizure
In most cases, the proper emergency response to an attack is simply to prevent the patients from self-injury by moving them away from sharp edges, placing something soft beneath the head and carefully rolling them into the recovery position to avoid suffocation.

Should the person throw up, the material should be allowed to drip out the side of the person’s mouth by itself. If a seizure lasts longer than five minutes, or if the seizures begin coming in ‘waves’ (one after another), then rush the patient to hospital immediately.

During a seizure, objects should never be placed in a person’s mouth as this could result in serious injury to either party.

Despite common talk, it is not possible for a person to swallow their tongue during a seizure.

However, it is more likely the person will bite their tongue, especially if an object is placed in the mouth. When the person is unconscious, never attempt to rouse them. Let the seizure take its full course.

After a seizure, the person may go into a deep sleep or remain disoriented and often unaware that they have just had a seizure. Keep the person under observation until complete recovery. Do not feed them anything until they have returned to normal. The epileptic should not be allowed to wander about unsupervised. Many patients will sleep deeply for a few hours after a seizure, others get headaches which respond to medications.

Please note how long and how severe the seizure was and any mannerisms displayed during the seizure. The doctor will need this information in diagnosing the type of seizure the person gets.

Treatment with drugs
Some medications can be taken daily in order to prevent seizures altogether or reduce the frequency of their occurrence. These are termed “anticonvulsant” or “anti-epileptic” drugs. All such drugs have side effects that have to be managed. Make sure they are given under the supervision of a health worker.

Treatment with surgery
Surgical treatment is required when an underlying brain abnormality, such as a tumour, can be identified. The abnormality must be removable by a neurosurgeon. It is usually only offered to patients whose epilepsy has not been controlled by adequate attempts with multiple medications.

Mbale’s CURE Children’s Hospital, in conjunction with West Virginia, US, developed a comprehensive epilepsy evaluation and treatment centre which introduced the first epilepsy surgery programme for medically intractable epilepsy in East Africa. According to Peter Sagabo, an officer at CURE Hospital, they have performed successful surgeries.

Benjamin Warf, a medical director and chief of surgery at CURE Mbale, was reported on the net saying they are evaluating 400 to 450 patients a year in Mbale’s Epilepsy Monitoring Unit.

Sagabo says the total cost of surgery is around sh2.6m and currently, the procedure is limited to patients between six and 20 years of age.

Other treatment
The Johns Hopkins University recommended Ketogenic diets, which are high in fat and extremely low in carbohydrates, with intake of fluids often limited. It is believed that it increases the acidity which alters the brain metabolism.

Their study reported that 50% of those patients starting the Ketogenic diet reported a decrease in seizures of 50% or more, with 29% of patients reporting a 90% reduction in symptoms.

Other treatment methods include acupuncture, psychological interventions and yoga.

How to deal with epilepsy

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