Nirmal Surya

According to WHO, Epilepsy affects an estimated 50 million people worldwide, which is a major health concern for all the countries. Developing countries have a higher prevalence of Epilepsy due to malnutrition, traumatic events, obstetric complications, drug abuse and infections. The life time prevalence rate for epilepsy in developing countries varies from 1.5 – 14 per 1000 in Asia. to 5.1 – 57.0 per 1000 in Latin America and 5.2 – 74.4 per 1000 in sub Sahara Africa. In India the prevalence studies of Epilepsy suggests that there are approximately 20-25 million people. In India and majority of the developing countries there is a wide treatment gap, which increases in the rural population.

With an increased in prevalence and an increase in the treatment gap the disability associated with Epilepsy is not discussed in literature.  Approximately 30%  patients with epilepsy have significant neurological co-morbidity (ID, CP, Autism, ADHD, Stroke, Head injury and Encephalitis. In developing world epilepsy is associated with many disabilities particularly in children, in Children with Epilepsy 30 – 40% have ID and 7 – 42% with autism. In population based study 38% of children with CP has epilepsy. ADHD, ASD are more common with epilepsy.

The more serious the neurological co-morbidity, higher the incidence of epilepsy, each disability needs to be addressed separately besides the disability related to epilepsy itself. There is paralysis seen due to hypoxic brain injuries causing secondary epilepsy. Trauma and burns due to seizure related activities also contribute to   the stigma and misconceptions. In some patients, social stigma can pose a greater challenge than the epilepsy itself. People with epilepsy have an increased risk of poor self-esteem, depression, and suicide.

 A multi disciplinary team approach for a proper management of an epilepsy patient should be done as epilepsy is more then just a seizure and PWE  suffer from motor dysfunction or speech disturbance due to structural lesion, Neurodisability with epilepsy could lead to cognitive and learning disability therefore a MDT consisting of physiotherapist, occupational therapist, speech and language therapist, neuropsychologist are needed to deal appropriately . Lastly many Antiepileptic drugs themselves can cause cognitive and behavioral disturbances and one need to identify at earliest and treat accordingly.