Epilepsy: A disease of poverty in Nepal

Chhatra Karki, CNS Correspondent, Nepal
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CNS: citizen-news.org
Epilepsy, a neurological problem, is present globally, but studies indicate that  its presence is highly dense in developing countries. Experts opine that malnutrition is the major cause behind the wide spread of this disease. It is because of the malnutrition which affects inhibitory neurotransmitters and electrolytes that stimulate the brain activities. Senior Neurophysician Dr. Niranjan Acharya from the Department of Medicine, Civil Service Hospital, Kathmandu, Nepal elaborates that epilepsy is a chronic disorder which massively affects the personal, psychological and social dimensions of the patients.

He says, "Epilepsy has emerged as a menace in Nepal. A study shows that 7 out of 1000 persons suffer from it in Nepal."

100 patients of epilepsy visiting neurology OPD or emergency in TUTH, Kathmandu were interviewed on clinical profile, etiological diagnosis and clinical outcomes, during the period 1st Jan 2007 to 10th Jan 2010. TUTH is a big 420 bedded hospital in Nepal. The patients were treated for 2 years under direct observation in epilepsy clinic. The age group of the patients taken in the study was from as young as 1.5years to as old as 69 years. Dr. Acharya who was involved in the study said that 63% of the total population of the study were from very poor community. According to him,"This disease has engulfed the very poor community."

Generalized Tonic Clonic Seizure (GTCs) is a very normal type of epilepsy and psychiatric disorder is very common in epilepsy. The study conducted in TUTH showed that 12% patients had mental problems. According to Dr. Acharya, epilepsy patients are prone to depression because of psychological and neurological causes.

A study done in Europe, America, Asia and Africa shows that the global presence of this disease ranges from 0.5% to 0.9%. Very little is known about epilepsy in Nepal and the government has not released actual statistics about the patients. According to researcher KC Rajbhandari, an estimated 0.7% people in Nepal are affected with this disease. It is common in all age groups and is particularly spread in people of the third world countries. Dr. Acharya says,"In Nepal the disease is more common in villagers than in city dwellers. Social rejection is also associated with this disease."

The epilepsy that affects the nervous system is called neurocysticercosis (NCC) and is common in India, China, Africa, Nepal, Latin America and other countries. According to researchers, S otelo and Del Brutto, "Cysticercosis is parasitic infection which spreads from the eggs of tapeworm." Cysticercosis leads to epilepsy as soon as the infection reaches the central nervous system attacking the brain. If pork is not cooked properly, then the tapeworm in the pork can cause the infection. According to Dr. Acharya, it starts when food containing eggs of tapeworm reaches the stomach. Exposure to gastric acid destroys the protective capsule and larval cysts are formed which are called oncosperes. Oncospheres affects brain, muscle, eye and other organs after reaching the vascular system through intestinal tract. As soon as the cysts reaches the brain, it dismantles immune system and remains in the brain as viable cyst for years. Dr Acharys elaborates,"The first diagnosis of epilepsy is due to active cysts rather than calcified granulomas. Chronic epilepsy is associated with calcified granulomas. Both active cysts and colloidal cysts cause epilepsy."

Within 6-12 months of infection, the germs grow very rapidly. During this period, the patients will have high seizure reoccurence rates. Dr Acharya suggests that this disease can be controlled with immediate medication. Medicines like carbamazepine, phenytoin, sodium valporate, phenobarbitone are administered to the patients. Timely diagnosis and treatment are the controlling measures for this disease.

Chhatra Karki, CNS Correspondent, Nepal
9 April 2015