What is Epilepsy?

Epilepsy - Key Facts

Key Facts

  • Epilepsy is a chronic non-communicable disease of the brain that affects people of all ages.
  • Around 50 million people worldwide have epilepsy, making it one of the most common neurological diseases globally according to the World Health Organisation.
  • It is estimated that 1% of the population in the Republic of Mauritius have epilepsy while 70% of people living with epilepsy could live seizure- free if properly diagnosed and treated.
  • The risk of premature death in people with epilepsy is up to three times higher than for the general population.
  • People with epilepsy and their families suffer from stigma and discrimination.

Epilepsy is a chronic non-communicable disease of the brain that affects around 15,000 people in the Republic of Mauritius. It is characterized by recurrent seizures, which are brief episodes of involuntary movement that may involve a part of the body (partial) or the entire body (generalized) and are sometimes accompanied by loss of consciousness and control of bowel or bladder function.

Seizure episodes are a result of excessive electrical discharges in a group of brain cells. Different parts of the brain can be the site of such discharges. Seizures can vary from the briefest lapses of attention or muscle jerks to severe and prolonged convulsions. Seizures can also vary in frequency, from less than 1 per year to several per day.

One seizure does not signify epilepsy (up to 10% of people worldwide have one seizure during their lifetime). Epilepsy is defined as having two or more unprovoked seizures. Epilepsy is one of the world’s oldest recognized conditions, with written records dating back to 4000 BC. Fear, misunderstanding, discrimination and social stigma have surrounded epilepsy for centuries. This stigma continues in many countries today and can impact on the quality of life for people with the disease and their families. Epilepsy is estimated at 1% in the Republic of Mauritius.

Signs and Symptoms

Characteristics of seizures vary and depend on where in the brain the disturbance first starts, and how far it spreads. Temporary symptoms occur, such as loss of awareness or consciousness, and disturbances of movement, sensation (including vision, hearing and taste), mood, or other cognitive functions.

People with epilepsy tend to have more physical problems (such as fractures andbruising from injuries related to seizures), as well as higher rates of psychological conditions, including anxiety and depression. Similarly, the risk of premature death in people with epilepsy is up to three times higher than in the general population.

A great proportion of the causes of death related to epilepsy are potentially preventable, such as falls, drowning, burns and prolonged seizures.

Rates of Disease Worldwide

Epilepsy accounts for a significant proportion of the world’s disease burden, affecting around 50 million people worldwide. The estimated proportion of the general population with active epilepsy (i.e. continuing seizures or with the need for treatment) at a given time is between 4 and 10 per 1000 people.

Globally, an estimated five million people are diagnosed with epilepsy each year. In high-income countries, there are estimated to be 49 per 100 000 people diagnosed with epilepsy each year. In low- and middle-income countries, this figure can be as high as 139 per 100 000. This is likely due to the increased risk of endemic conditions such as malaria or neurocysticercosis; the higher incidence of road traffic injuries; birth-related injuries; and variations in medical infrastructure, the availability of preventive health programmes and accessible care. Close to 80% of people with epilepsy live in low- and middle-income countries.

Causes

Epilepsy is not contagious. Although many underlying disease mechanisms can lead toepilepsy, the cause of the disease is still unknown in about 50% of cases globally. The causes of epilepsy are divided into the following categories: structural, genetic, infectious, metabolic, immune and unknown. Examples include:

  • brain damage from prenatal or perinatal causes (e.g. a loss of oxygen or trauma during birth, low birth weight);
  • congenital abnormalities or genetic conditions with associated brain malformations;
  • a severe head injury;
  • a stroke that restricts the amount of oxygen to the brain;
  • an infection of the brain such as meningitis, encephalitis or neurocysticercosis;
  • certain genetic syndromes; and
  • a brain tumour.

Treatment

Seizures can be controlled. Up to 70% of people living with epilepsy could become seizure free with appropriate use of anti-seizure medicines. Treatment is available, with daily medication provided for free by the public health care services in the Republic of Mauritius. Discontinuing anti-seizure medicine can be considered after 2 years without seizures and should take into account relevant clinical, social and personal factors. A documented etiology of the seizure and an abnormal electroencephalography (EEG)pattern are the two most consistent predictors of seizure recurrence.

Prevention

An estimated 25% of epilepsy cases are preventable.

  • Preventing head injury is the most effective way to prevent post-traumatic epilepsy.
  • Adequate perinatal care can reduce new cases of epilepsy caused by birth injury.
  • The use of drugs and other methods to lower the body temperature of a feverish child can reduce the chance of febrile seizures.
  • The prevention of epilepsy associated with stroke is focused on cardiovascular risk factor reduction, e.g. measures to prevent or control high blood pressure, diabetes and obesity, and the avoidance of tobacco and excessive alcohol use.
  • Central nervous system infections are common causes of epilepsy in tropical areas, where many low- and middle-income countries are concentrated. Elimination of parasites in these environments and education on how to avoid infections can be effective ways to reduce epilepsy.