Epilepsy Rising Among Elderly Nigerians: Stroke and Neurodegeneration to Blame

Dr. Paul Nwani, a neurologist at the Nnamdi Azikiwe University Teaching Hospital in Nnewi, serves as the president of the Nigerian League Against Epilepsy. During an interview conducted by Sade Oguntola, he addresses the topic of epilepsy—a condition widely misunderstood and heavily stigmatized within Nigeria.

What does epilepsy entail? A common belief is that it has become uncommon; just how accurate is this perception?

Epilepsy is a widespread neurological condition and among the most frequent non-infectious ailments, impacting roughly 70 million individuals globally. This disorder involves a persistent propensity for inducing epileptic seizures in the brain. If unaddressed, the likelihood of these episodes recurring remains significant. Frequent epileptic fits can harm neurons and hinder their functions, particularly during developmental stages where the brain is more vulnerable.

Any disruption in the typical communication among neurons within the brain may trigger a seizure. The manifestations of these seizures vary depending on their location in the brain. They might present as subtle occurrences barely noticeable to others or as intense episodes. Consequently, when someone visits a medical facility expressing concerns about what they experienced, a physician might diagnose a seizure even though the individual contends otherwise due to the absence of observable tremors or bodily spasms. It’s important to understand that not every seizure involves visible shaking or muscle contractions.

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How is epilepsy diagnosed?

A physician will diagnose someone with epilepsy if they experience two or more unprovoked seizures occurring at least 24 hours apart. Nevertheless, under specific conditions, a single seizure coupled with substantial lab findings indicating a significant likelihood of recurrence without intervention may also warrant an epilepsy diagnosis. "Unprovoked" implies that factors unrelated to brain disorders do not precipitate these seizures; for example, fluctuations in blood glucose levels might cause seizures in individuals with diabetes but would not classify them as having epilepsy.

Many believe that epilepsy has become uncommon nowadays, which isn’t accurate. In fact, instances of epilepsy are rising globally. Additionally, this condition appears more frequently in rural regions compared to urban ones. Effective management of seizures among individuals with epilepsy in cities can lead urban residents to underestimate how prevalent the condition remains.

What triggers it? What are the typical reasons for epilepsy in Nigeria?

Epilepsy is a neurological condition characterized by irregularities within the brain leading to unusual electrical impulses. Various health issues or incidents may trigger epilepsy. Additionally, certain circumstances might heighten the chance of acquiring epilepsy, with these varying across distinct age brackets. For young individuals, typical triggers and contributing elements consist of pediatric illnesses such as meningitis and encephalitis, specific viruses contracted during gestation, preterm delivery, birthing injuries, oxygen deprivation at birth, genetic anomalies present from birth, along with familial seizure histories and instances of early-life convulsions.

For young individuals, common triggers for epilepsy include infections such as HIV, head injuries, substance use particularly excessive alcohol consumption, hereditary components, birth defects, and a family background of seizure disorders. Conversely, for elderly populations, significant contributors to epilepsy often involve strokes, brain tumors, degenerative neurological illnesses, and traumatic brain injuries. Nonetheless, there remain instances where the underlying cause or risk factor for epilepsy remains unidentified.

At present, there is a rising incidence of epilepsy among older Nigerians attributed to their extended lifespans along with the growing frequency of strokes and other neurodegenerative conditions associated with aging within the country. Additionally, across Africa and other developing regions, epilepsy is more common partly because of the significant presence of causes and risks such as limited access and availability of treatments for this condition on the continent.

Can individuals outgrow epilepsy?

Certainly, it varies based on the specific kind of epilepsy. Some forms, particularly those classified as idiopathic, show a higher likelihood of spontaneous improvement. For certain epileptic conditions beginning in childhood, symptoms often diminish over time. Nevertheless, the primary worry lies in potential varying extents of neurological harm leading to issues like memory loss, mental health challenges, and difficulties in social interactions—alongside an overall diminished quality of life—if treatment isn’t sought and seizures remain uncontrolled.

Several treatment approaches are available for managing epilepsy with the primary aim being complete cessation of seizures. Antiepileptic medications form a key part of these treatments. Approximately seventy percent of epilepsy instances respond well to suitable drug therapies tailored according to the kind of seizures experienced. Typically, patients who have not had seizures for around two years might consider tapering off their medication under medical supervision; many sustain this state without recurrence although others could experience another onset. However, roughly thirty percent of individuals still struggle with persistent seizures even after trying out prescribed medicines. In certain advanced countries, 'medicinal cannabis' has emerged as a potential remedy for particular forms of epilepsy. Other therapeutic interventions encompass surgical procedures, specialized diets such as the ketogenic regimen, and neurostimulation via the vagus nerve. Surgical intervention becomes necessary when epilepsies arise due to factors like cerebral tumors or stem from identifiable areas within the brain structure. A distinctive eating plan known specifically as the ketogenic diet serves both diagnostic and curative roles in controlling epilepsy through nutritional means.

Why is it incorrect to believe that epilepsy only impacts children?

Epilepsy impacts individuals across all ages. It was once believed that this condition primarily affected children, but this perception is evolving. This misconception arose because statistical studies often highlight higher incidence rates in those under 20 years old. Additionally, many known triggers and reasons for developing epilepsy tend to impact younger populations more frequently. Nonetheless, as global demographics shift towards an older population with rising numbers of senior citizens, new causes associated specifically with advanced age have started becoming apparent. In today’s industrialized countries, we observe dual spikes in epilepsy diagnoses: one within childhood and another amongst seniors. These latter instances are linked increasingly to strokes and their aftermaths, along with various neurological degenerative diseases.

Is it accurate to say that individuals with epilepsy are mentally ill or have intellectual disabilities?

Number 1: Epilepsy is a neurological disorder affecting the brain. Throughout history, individuals with epilepsy have achieved significant accomplishments across various fields. However, it’s important to note that certain people living with epilepsy might experience psychiatric issues either due to their condition or as an adverse reaction to anti-epileptic drugs (AEDs). Conversely, some individuals initially diagnosed with primary mental health and behavioral conditions could later develop symptoms of epilepsy.

Epilepsy is a neurological condition characterized by the occurrence of seizures. Various types of epileptic syndromes combine different forms of seizures along with additional symptoms recognized within medical literature. It’s important to note that having a seizure qualifies one for an epilepsy diagnosis, but experiencing a seizure doesn’t necessarily indicate epilepsy. Instead, such episodes may signal numerous health issues including uncontrolled glucose levels in diabetics, abnormal proteins appearing in the urine among those suffering from long-term renal disorders, as well as conditions affecting the brain like meningitis or encephalitis. These situations do not imply the presence of epilepsy; rather they point towards another underlying acute ailment where the seizure serves merely as a manifestation of said condition.

What difficulties do individuals with epilepsy encounter in Nigeria?

The difficulties encountered by individuals living with epilepsy in Nigeria are significant. Stigma and discrimination, issues prevalent globally among those with epilepsy, persist within the country as well. These negative attitudes permeate every aspect of society, even healthcare settings, leading to the social exclusion of persons living with epilepsy (PLWE). Misconceptions rooted in folklore and religion exacerbate this stigma surrounding the condition. Additionally, people dealing with epilepsy face constant anxiety over unpredictable seizure episodes, adding another layer of complexity. Such fears contribute significantly to their self-imposed expectation of potential mistreatment they might encounter.

The scarcity of antiepileptic medications and their exorbitant prices when they do become available present significant challenges. Additionally, accessing healthcare centers equipped with the necessary staff and resources for proper epilepsy treatment is difficult due to restricted availability. The nation has only a few specialists qualified to handle epilepsy cases effectively. Although several NGOs focus on providing epilepsy care within the country, governmental assistance for individuals affected by epilepsy remains insufficient.

A significant amount falls upon parents and broader society when caring for individuals with epilepsy (PLWE). It’s crucial to comprehend this disorder, dispel numerous misconceptions about the ailment, and recognize that it is a treatable medical issue using conventional medication. During an epileptic episode, patients must be protected from dangerous items; forcibly inserting spoons to avoid tongue-biting should be avoided, as well as administering traditional remedies such as those prepared with cow urine to halt seizures. By the time someone might bite their tongue during a fit, introducing a spoon won’t help anymore. Additionally, substances found in cow urine could decrease blood sugar levels, potentially exacerbating seizures rather than alleviating them. Instead, immediate action should involve seeking professional healthcare at hospitals where evidence-based treatments are provided, steering clear of unverified herbal therapies or faith-healing practices.

Nigerians strongly adhere to their religious beliefs, which we acknowledge. We encourage our patients to continue taking their medication and praying to God. However, they should refrain from consuming any oral treatments at prayer houses or spiritual centers. Some of these substances, such as green water, could potentially exacerbate their conditions.

There is considerable work ahead for the government to enhance the support provided to individuals with epilepsy within the country. This involves ensuring sufficient staffing through training and ongoing education of healthcare providers who treat epilepsy, along with funding research initiatives focused on this condition. Additionally, the establishment of properly outfitted hospitals and clinics capable of caring for patients living with epilepsy must be prioritized. Furthermore, the government needs to guarantee both accessibility and cost-effectiveness of anti-epilepsy medications across all regions.

The government can back the initiative led by the NLAe (Nigerian League Against Epilepsy) and associated groups as they strive to boost public understanding about epilepsy and dispel misconceptions around the condition. These misunderstandings rooted in outdated traditions and religion influence both how individuals affected by epilepsy seek medical help and how society perceives them. Enacting and implementing antidiscrimination measures for those with epilepsy could be an essential step taken at governmental level. In the previous year, the Nigerian League Against Epilepsy released a policy document outlining the league’s stance on various aspects including education, driving rights, and job opportunities for epileptic patients. To enhance patient care and overall well-being, it is crucial to put into law these policies laid out within the document.

How can we stop epilepsy from occurring at the familial, communal, and governmental levels?

The public must be educated about the risk factors and causes of epilepsy, with collaborative initiatives involving families, communities, and governments. Expectant mothers ought to receive proper prenatal care and delivery services. Infections during childhood and parasitic infections such as cysticercosis (a pork tapeworm infection) need to be managed effectively. Additionally, joint endeavors between communities and authorities should aim to prevent substance misuse amongst youth. Furthermore, decreasing and handling stroke-related risks across various stages can mitigate both strokes and subsequent occurrences of epilepsy within senior demographics.

In numerous nations, laws often embody generations of misconceptions regarding epilepsy. Which Nigerian statutes encroach upon the rights of people living with epilepsy (PLWE) and require amendment?

Laws that previously violated the rights of individuals with epilepsy have been abolished in various countries. As far as I know, Nigeria does not currently have legislation denying people with epilepsy access to places like restaurants, theaters, recreation centers, and other public facilities. Additionally, the Nigerian League Against Epilepsy (NLaE) has issued statements emphasizing the necessity of protecting these individuals' rights from infringement.

When it comes to matters of marriage, numerous complexities often arise. In a country such as Nigeria, where familial connections frequently dictate various aspects related to marital affairs, there isn’t a specific statute allowing for the dissolution of a marriage due to epilepsy. Nevertheless, the law mandates mutual agreement for a union to be considered legitimate. Consent holds weight only when it’s fully enlightened; neither spouse should conceal crucial details from one another during the matrimonial process. Legal professionals might contend that withholding information about epilepsy could undermine consent and thus invalidate what would otherwise be deemed a lawful marriage—though final judgment rests solely with courts having appropriate authority. Practically speaking, however, we recommend informing potential partners about one’s health status or facilitating discussions between them and healthcare providers, which approach has proven beneficial in certain cases.

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