Greater than 12 million individuals in India undergo from epilepsy and a big quantity don’t obtain remedy. November 17 is noticed as Nationwide Epilepsy Day to lift consciousness and dispel myths across the situation.
Excerpts from the interview with Dr. Anirban Deep Banerjee, Affiliate Director – Neurosurgery, Institute of Neurosciences, Medanta, Gurugram.
Q: What’s the illness burden of epilepsy in India?
A: In India, epilepsy carries a big illness burden. With a conservative estimate of 1% as prevalence of epilepsy, there are greater than 12 million individuals with epilepsy (PWE) in India, which contributes to just about one-sixth of the worldwide burden. This excessive prevalence contributes to substantial healthcare prices, lack of productiveness, and impacts on the general high quality of life for these affected.
Q: What’s multifocal epilepsy?
A: Multifocal epilepsy refers to a sort of epilepsy the place seizures originate from a number of areas within the mind. It may be tougher to deal with because the seizures come up from totally different mind components concurrently or at totally different instances.
Q: Who’s most liable to be affected?
A: Epilepsy can have an effect on people of any age, however sure teams are extra susceptible. Youngsters and older adults are extra vulnerable, with epilepsy typically creating in childhood or after the age of 60. Moreover, these with a household historical past of epilepsy, mind accidents, infections, or developmental problems like autism spectrum dysfunction are at a better danger.
Q: Is there a gender differential?
A: Some sorts of epilepsy could have a slight male predominance, whereas others don’t present a big gender bias.
Q: How epilepsy impacts a affected person?
A: Epilepsy disrupts the conventional functioning of the mind, inflicting recurrent seizures. These seizures are like electrical storms within the mind, resulting in sudden, short-term modifications in behaviour, consciousness, or actions. This can lead to varied signs, corresponding to convulsions, staring spells, short-term confusion, lack of consciousness, and strange sensations or feelings.
Q: What are the obtainable remedy choices?
A: Remedy for epilepsy sometimes entails medicines to regulate seizures. Anti-epileptic medication (AEDs) are generally prescribed and may successfully cut back or eradicate seizures in lots of sufferers. For these whose seizures don’t reply to medicines, different choices like ketogenic food plan, surgical procedure, or nerve stimulation therapies is perhaps thought of.
Q: How has Deep Mind Stimulation (DBS) revolutionised affected person care?
A: DBS has revolutionised look after these with drug-resistant epilepsy, particularly these with seizures originating from a number of mind areas. It entails implanting electrodes into particular areas of the mind and delivering electrical impulses to control irregular mind exercise, thereby lowering the frequency and severity of seizures.
DBS for epilepsy offers a significant therapeutic possibility when medicines are not efficient and respective surgical procedure is just not prone to be useful. This contains of a giant cohort of considerably distressed sufferers. The anterior nucleus of thalamus, a small area deep contained in the mind, has been recognized after years of analysis to be an influential mediator of seizure propagation, whereby an epileptic exercise initiated in a particular targeted space (focal seizure) spreads to bigger areas of the mind.
Neuromodulation of this vital nodal level by the use of DBS (‘gating-mechanism’), corroborated by the SANTE (Stimulation of the Anterior Nucleus of the Thalamus in Epilepsy) trial, confirmed lasting advantages when it comes to lowered seizure frequency and sustainable enhancements in high quality of life. These outcomes led the suitable statutory our bodies worldwide to approve this remedy for adults affected by medically refractory focal epilepsy (with or with out secondary generalisation).
Q: Are there any particular choice standards to manage DBS?
A: The next are the choice standards:
1. A minimum of 18 years of age.
2. Identified with epilepsy characterised by partial-onset seizures, with/with out secondary generalisation.
3. Refractory to anti-epileptic medicines that’s, failure of sufficient seizure management regardless of acceptable dosage of not less than three anti-epileptic medicines, in mono-or polytherapy.
4. Common of over six seizures per thirty days for final three months (with not more than 30 days in between two consecutive seizure episodes).
As an example, a DBS surgical procedure carried out by me on a younger male affected person in his fourth decade of life in July this yr. He got here with a criticism of intractable seizures for many years. His high quality of life was severely compromised. Following a radical clinico-radiological analysis, the affected person was deemed a superb candidate for DBS, whereby he underwent brain-pacemaker surgical procedure of bilateral anterior nucleus of the thalamus. He tolerated the surgical procedure effectively. In his current follow-up, appreciable discount in episodes of main seizures was famous. Resultantly, the affected person’s high quality of life has improved.
Q: What different new/revolutionary remedy choices can be found?
A: Revolutionary remedies embody responsive neurostimulation gadgets that detect seizure exercise and ship focused stimulation to forestall seizures. Moreover, analysis into new medicines, genetic therapies, and non-invasive mind stimulation methods like transcranial magnetic stimulation (TMS) reveals promise in managing epilepsy.
Q: Can epilepsy be deadly?
A: Whereas most seizures should not life-threatening, sure sorts of seizures or problems might be deadly. As an example, extended seizures (standing epilepticus) or sudden surprising loss of life in epilepsy (SUDEP) might be life-threatening, though SUDEP is uncommon.
Q: What situations – genetics or in any other case – influence epilepsy?
A: Genetics performs a task in some types of epilepsy. Sure genetic mutations or variations could make a person extra vulnerable to seizures. Moreover, mind accidents from trauma, infections, strokes, mind tumours, and developmental problems may also contribute to the event of epilepsy.
Q: What are the position of caregivers particularly given the taboos and stigma hooked up to epilepsy?
A: Caregivers play an important position in supporting people with epilepsy. They supply emotional help, help in remedy adherence, assist throughout seizures, and advocate for his or her family members in navigating societal challenges, together with stigma and misconceptions related to epilepsy. Educating the group about epilepsy helps cut back stigma and fosters a extra supportive atmosphere for these affected.
