By Bernard Muthaka
One of the ways of identifying a witch, wrote a member of a religious group in the 15th century, was by the presence of seizures. Coming from such an authoritative figure, this declaration led to a wave of persecution and torture, which caused the deaths of thousands of people thought to be witches.
The management of epilepsy has for years been hampered by the misunderstanding, fear and stigma associated with the disease, especially due to the seizures that are the common manifestations of the condition.
A study carried out at the KEMRI/Welcome Trust Centre in Kilifi, however, says simple prevention of parasitic infections and proper antenatal care can prevent incidence of epilepsy by between 30 per cent and 60 per cent.
“Many cases of epilepsy could be entirely preventable with elimination of parasites in Africa, some of which - for example, river blindness - have been controlled in some areas,” says Professor Charles Newton, who took part in the study.
He says that facilities for diagnosis, treatment and on-going management of epilepsy are virtually non-existent in most of the African countries, making prevention the best bet for the world’s poorest regions.
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The study, conducted in Kenya, South Africa, Uganda, Tanzania and Ghana, screened 586, 607 residents and identified 1,711 who were diagnosed as having active convulsive epilepsy. The study found that adults who had been exposed to parasitic diseases were 1.5-3 times more likely to have epilepsy than those who had not.
Epilepsy has previously been linked to various parasite infections but this is the first study to reveal the extent of the problem.
Despite being one of the most cost-effective disorders to treat, there are twice as many people living with epilepsy in low-income countries than in rich nations.
Experts say that six out of every ten of those affected in poor countries are not accessing any appropriate treatment.
In the increased global attention to non-communicable diseases, epilepsy is conspicuously absent.
“Epilepsy needs to be brought into the agenda of non-communicable diseases. It was not mentioned in the UN General Assembly Meeting in New York to address the global burden of non-communicable diseases, and yet it represents a substantial burden of ill health,” says Prof Newton.
There have been attempts to advocate for more visibility and resources, including initiatives such as The Kenya Association for the Welfare of People with Epilepsy.
However, the impact of the disease is still not clear, mainly due to little data on epidemiology and extent of the disease. The organisation says that if they can access proper treatment, 70 per cent of people with epilepsy can live seizure-free lives.
Head trauma, complications during childbirth, and parasite infections such as river blindness are among the highest risk factors for epilepsy.
In an interesting observation, the Kilifi study says that both malnutrition and cassava consumption were positively associated with epilepsy in the adults who took part in the study.
Diets in which cassava is a staple are common in poor areas where malnutrition is widespread, and other studies have also reported positive associations between epilepsy and malnutrition, but the study suggests that malnutrition is more likely to be a result of epilepsy than a cause.