In India, every year November 17 is observed as the National Epilepsy Day to create awareness about epilepsy. Epilepsy is a chronic disorder of the brain characterized by recurrent ‘seizures’ or ‘fits’. The seizures are caused as a result of sudden, excessive electrical discharges in the neurons (brain cells). The etiology of the disease traces back to brain damage from prenatal or perinatal injury, congenital abnormalities, brain infections, stroke and brain tumors, head injury, and prolonged high fever during childhood. The condition can affect people at any age and each age group has unique concerns and problems. It is considered a universal global neurological problem as according to the WHO estimates, 50 million people worldwide are living with epilepsy. Further, it is estimated that 10-12 million of this population are living in India, contributing to almost one-sixth of the disease load.
The prevalence estimates in India range from 3.0 to 11.9/1000 population (Gourie-Devi M.,2014). There is the heterogeneity of distribution of epilepsy cases depending on socioeconomic and geographical variations, with higher occurrence in males, rural areas, and lower socioeconomic status. In many developing countries like India, people with epilepsy do not receive appropriate treatment for their condition. This is due to various factors such as lack of access to or knowledge of anti-epileptic drugs, poverty, cultural beliefs, stigma, poor health delivery infrastructure, and shortage of trained professionals. Due to the superstitions and cultural beliefs, people with epilepsy (PWE) seek treatment from traditional healers rather than trained medical practitioners. The associated disability and psychosocial impact caused by epilepsy can be immense and impose a huge burden on the individual, family, and society. The condition of epilepsy can have an adverse effect on education, employment, marriage, and other essential social opportunities. The economic burden associated with epilepsy is also very high due to various treatment and travel costs. Despite the improvement in various medical and educational parameters of the disease, there is no significant change in the perception, stigma, and discrimination of epilepsy across the country. The huge treatment gap and poor quality of life are further worsened by the associated comorbidities and conditions including anxiety, depression, behavior problems, and cognitive dysfunction.
The treatment of epilepsy typically focuses on anticonvulsant medications, surgical interventions, and device implantations. However, to improve psychological well-being, according to WHO, psychological treatments such as relaxation therapy, treatments based on cognitive-behavioral therapy (CBT) principles, psychoeducational programs, and family counselling are being considered. Anecdotal reports have shown that such treatments can alleviate anxiety, depression, behavior problems along with reducing the seizure frequency. Epileptic seizures can be precipitated by internal psychological triggers such as stress, anxiety, anger, or mental tasks/thoughts; and thus, awareness of stimuli that precipitate the seizures can play a crucial role. Cognitive-behavioral therapy (CBT) can foster an increased sense of self-control over seizure occurrence by assessment of psychological stressors. Mindfulness and Arousal-based approaches can facilitate improved seizure anticipation and better stress management, with acceptance serving as a coping mechanism for seizure-related symptoms. Yoga and meditation can induce relaxation and diminish stress, along with long-term benefits of a decrease in seizure frequency. Psychoeducational interventions with children with epilepsy and their parents and also adults can lead to improved self-efficacy, changes in knowledge about seizures, and changes in the patient and parent’s behavior. Such programs can also ensure better adjustment and reduced stigma.
A multidisciplinary response is needed to address the burden and impact of epilepsy which calls for an integrated and multipronged approach for epilepsy care, prevention, and rehabilitation. A significant number of cases in India can be prevented through effective immunization, perinatal care, and improved food hygiene. There is also a need to organize services according to the public health approach model by capacity-building and using existing healthcare facilities. Psychosocial and vocational rehabilitation can also help fulfill important needs of the PWE by providing educational and employment opportunities in a non-stigmatizing environment.
- Garg, D. (2020). Specific considerations for epilepsy in India. Current Medical Issues, 18(2), 105. Retrieved from: https://www.cmijournal.org/article.asp?issn=0973-4651;year=2020;volume=18;issue=2;spage=105;epage=110;aulast=Garg
- Gururaj, G., Satishchandra, P., & Amudhan, S. (2015). Epilepsy in India II: Impact, burden, and need for a multisectoral public health response. Annals of Indian Academy of Neurology, 0(0), 0. Retrieved from: https://www.annalsofian.org/article.asp?issn=0972-2327;year=2015;volume=18;issue=4;spage=369;epage=381;aulast=Amudhan
- Leeman-Markowski, B. A., & Schachter, S. C. (2017). Cognitive and Behavioral Interventions in Epilepsy. Current Neurology and Neuroscience Reports, 17(5). Retrieved from: https://link.springer.com/article/10.1007/s11910-017-0752-z
- Psychological interventions in adults and children with epilepsy. (2015, October 08). Retrieved November 17, 2020. Retrieved from: https://www.who.int/mental_health/mhgap/evidence/epilepsy/q10/en/