The Prevalence of Epilepsy among Himalayans

Introduction

Epilepsy is best described as a combination of neurological disorders that a person suffering from the illness maintains over a significant period of time. The most distinguishing characteristic of epilepsy is the occurrence of seizures. It is not particularly known why epileptics suffer from seizures of these kinds. Some people appear to develop epileptic seizures for no apparent reason, and still other people will develop the symptoms of epilepsy after experiencing a brain injury, brain tumors, or the abuse of drugs and alcohol. The physiological cause of epilepsy is an excess of cortical nerve activity in the human brain (Shorvon, 2011). There is no known cure for epilepsy, although epileptic seizures can be controlled through medicine, surgery, dietary habits, or the process of neuro-stimulation. Anti-seizure medication is the preferred form of treatment in over two-thirds of epilepsy cases. Some cases of epilepsy are temporary in nature, and the patient will eventually make a full recovery. Approximately one percent of human beings on a global basis suffer from epilepsy, with the great majority of cases (approximately four out of five) occurring in the lesser developed nations (Holmes&. Browne, 2008). This data indicates a relationship between the likelihood of an individual’s development of epilepsy, and the health and environmental conditions found in poor countries.

Diagnosis

A diagnosis of epilepsy is usually not given until the first seizure occurs, and the event of a second seizure is used to confirm the diagnosis. The primary tools utilized by healthcare professionals during the course of diagnosis are neuroimaging and the electroencephalogram. An epileptic seizure must have no other identifiable cause in order to qualify for the diagnosis. Seizures may either be localized within the brain or distributed. The latter kind of epileptic seizures may be classified as grand mal, petit mal, tonic, clonic, myoclonic, or atonic. A localized seizure may be characterized as either simple or complex (NIHCH, 2012). An epileptic may also experience seizures of multiple varieties.

An important distinction must also be made between epileptic seizures of a focal nature and those of a more generalized variety. Focal seizures are only partial in nature, and the patient often does not lose consciousness. At the most basic level, focal seizures may affect both the motor functioning and the sensory perception of the epileptic. There may also be autonomic or physic symptoms. A more serious form of focal seizure affects the temporal lobe, and the patient may lose consciousness in this instance. A focal seizure of the most serious or complex kind may lead to a generalized seizure. These kinds of seizures are more threatening to the patient’s well-being, and normally accompany the loss of consciousness. The victim of generalized seizures will experience observable muscle twitching. A myoclonic seizure is evident if the muscle twitching becomes more severe. A clonic seizure involves more intense symptoms, and tonic-clonic seizures are even more serious. These kinds of seizures will include the patient biting their tongue, urinating or defecating on themselves, and respiratory arrest also becomes a danger. With an atonic seizure, a person will lose all muscle control and collapse in a way that resembles fainting (Gastaut, 1970). Epileptic seizures clearly have a debilitating effect on the patient.

A variety of tests may be utilized when seizures occur that may assist with the diagnostic process. The levels of calcium, glucose, and electrolyte possessed by a patient may be tested in order to determine the role of these in the incidence of seizures. Electrocardiograms and lumbar punctures may be utilized to diagnose the contribution of heart rhythm or a disorder of the central nervous system to the occurrence of a seizure. Urinalysis and blood analysis may also be used to determine the role of metabolic disorders in the experience of a seizure by the patient. A high blood prolactin level in the moments eventually following a seizure may be identified as symptomatic of an epileptic rather than non-epileptic seizure (Engel, 2008). The risk factor involving the possibility of seizures varies among patients.

The EEG may be used to monitor brain activity and provide an indication of the degree to which the patient is at risk for seizures. An EEG may also help to diagnose the type of seizure that is occurring in the patient. However, the EEG may also result in a false-positive diagnosis of an epileptic seizure, and is especially ineffective as a diagnostic tool when used to diagnose children. The use of an MRI or CT scan is now widely considered to be more effective than an EEG in many instances, particularly in cases involved cerebral bleeding (Bradley, 2012). For this reason, MRI and CT testing have become more commonly used.

Epilepsy among Himalayans: Initial Findings and Impressions

An examination of patients for various neurological disorders in the Himalayan region of India, notorious for its high altitudes, was able to effectively chart the frequency and variety of disorders of these kinds. The primary methodology utilized was the EEG. The neurological disorders tested for were epilepsy and migraine headaches. Of the population sample that was examined, there were two hundred and thirty-two females and one hundred and twenty-six males. Of the age ranges of the females, one was younger than two years of age, six were between the ages of two and nine, twenty-five between ten and nineteen, thirty-two between twenty and twenty-nine, sixty-seven between thirty and thirty-nine, forty-four between forty and forty-nine, twenty-four between fifty and fifty-nine, twenty-four between sixty and sixty-nine, seven between seventy and seventy-nine, one between eighty and eighty-nine, and one between ninety and ninety-nine.

Of the age ranges of the males in the sample, three were younger than two years of age, eighteen were between ages two and nine, twenty between ten and nineteen, fourteen between twenty and twenty-nine, thirteen between thirty and thirty-nine, thirteen between forty and forty-nine, twenty-two between fifty and fifty-nine, nineteen between sixty and sixty-nine, fifteen between seventy and seventy-nine, two between eighty and eighty-nine, and zero between ninety and ninety-nine.

Forty females and forty-two males were shown to have epilepsy. Of the age ranges for females with epilepsy, one was between two and nine years of age, nine between ten and nineteen years of age, ten between twenty and twenty-nine years of age, eleven between thirty and thirty-nine, six between forty and forty-nine, two between fifty and fifty-nine, zero between sixty and sixty-nine, one between seventy and seventy-nine, and zero above the age of seventy-nine. Of the age ranges for males diagnosed with epilepsy, one was less than two years of age, seven between the ages of two and nine, nine between ten and nineteen, eight between twenty and twenty-nine, seven between thirty and thirty-nine, three between forty and forty-nine, five between fifty and fifty-nine, one between sixty-and sixty-nine, one between seventy and seventy-nine, and zero above the age of eighty.

As for incidents of migraine headaches, one hundred and twenty females and twenty-four males exhibited symptoms of these kinds. Among females, none were below the age of ten. Nine were between the ages of ten and nineteen, sixteen between twenty and twenty-nine, forty-four between thirty and thirty-nine, twenty-seven between forty and forty-nine, fourteen between fifty and fifty-nine, ten between sixty and sixty-nine, and zero over the age of sixty-nine. Among males diagnosed with migraine headaches, zero were less than two years of age. One was between the ages of two and nine, six between ten and nineteen, three between twenty and twenty-nine, two between thirty and thirty-nine, four between forty and forty-nine, five between fifty and fifty-nine, one between sixty and sixty-nine, one between seventy and seventy-nine, and one between eighty and eighty-nine.

There were both seventy-two females and seventy-two males who tested normal. Among females, only one was younger than two years of age. Five were between the ages of two and nine, seven between ten and nineteen, six between twenty and twenty-nine, twelve between thirty and thirty-nine, eleven between forty and forty-nine, eight between fifty and fifty-nine, fourteen between sixty and sixty-nine, six between seventy and seventy-nine, one between eighty and eighty-nine, and one between ninety and ninety-nine. Of the males who tested normal, two were less than two years of age, ten were between the ages of two and nine, five between ten and nineteen, three between twenty and twenty-nine, four between thirty and thirty-nine, six between forty and forty-nine, eleven between fifty and fifty-nine, seventeen between sixty and sixty-nine, thirteen between seventy and seventy-nine, one between eighty and eighty-nine, and zero over the age of ninety.

Additionally, the study identified sixty-five persons with a propensity towards the development of epilepsy based on their EEG analysis. Twenty-seven of these were female and thirty-eight were male. Of the females, one was less than two years of age, three were between ages two and nine, seven between ten and nineteen, eight between twenty and twenty-nine, two between thirty and thirty-nine, five between forty and forty-nine, one between fifty and fifty-nine, and zero above the age of fifty-nine. Of the males, one was below the age of two years, nine between ages two and nine, nine between ten and nineteen, five between twenty and twenty-nine, six between thirty and thirty-nine, four between forty and forty-nine, two between fifty and fifty-nine, one between sixty and sixty-nine, and one between seventy and seventy-nine.

As for the types of epilepsy found in the study, approximately fifty percent of the epileptics examined displayed symptoms of generalized epilepsy. The milder forms of generalized seizures, clonic and myoclonic, were the most common. The reported symptoms of these epileptics were highly varied in nature, and the majority of epileptics experiencing generalized seizures had developed the disorder during childhood or adolescence. The overall exposure they had previously had to treatment, and their responsiveness to treatment was also highly varied. Focal seizures experienced by the patients included left frontal lobe seizures, temporal lobe seizures, syncope, and benign rolandic seizures. At least three patients reported absence seizures.

Among non-epileptic patients with other abnormalities, Parkinson’s disease was among the most common. Other difficulties found among these patients included vertigo, pyramidal tract dysfunction, cervical radiculopathy, ganglia disorder, pinched nerves, Down’s Syndrome, prenatal brain injury, stroke, brain disorders resulting from venereal disease infections, cerebral palsy, edema, psychosomatic pain, post-meningitis, migraines, lower back pains, generalized anxiety disorders, paranoia, dementia, mitral valve disease, tension headache, hearing loss, streptomycin, paresthesia, progressive anterior horn cell disease, akinetic rigid syndrome, nerve palsy, and trigeminal neuralgia.

Given the rather large size of the sample, it may be concluded that a relatively even division exists between epileptics who experience focal seizures and those who experience generalized seizures. Among those who experience generalized seizures, the majority have a propensity towards the least serious forms of seizures. Only a minority of epileptics are inclined to experience the most severe forms of seizures. The data also indicates that when seizures do occur, anti-seizure medication is the most effective form of treatment. The evidence also shows that the earlier in life a person develops epilepsy, the more serious their symptoms, including seizures, will be in the future. As for those non-epileptic patients exhibiting neurological abnormalities, the information pertaining to their birth, medical, and socioeconomic histories indicate the severely adverse effect of lack of regular access to adequate healthcare. Many of the symptoms and disorders exhibited by these patients were traceable to a lack of preventive medicine, lack of prenatal care, lack of access to crucial medications, lack of education in self-care, and lack of early diagnosis of health problems. This, in turn, provides powerful evidence concerning the relationships between socioeconomic and environmental factors, and health maintenance.

Socioeconomic, Occupational, and Altitude Factors

Those diagnosed with epilepsy or a propensity for the development of epilepsy varied widely in terms of their socioeconomic or occupational status, as well as their altitude location. Regarding socio-economic factors, five were classified as poor. Four were lower class. Nine were lower middle class. Fifty were middle class while only three were considered high class or upper class. As for occupational factors, twenty-five were students, and students were the largest occupational group represented. Other occupational groups with significant representation were housewives, skilled workers, teachers, farmers, and the unemployed. Professionals and the highly educated were the least well-represented. Regarding altitude factors, only four were at altitudes higher than four thousand meters. Forty were above three thousand meters. Twenty-eight were above two thousand meters. The birth histories of the overwhelming majority of these patients were either “normal” or unable to be determined. Epilepsy was the most frequently diagnosed disorder among the patients, although other patients experienced a seizure, migraines, or other difficulties not related to epilepsy.

As for patients with a specific diagnosis of epilepsy, six were classified as poor. Four were lower class. Ten were lower middle class. Fifty were middle class. Only three were upper class or high class. Once again, the most prevalent occupations were those of students, teachers, housewives, farmers, and skilled workers, with a much smaller sample of professionals. As with the patients suffering from neurological disorders generally, most of these epilepsy patients originated from altitudes ranging between two and four thousand meters, with those from altitudes higher than four thousand meters being much rarer. Seizures were the most commonly reported symptoms.

The general observations that can be drawn from this data indicate that there is a great overrepresentation of the middle classes among the patients with identifiable symptoms of epilepsy or neurological disorders generally. There is no known medical or environmental explanation for this. Instead, it is far more probable that the middle classes are overrepresented due to the relative availability of healthcare and medical treatment. The poor and lower classes are most likely underrepresented in this statistical data due to their lack of access to healthcare. Their symptoms are not reported because they have never received treatment. This is also a strong indication that epilepsy and neurological disorders are to a great degree caused by environmental factors.

The powerful bit of evidence for this hypothesis presented by the data is a very strong under-representation of the upper classes. Apparently, those from the wealthy and affluent classes are far less likely to develop such difficulties. It is not possible to determine from the data what the causes of this differential may be precisely, but intuition would dictate that such environmental and social factors as lack of access to healthcare, preventative medicine, prenatal care, a healthy diet, sanitary living conditions, etc. are powerful contributing factors to the development of neurological disorder, including epilepsy. Likewise, the under-representation of the lower classes indicates there likely are a far greater number of these disorders occurring in the Himalayan regions than what the statistics are able to account for. The under-representation of people from the higher altitudes may also indicate a lack of access to healthcare by people in the more remote areas of the Himalayan region.

Notes on Methodology and Treatment

The patients were drawn from those who already held appointments to be seen by a physician or clinician at a half-day clinic. The patients were primarily interviewed in a clinic with the use of a translator. A chart had already been made for each patient with the demographic information and medical history of the patient being included in the chart. The medications being consumed by the patient, previous positive examination findings, and previous test results were also included on the patient’s chart. The impressions of the medical professional examining the patient, and the patient’s short term and long term treatment plans were also included on the chart. Medications were provided to patients requiring treatment at the site of the examination. These medications were provided from either stock supplies or acquired from local pharmacies. The EEGs were done at the same location and on the same day. Some EEGs were occasionally done at the local hospital. Some of the patients were also given follow up examinations within days after their original examinations.

Conclusion: Treatment and Management of Epilepsy

A danger concerning the treatment of epilepsy is the high potential for misdiagnosis. It has been estimated that an actual misdiagnosis occurs somewhere between five to thirty percent of cases of purported epilepsy. This rather wide margin of error would indicate that the diagnostic methodology is still very imprecise. Many kinds of neurological symptoms are often falsely attributed to epilepsy or the possibility of such. Some of the more frequent symptoms of this kind include non-epileptic seizures (sometimes called “psychogenic” seizures), migraine headaches of the kind previously discussed, narcolepsy, panic attacks, hyperventilation, and syncope. For example, only twenty percent of sufferers of psychogenic seizures are actual epileptics. Indeed, many routine childhood difficulties are often mistaken even by medical professionals as evidence of epilepsy. Problematic symptoms of this kind may include excessive shuddering, muscle spasms, nightmares and bad dreams, excessive bedwetting, even periods of prolonged breath-holding (Sheila & Farrell, 2004). None of these factors indicate the presence of epilepsy in and of themselves.

It is not particularly well-known to the medical profession as to how to best prevent the onset of epilepsy. The only known preventable causes of epilepsy are head injuries (Shorvon, Perucca & Engel, 2009). Therefore, medical professionals should advise patients to avoid excessively risky and dangerous activities and to always utilize safety devices, such as safety helmets for bicycle and motorcycle riding, or skateboarding. There is also evidence that the prevalence of pork tapeworms is a contributing factor to epilepsy, and efforts to reduce incidents of such parasites have been accompanied by a parallel reduction in epilepsy.

Epileptic individuals can often suffer from difficulties that sometimes require the administering of emergency first aid. A person suffering from an epileptic seizure may be at risk for asphyxiation due to the swallowing of the tongue, or the accumulation of excessive fluids in the lungs. Someone who encounters a person suffering from an epileptic seizure should seek medical treatment for that person immediately. Epilepsy can be treated with a wide variety of medications included diazepam and Phenobarbital (Saraceno, Avanzini & Lee, 2005). However, these are habit-forming and may lead to chemical dependency. In the west, alternative treatment methods for seizures include CBD oil, among others. At times, certain forms of neurosurgery can help towards the reduction of the occurrence of seizures (Wheless, Willmore & Brumback, 2009). A low fat, high protein, and low carbohydrate diet has been shown to reduce the occurrence of seizures by as much as one third (Wyllie, 2012). Epileptics are sometimes able to manage their condition simply by maintaining a healthy lifestyle.

References

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Sheila, J. & Farrell, K. (2004). Epilepsy in children (2nd ed.). London: Arnold.

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Wyllie, W. (2012). Wyllie's treatment of epilepsy: Principles and practice. Lippincott, Williams & Wilkins.