Epilepsy

Epilepsy is a chronic neurological disorder characterised by recurrent, unprovoked seizures — sudden, uncontrolled bursts of electrical activity in the brain that temporarily affect movement, behaviour, sensation, or consciousness. A single seizure does not constitute epilepsy; the diagnosis requires two or more unprovoked seizures occurring more than 24 hours apart. Epilepsy is one of the most common neurological diseases worldwide, affecting approximately 50 million people. Nigeria has a high burden — an estimated 4–5 million Nigerians live with epilepsy, many without access to treatment. Contrary to widespread belief in Nigeria, epilepsy is not contagious, not caused by evil spirits, and is not a sign of madness. It is a treatable medical condition.

The hallmark of epilepsy is recurrent seizures. Seizures are classified by their onset: Focal (partial) seizures — begin in one area of the brain: • Focal aware seizure: the person remains conscious but experiences abnormal sensations (tingling, visual changes, a rising feeling in the stomach, smell), automatic movements (lip smacking, hand rubbing), or unusual emotions: often called an "aura" • Focal impaired awareness seizure: consciousness is affected; the person appears confused, stares blankly, or makes repetitive movements Generalised seizures — involve both sides of the brain simultaneously: • Tonic-clonic (grand mal): the most recognisable type: the person loses consciousness, the body stiffens (tonic phase), then shakes rhythmically (clonic phase), typically for 1–3 minutes, followed by a period of confusion and tiredness (postictal state) • Absence seizure: brief loss of awareness (typically 5–30 seconds), appearing as staring spells; the person resumes activity as if nothing happened; common in children • Myoclonic seizure: brief, sudden muscle jerks or twitches • Atonic seizure ("drop attack"): sudden loss of muscle tone, causing the person to collapse • Tonic seizure: sudden muscle stiffening

Epilepsy can result from a wide range of causes, or may be of unknown origin: Structural causes: • Brain injuries from head trauma (road traffic accidents: a major cause in Nigeria) • Stroke or brain haemorrhage • Brain tumours • Birth-related brain injury (hypoxia, trauma) • Developmental brain abnormalities Infectious causes (important in Nigeria): • Cerebral malaria: severe malaria can damage the brain and leave epilepsy as a sequela • Neurocysticercosis: tapeworm larvae in the brain; the most common cause of new-onset epilepsy in adults in many low-income countries • Meningitis and encephalitis • HIV-related brain disease Genetic causes: • Many epilepsy syndromes have strong genetic components • Inherited ion channel disorders Metabolic causes: • Low blood glucose, low sodium, liver or kidney failure Idiopathic (unknown cause): • In a significant proportion of people with epilepsy, no cause is found

• History of head injury (road traffic accidents, falls, assaults) • Family history of epilepsy • History of cerebral malaria, meningitis, or encephalitis • Birth complications (hypoxia, prematurity) • Neurocysticercosis (consuming undercooked pork from infected pigs) • Stroke • HIV infection • Alcohol misuse and sudden withdrawal • Febrile seizures in childhood: a history of prolonged febrile seizures slightly increases epilepsy risk

• Status epilepticus (seizures lasting over 5 minutes or cluster seizures): can cause brain damage or death without emergency treatment • Injury during seizures: falls, burns, drowning, road accidents • Sudden Unexpected Death in Epilepsy (SUDEP): rare but real; risk is highest in poorly controlled epilepsy • Aspiration pneumonia: inhaling vomit during a seizure • Side effects of antiepileptic medication (drowsiness, liver effects, bone thinning) • Psychological and social consequences: – Stigma, discrimination, and social isolation in Nigeria – Depression and anxiety (2–3 times more common in people with epilepsy) – Restrictions on driving and certain occupations – Reduced employment and educational opportunities – Impact on marriage and family relationships

Epilepsy cannot always be prevented, but the following reduce risk: • Prevent head injury: wear a helmet when riding a motorcycle or bicycle; wear a seatbelt in vehicles • Prevent cerebral malaria: use insecticide-treated mosquito nets; seek prompt malaria treatment • Prevent neurocysticercosis: eat only well-cooked pork; maintain good sanitation; wash hands thoroughly before handling food • Prevent birth complications: attend regular antenatal care; deliver with a skilled birth attendant • Prevent meningitis: keep vaccinations up to date (meningococcal, Hib, pneumococcal) • Control other chronic conditions that can cause seizures (hypertension, diabetes) For people living with epilepsy: • Take antiepileptic medication consistently every day as prescribed: most people with epilepsy can achieve good seizure control with medication • Do not stop medication suddenly without medical guidance • Identify and avoid personal seizure triggers (sleep deprivation, alcohol, flashing lights in photosensitive individuals) • Inform family members how to safely respond to a seizure • Free or subsidised antiepileptic drugs are available through government health facilities in Nigeria