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Table of Contents    
EDITORIAL
Year : 2017  |  Volume : 65  |  Issue : 7  |  Page : 4-5

Addressing the burden of epilepsy in India…


Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India

Date of Web Publication8-Mar-2017

Correspondence Address:
Malla Bhaskara Rao
Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.201671

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How to cite this article:
Rao MB. Addressing the burden of epilepsy in India…. Neurol India 2017;65, Suppl S1:4-5

How to cite this URL:
Rao MB. Addressing the burden of epilepsy in India…. Neurol India [serial online] 2017 [cited 2017 Nov 22];65, Suppl S1:4-5. Available from: http://www.neurologyindia.com/text.asp?2017/65/7/4/201671


India carries an enormous burden of epilepsy. By conservative estimates, there are ten million people with epilepsy (PWE), three million with drug resistant epilepsy (DRE) and one million potential candidates for epilepsy surgery (ES) in India. Drug-resistant epilepsy (DRE) can be associated with developmental delay in infants and young children, and severe disability and morbidity in older children and adults, as well as a mortality rate of 5–10 times that of the general population. It accounts for 80% of the health care costs for epilepsy.[1] Treatment goals for epilepsy are no seizures, no side effects, and seizure control as soon as possible, but these goals are too often unmet. A comprehensive epilepsy management must go beyond seizure control and include prevention of comorbidities to improve the quality of life. By correct diagnosis and simple monotherapy with first line anti-epileptic drugs, majority of these people will achieve cure or control of their epilepsy.[2] Unfortunately, there is enormous primary and secondary treatment gap in the medical management. The paucity of intensive care units and ventilators in India limit the use of management protocols for status epilepticus. Similarly, many eligible patients will not avail the advantage of epilepsy surgery because of illiteracy, ignorance and the wrongly perceived risks, costs and complications of epilepsy surgery.

Motivated teams with institutional support like SCTIMST, Trivandrum, AIIMS, New Delhi and NIMHANS, Bangalore have successfully established comprehensive epilepsy care programmes.[3],[4],[5] Sizable number of people, especially with drug resistant epilepsy, underwent detailed evaluation and management at these centres over the past two decades. Based on experience of these centres, in due course, several other centres have emerged all over the country, both in the public and private sector. Strategies like rational polytherapy for people with DRE, standardised non-invasive pre-surgical evaluation protocols and optimum utilization of resources for invasive monitoring as well as a step-wise approach in the surgical management of difficult and complex cases were utilised at these centres. According to a recent survey, over 7000 epilepsy surgery procedures have been performed across 38 centres in India between 1995 and 2016.[6] The reported postoperative outcomes from all these centres are comparable to those reported from the well-established centres in high-income countries. Still, only 1 in 1000 eligible patients in India undergo epilepsy surgery because of which the enormous surgical treatment gap continues to persist.

Professional organizations like the International League against Epilepsy and the India Epilepsy Society have provided evidence-based recommendations for the evaluation and treatment of first seizure, use of antiepileptic medications, treatment of status epilepticus, management of epilepsy in specific populations and the use of epilepsy surgery. All patients with medication-resistant epilepsy, defined as failure of 2 appropriate trials of antiseizure drugs due to inefficacy and not intolerance, who continue to be compromised by seizures, deserve a timely consultation at a full-service epilepsy centre. In order to reduce the burden of drug resistant epilepsy, clearly there is an urgent need to establish more comprehensive epilepsy care programmes in India. Early referral provides the best opportunity to avoid irreversible psychological and social problems, a lifetime of disability, and premature death. Presurgical evaluation has become sufficiently streamlined now to enable new centres to carry out video-EEG recordings and epilepsy specific protocols for magnetic resonance imaging. Now it will be possible for these centres to operate successfully on most patients with refractory temporal lobe epilepsy and neocortical epilepsy due to well-circumscribed structural lesions. These new centres can pool their resources and collaborate with the established centres. National epilepsy surgery support activity is a step in this direction.[7]

Worldwide tremendous progress is anticipated in the field of epilepsy research such as establishing 7T MRI in neuroimaging, the Human Connectome Project as well as high frequency oscillations in electrophysiology.[8],[9] In order not to lag behind, there is a need to increase the quality of epilepsy research in India. A centralised data base and facility for human tissue repository of the surgical specimens would generate enormous amount of data and provide practice parameters regarding the indications, surgical techniques and outcomes of epilepsy surgery procedures.

Establishment of National Epilepsy Control Programme hopefully will bring uniformity in the quality of clinical services, manpower training and research in India. It must facilitate the networking of centres providing comprehensive epilepsy care programmes; collaborations between national and international institutions and funding from governmental as well as non-governmental agencies are essential to carry out these initiatives. Policy makers must realise that the primary investment in epilepsy care is in human resources, particularly appropriately trained neurologists, neurosurgeons, clinical neurophysiologists, neuropsychologists, neuroradiologists, psychiatrists, neuropathologists and social workers.

The ultimate goal to make the epilepsy treatment available for all of the ten million people and reduce the financial and human cost of epilepsy is feasible only by concerted effort by the governmental as well as non-governmental agencies and by educating patients, the general public, and medical communities. If we succeed in taking care of people with drug resistant epilepsy, by rational usage of anti-epileptic medication, surgery, and alternate methods including life style changes, there will be substantial decrease in the over all burden of the disease in India.

 
  References Top

1.
Engel Jr J. What can we do for people with drug-resistant epilepsy?: The 2016 Wartenberg Lecture. Neurology 2016;87:2483-9.  Back to cited text no. 1
    
2.
Newale S, Bachani DS. Demographic characteristics of epilepsy patients and antiepileptic drug utilization in adult patients: Results of a cross-sectional survey. Neurol India 2016;64:1180-6.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Rao MB, Radhakrishnan K. Is epilepsy surgery possible in countries with limited resources? Epilepsia 2000;41:S31-S34.  Back to cited text no. 3
    
4.
Bhatia M, Singh VP, Jain S, Gaekwad S, Bal CS, Sarkar C, et al. Epilepsy surgery in India: All India Institute of Medical Sciences experience. J Assoc Phys India 1999;47:492-5.  Back to cited text no. 4
    
5.
Savitr Sastri BV, Arivazhagan A, Sinha S, Mahadevan A, Bharath RD, Saini J, et al. Clinico-pathological factors influencing surgical outcome in drug resistant epilepsy secondary to mesial temporal sclerosis. J Neurol Sci 2014;340:183-90.  Back to cited text no. 5
    
6.
Rathore C, Radhakrishnan K. Epidemiology of epilepsy surgery in India. Neurol India 2017;65:S52-9.  Back to cited text no. 6
  [Full text]  
7.
Rathore C, Rao MB, Radhakrishnan K. National epilepsy surgery program: Realistic goals and pragmatic solutions. Neurol India 2014; 62:124-9.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Dixit AB, Banerjee J, Tripathi M, Chandra P S. Presurgical epileptogenic network analysis: A way to enhance epilepsy surgery outcome. Neurol India 2015;63:743-50.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Chiang S, Haneef Z, Stern JM, Engel Jr J. Use of resting-state fMRI in planning epilepsy surgery. Neurol India 2017;65:S25-33.  Back to cited text no. 9
    




 

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