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Epilepsy is a chronic disorder of the brain characterised by recurrent seizures. Shutterstock

Kenya has gaps in diagnosing and managing epilepsy

Epilepsy affects the brain and causes repeated seizures. Prompt diagnosis and effective management are key to controlling the condition, the cause of which is not fully understood . There are huge gaps in the way that epilepsy is managed in African countries, including Kenya. The Conversation Africa’s Health Editor Joy Wanja Muraya spoke to Dr Symon Kariuki on what success might look like.

Can you explain epilepsy, and its prevalence in Kenya?

Epilepsy is a serious condition affecting the nervous system. Unprovoked repetitive seizures, often leading to a loss of consciousness, are common in persons with epilepsy. Epilepsy can affect any person irrespective of age, sex, economic or geographic location.

The actual cause of epilepsy is not fully understood, and research about this is ongoing. What’s known is that seizures are caused by abnormal and excessive electrical discharges in the brain.

Research in Kenya rates birth trauma, infections of the brain and head injuries as the top causes. Other risk factors include a family history of seizures.

The severity of symptoms depends on which part of the brain is affected. The seizures can present as visible fits or convulsions, muscle contractions, odd stares, impaired awareness or confusion and behaviour like lip smacking, cycling movements, or moaning.

According to a study we conducted in rural Kenya and other African countries, half of the 2,170 people with active convulsive epilepsy were children and 69% of the seizures began in childhood.

Other studies found that the prevalence of epilepsy is about 20 cases in every 1,000 people. About 77 new cases in every 100, 000 people are diagnosed every year. These estimates are two to three times higher than in developed countries.

What about diagnosis and treatment of the disease in Kenya?

A detailed medical history from the patient, family members and eyewitnesses is an important diagnosis step in patients with repeated unprovoked seizures. The health worker takes a history of the seizures, the triggers and the date they began. Recorded videos of seizures should be also considered.

Laboratory blood tests are done to rule out severe seizures. One seizure doesn’t signify an epilepsy diagnosis because up to 10% of people globally can have a seizure during their lifetime. Epilepsy is defined as having two or more unprovoked seizures.

The measurement of electrical activity in different parts of the brain through a test known as an electroencephalography can diagnose some forms of epilepsy particularly in people without physical signs of the condition.

Imaging tests like computed tomography (CT) scan and Magnetic resonance imaging (MRI) can be prohibitive because they are expensive and thus unavailable in many rural areas in Kenya. But people with a history of birth problems or head injuries should take them.

Epilepsy treatment drugs should be given immediately on diagnosis to control seizures and improve the quality of life. An epilepsy specialist may also prescribe a specific class of drugs for prolonged seizures.

Where are the gaps in Kenya?

Kenya’s lack of accessible and affordable health care is a major gap. There’s also a lack of awareness about the disease.

About 70% of newly diagnosed children and adults with epilepsy can be successfully treated with anti-epileptic drugs. But in Kenya the diagnosis rate is still very poor.

Often medical treatment isn’t sought because some people believe that epilepsy is caused by a person being possessed by supernatural forces or powers. This increases stigma and discrimination.

Some persons with epilepsy express concerns about the negative effects of the available epilepsy drugs, which can discourage medical treatment. This can be addressed by the government investing in newer tolerable drugs.

Kenya has a few epilepsy specialists, about 25 including neurologists, neurosurgeons and epileptologists- experts in epileptic seizures and seizure disorders. However they’re mostly based in cities. On top of this there aren’t services, like neurosurgeons and imaging facilities, in rural and semi-urban areas.

Kenya can learn from countries like South Africa which is leading in training epilepsy specialists. Zimbabwe and The Gambia are working to incorporate managing epilepsy into primary health care provision.

What is the way forward?

Narrowing the treatment gap in Kenya should be a collaborative effort between the ministry of health, stakeholders of epilepsy care, and research institutions.

As a first step training more health workers would strengthen primary health care. This would ensure that epilepsy is identified early enough to begin treatment.

Public health education would improve knowledge of the disease and reduce stigma and discrimination. Support groups and community epilepsy clinics could also be supported to increase epilepsy awareness. Sustained health education improves knowledge about epilepsy.

Research institutions are critical in setting up epidemiological studies to provide reliable epilepsy data. This would make planning care much easier.

And evaluating the effectiveness of available or new epilepsy drugs is critical. In addition, ongoing research has the potential to quantify the burden of epilepsy in urban areas, and possibly preventable risk factors.

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