Epilepsy is a condition that people, especially the illiterate associate with witchcraft. But medical experts say epilepsy is not caused by witchcraft. An example is 20-year-old Justine Uwizeye who suffered her first seizure three years ago. Everyone, including relatives and family friends agreed that she was a victim of witchcraft, so her mother took her to as many traditional healers to get a cure. But the frequent visits to traditional healers did not yield anything until she visited hospital where she was diagnosed with Epilepsy.

Alphonse Majyambere, a psychiatrist at MedPlus Clinic, says most epilepsy patients visit health facilities when the disease has advanced, since many first visit traditional healers thinking it’s witch craft.

Epilepsy is a brain disorder in which a person has repeated seizures (convulsions) over time. Seizures are episodes of disturbed brain activity that cause changes in attention or behaviour.

According to Dr Rachna Pande , a specialist in internal medicine at Ruhengeri Hospital , seizures may be generalised as involving the whole body. 

The affected person may suddenly fall down while standing or doing some work followed by involuntary outward movement. The tongue may come out accompanied by frothing from the mouth. There may also be respiratory arrest in severe cases and the epileptic may become unconscious. When they regain consciousness, they may have no memory of the preceding event. They usually get exhausted and may sleep for hours following the attack. And it tends to come instantly, making it hard to avoid it.

"Partial seizures involve only a part of the body — may be a limb or face. The person may suddenly start staring blankly or making rhythmic smacking or grimacing movements of the lips,” she says.

According to David Uwayezu, a psychiatrist with Spenna Clinic, Kimironko, epilepsy occurs when permanent changes in brain tissue cause the brain to be too excitable or jumpy. The brain sends out abnormal signals. This results in repeated, unpredictable seizures. 

He points out that low oxygen during birth, brain tumors, abnormal levels of substances such as sodium or blood sugar , infections such as meningitis, stroke or any other type of damage to the brain, can cause epilepsy, but adds that sometimes it is genetic.

Pande says that diagnosis of epilepsy is based on a history of recurrent seizures and electroencephalogram (E.E.G) which shows the electric activity of the brain). In between seizures, these people are mostly normal. 

She mentions that certain factors trigger the attacks in susceptible people. These are bright flickering lights, loud music or sounds, high fever especially in children and phobia for heights.

"Unaccustomed exertion in any form, excess consumption of alcohol can also precipitate a seizure. Pregnancy also aggravates epilepsy,” she notes.

Diagnosis

The doctor will perform a physical examination including a detailed look at the brain and nervous system.Uwayezu says that an EEG (electroencephalogram) is done to check the electrical activity in the brain. People with epilepsy will often have abnormal electrical activity seen on this test. In some cases, the test may show the area in the brain where the seizures start. The brain may appear normal after a seizure or between seizures.

He mentions that to diagnose epilepsy or plan for epilepsy surgery, one may need to wear an EEG recorder for days or weeks while they go about everyday life. 

Tests that may be done include; blood chemistry, blood sugar, complete blood count, kidney function tests, liver function tests, lumbar puncture (spinal tap) and tests for infectious diseases. Head CT or MRI scan is also often done to find the cause and location of the problem in the brain.

Uwayezu says that medication may not necessarily cure the disease but atleast prevents seizures. The medicines work by stabilising the electrical activity of the brain. And one may need to take medication every day to prevent them.

He notes that some of the medicines include carbamazepine, sodium valproate, lamotrigine, phenytoin, oxcarbazepine, ethosuximide, among others.

Dr Pande remarks that bright lights, loud sounds, alcohol or exertion should be avoided. Careful driving is needed with permission from the doctor. The person’s family and friends also have to closely monitor the person. 

In case of youngsters, their epileptic status should be disclosed to the school authorities and friends so that in case of emergency they can help. 

"If one sees a person having an attack of epilepsy he / she should be immediately put in a lateral position with head flexed so as to avoid aspiration of fluid in lungs in case of frothing. A gag should be placed in the mouth so that no injury occurs because of tongue bite. The person should be sent to the hospital immediately,” she says.

Women on anti-epileptic medication should be careful while taking contraceptive pills. Anti-epilepsy pills reduce the effectiveness of contraceptive pills. If pregnant, they should be very careful as the attacks may be aggravated. Also the medications are harmful to the fetus, Dr. Rachna concludes.

Local situation

Statistics from Ndera neuro-psychiatric hospital and its two affiliate clinics; Caraes-Butare and Ikizere Centre in Huye and KicuKiro districts respectively show that of all mental illnesses, epilepsy and schizophrenia (plus other psychotic disorders) had the biggest occurrence, with 29.7% and 19.6% respectively between 2012 and 2013. 

Dr. Jean Michel Iyamuremye, the director of nursing at Ndera, blames the increase of epilepsy on existence of home based child deliveries, which expose infants to infections that in the long run develop into the disease.

General statistics

The report (from Ndera) points out that during the same time, the number of people consulting for mental illnesses increased by 26% from 39,069 in 2012 to 49,161 in 2013.

It adds that mental illness cases were higher in adult females with 44%, compared to 40 percent in adult males, and 16% in children. He says these cases are most common among people between the age of 18 and 35. The report however points out, that mortality of mentally ill patients reduced from 27 in 2012, to 24 in 2013. 

There are only 6 psychiatrists countrywide and Ndera is the major centre for mental healthcare.