Epilepsy in Ethiopia
Ethiopia shares the burden of Epilepsy and over 1 million are estimated to have active epilepsy. Historically, care is given by mental health practitioners and it is estimated that 25% of the patients receiving treatment at the main outpatient and inpatient mental health care provider hospital, Amanuel Hospital are people with epilepsy. The main medication is Phenobarbital 80%, Phenytoin 10% Carbamazepine 5% and Sodium valproate 5%.
The disability associated with epilepsy in Ethiopia is high: where people are already struggling for survival, the catastrophic impact of a chronic and disabling illness on the person and their family can be well-appreciated. The lack of epilepsy services or any kind of financial support for families with epilepsy ill member are the biggest factors causing caregiver burden in Ethiopia.
Only 5% of people with epilepsy receive medical treatment . The causes of this ‘treatment gap’ include inaccessibility of medical services, unavailability of anti-epileptic drugs, lack of awareness of medical treatment and cultural factors.
Diagnosis and Treatment
The rural poor, who are isolated and have limited access to healthcare, frequently attribute epilepsy to supernatural causes or evil spirits and most will first seek help from traditional healers, which leaves them vulnerable to permanent injury caused by untreated and ongoing seizures. Patients with severe burns to the face and body sustained by falling into open cooking fires during a seizure are a tragic but common reality.
The Treatment Gap
In Ethiopia, few people with epilepsy receive orthodox medical treatments (about 13%); they are excluded from care and consequently remain in the shadow of this ”treatment gap”, which is estimated to be over 95 %. The proportion receiving adequate treatment is likely to be under 5%. When available, appropriate treatment successfully controls most cases and leads to remission in at least 70%. It is important to note that consistent epilepsy treatment is needed to prevent the recurrence of seizures, to avoid the mortality, morbidity and psycho-social effects associated with seizures.
Psychiatric co-morbidities in patients with epilepsy are relatively frequent and many people with epilepsy suffer from mental health problems. It is estimated that 20-30% of patients with epilepsy have some sort of psychiatric problem. The most common psychiatric conditions in epilepsy are depression, anxiety, and psychosis. Early recognition and management of psychiatric disorders in patients with epilepsy is extremely important, because it improves the quality of life, decreases the number of suicides, and aids in better seizure control. Neurologists tend to focus on seizure control, and psychiatric co-morbidities are often underestimated.
Lack of knowledge of the causes of epilepsy has been associated with negative attitudes, beliefs and stigma in the community, workplace and schools. The discrimination and social stigma that surround epilepsy are often more difficult to overcome than the seizures themselves. In most cases the stigma of the disorder plays a major role in discouraging people from seeking treatment for symptoms and becoming identified with the disorder. People believe that epilepsy is contagious and hesitate to help or touch a person who has fallen during a seizure.