Account of Epilepsy Condition and Design a Booklet for Managing the Condition - Essay Example

Epilepsy Essay and Booklet Supervisor Introduction Epilepsy is not a single disease, but a heterogeneous condition in respect to its manifestation, aetiology and pathophysiology (Stafstrom and Rho, 2011). The International League against Epilepsy (ILAE) categorizes seizures into either partial or generalized. A partial seizure is derived from confined area of cerebral cortex, while generalized seizures mainly describe convulsive or non-convulsive seizures without focal onset (Senanayake and Román, 1993). This essay will describe a brief account of epilepsy condition, and design a booklet for managing the condition. Pathophysiology According to Engelborghs et al. (2000), the key feature of all epileptic syndromes is the persistent increase of neural excitability. In some form of epilepsy, such as those caused by disorders of neural migration and monogenic epilepsies, the pathophysiological mechanisms and underlying causes are understood, but the knowledge about the other types of epilepsies is only fragmental. Vezanni (2014) provide new insight into the pathophysiology of epilepsy by reporting that studies with rodents showed seizures induce high level of inflammatory mediators in the brain region. Disorders of neural migration that have intrauterine and genetic causes are the major developmental disorders that cause epilepsy. Various forms of agyria develop from abnormal patterns of neural migration, while neural heterotopia in sub cortical white matter is sometimes induced by failures of neural migration (Engelborghs, 2000). A clinical characteristic of an epileptic seizure is convulsions characterized by confusion, jerking, and breathlessness, rigidity of the muscles, salivation and at times incontinency of urine (Broek, 2013). According to Henry (2012), non-epileptic seizures are grouped together with epileptic seizures not because of their similar pathophysiology, but rather because non-epileptic seizures mimic epileptic seizures. This is compounded by the fact that the individual having the seizure cannot describe their own behaviours during the conditions that result to their loss of consciousness, and witnesses provide only limited information about the behaviours during the events. Fischer (1998) summarizes epileptic seizures as emanating from imbalance amongst two processes in the brain; excitatory and inhibitory processes. Aetiology Fischer (1998) claims that in 60-70% of seizure cases, no immediate cause of seizure can be described. You et al. (2002) agrees that in many cases, seizures are idiophathic. However, some risk factors are identified. The most common causes of acute symptomatic seizures in decreasing order are; head trauma, cerebrovascular diseases (CVD), alcohol or drug withdrawal, and metabolic disturbances. The condition is also observed to follow hereditary line. Wolf-Hirschhorn disorder and Downs’s syndrome are among the most common genetic disorders that increase the occurrence of epilepsy. It could also be caused by acquired causes (Beghi, 2004). The acquired causes of epilepsy include; prenatal and parietal risk factors, mental retardation, CNS infection, and dementia (Beghi, 2004). Prenatal and parietal risk factors include toxaemia and eclampsia during pregnancy, low birth weight, asphyxia, and other less-defined conditions. Cerebral palsy and mental retardation are not causes per se of epilepsy, but co-morbid markers of neurological impairment. CNS infection is a major risk factor for epilepsy. A person with meningitis has an increased risk of seven times compared to an uninfected person. Other CNS infections that increase the risk of epilepsy include cerebral malaria, HIV and arboviruses (Beghi, 2004). The risk factors and aetiologies of epilepsy vary with age and geographical location. Genetic conditions and congenital development are associated with the development of the disease in childhood and adolescence (Henry, 1998). CVD is a significant risk factor among the people aged over 60 years. The other risk factors show consistent tendencies across all ages. The acquired caused epilepsy, especially infections, is significant risk factors for epilepsy in developing countries as compared to developed countries (Sander, 2003). Incidence Incidence refers to the number of people who develop epilepsy in one year divided by the total number of people at risk in that year, and is usually expressed per 100,000 of the population (Sridharan, 2002). Generally, the incidences are recorded to be 50 per 100,000 in developed countries, and 100-190 per 100,000 in developing countries from the few studies undertaken in the developing countries. Developing countries are challenged by insufficient resources. The incidences of children affected with epilepsy in developed countries are decreasing, while there is evidence pointing to increased prevalence among the elderly (Sander, 2003). It is common for incidence figures of similar population to vary amongst studies. This is mainly because of methodological differences (Sridharan, 2002). For instance, Heaney et al. (2002) estimated the incidence rate of epilepsy in UK to be 51.5 per 100,000 individuals, while McDonald et al. (2000) showed reported the rates of 46 per 100,000 persons per year. The incidences are more common in children as compared to adults. There are no significant differences of incidence rates between gender and race, although people of low socioeconomic status have relatively higher incidence rates of epilepsy (Sridharan, 2002). Incidence offers more valuable information compared to prevalence. This is because they include people suffering from mild to severe cases of the condition. Prevalence refers to the number of diseased persons in a defined population, divided by the number of people in the population, and is usually expressed per 1000. Prevalence It is difficult to have an epidemiological study of epilepsy because of various reasons including; the condition is heterogeneous, night and mild seizures sometimes go unnoticed, the stigma attached to the condition makes some people not to report it, and indifferent diagnostic criteria complicate even data collection (Sridharan 2002). A person with active epilepsy can be distinguished as a person who had at least two epileptic seizure attacks in the last five years despite of the treatment regimen the person is on. According to Sridharan (2002), 3-5% of the world populations have seizures in their life, and between 0.5-1 percent of the population have active seizures. More specifically, he estimated that 3 million people in the UK, 20 million people in USA, and 55 million people in India have active epilepsy. Data from various researchers show epilepsy prevalence is different in countries. For instance, the prevalence of epilepsy per 1000 in the population is; “12.7 in Denmark, 8 in USA, 6.2 in UK, and 1.5 in Japan” (Sridharan, 2002, p. 666). In general, Senanayake and Román (1993) estimated the prevalence of the condition to be 3-9 per 1000 in the developed nations, and 10-18 per 1000 in developing countries. They noted that some populations such as the Wroughbarh clan of Liberia had some of the highest prevalence rates in the world, which were estimated at 49 per 1000. Specific studies in the UK by McDonald et al. (2000) showed that active epilepsy prevalence of the condition of 4 per 1000 differed slightly with Sridharan (2002) estimate of 6.2. Jacoby et al. (2004) noted the UK populations’ estimate of prevalence of epilepsy was varied. In their study, they claimed that 90% of the population in the UK perceived people with epilepsy to be as intelligent as people without the condition. However, the study concluded that stigma on epilepsy was still prevalent in the UK. It was seen that more than half of respondents in the study claimed that epileptic people are treated differently in the society, and more than a quarter of the respondents agreed with the perception that most epileptic patients have more personal problems compared to non-epileptic individuals. Why epilepsy? Epilepsy is chosen because it is a condition that can have serious implication in the physical and social well being of individuals and their families (Faught et al., 2012). It does not have boundaries of age, sex, religion, gender or geography. The condition is largely manageable if proper medication and care are applied. The picture is different in developing countries; over 80% of the known epilepsy occurs in these regions of the world. Nine out of ten cases of epilepsy in Africa are left untreated, although it is known that the condition is totally manageable (DeBoer et al., 2008). This does not mean that epilepsy is problematic only in developing countries. Baker et al., (1999), for instance, describe the stigma associated with epilepsy in Europe. In a study conducted by Baker et al., (1999), in 15 countries of Europe, it was recorded that 51% of the interviewed patients felt stigmatized, while 18% felt highly stigmatized. The most important factors in their study that cause stigma are age at the onset of epilepsy, worry about the condition, seizure type and country of origin. Problems of epilepsy are exacerbated by lack of accurate information about epilepsy (Baker et al., 1999, p. 103). Spatt et al. (2005) reported in their study that 41% of respondents did not know of the aetiology of epilepsy, and significant proportion thought that it was a mental disorder. It is because of this reason that a management booklet for epilepsy (see Appendix 1) was created. The booklet has the primary purpose of giving accurate information about epilepsy to the patients of epilepsy. Although the booklet can also be used by people who would like know the basics of epilepsy management. It is the aim of the booklet to give accurate information in efforts to reduce stigma that affects the epileptics in developed countries. Stigma from epilepsy has also been recorded in Korea (Lee et al., 2005) and in America by Theodore et al. (2006). The booklet critique According to Gal and Prigat (2004), readability and usability have been key factors in making patient information leaflets (PIL) non-usable for the target audiences. This is because in a large number of PILs, high readability skills are needed to understand the information in them. The authors, who in many cases are medics, forget that the target readers do not have the education background of healthcare to understand the content of their communication. The problem is persistent despite having the relevant information and guidelines concerning the correct ways of writing such guidelines. Warsi et al. (2004) claims since the cost of medication is increasing, self-management of chronic diseases significantly reduces costs. A well formulated patient information booklet can enhance self-management of epilepsy condition. It was observed by Gal and Prigat (2004) that the major obstacles that arise in developing PILs to include, the assumptions about client skills, lack of pilot testing and unidentified target audience. The assumptions about client skills mainly come about from the level of education and interests of the client. Most of the PILs are distributed to the general public without public testing to see which areas need revisions. This emanates mainly from restrictive budgets and strict deadlines. Additionally, the makers of PILs fail to describe the target audience. In many cases, a booklet/leaflet is made to be used by both the patient and a medical practitioner. A common assumption is that when a PIL is issued to a patient, the doctor will explain all the information in the booklet to the patient. However, doctors hardly have the time to fully explain the booklet, and/or the patient is usually not in the correct state of mind to process the information. The patient information booklet for epilepsy designed in this essay (see Appendix 1) attempts to provide information on management of epilepsy in an accurate and simple way. It refrains from using technical terms, and attempts to enhance readability by including pictorials to ease identifications. Additionally, the booklet enhances readability by use of different font colours. The topical headings are written in font size 20 in other to make it distinguishable, and in purple colour, because colour purple is often associated with epilepsy (Epilepsy Society, 2015). Additionally, the points that connote danger or threat to life are written in red font colour, while the points written in green font colours to signify positive measures that should be put into considerations. This is in concordance with Gil and le Bigot (2014) who reported that red is a colour that signifies danger in human psychology, while green colour shows calmness, safety, and encourages creativity. The main body in the entire booklet is written in size 12 font size, Times New Roman, and double spaced for easier reading. The booklet has the aim of presenting the information with clarity, while reassuring the patient and the general public that epilepsy is manageable. Specifically, the booklet is designed for people who have been diagnosed with the most common type of epilepsy, although general information on seizures is also described. The information for creating the booklet was collected mainly from NCGS (2012), NHS (2015) and patient.co.uk (2015). Conclusion Epilepsy is a condition that is dangerous if left unmanaged. Many communities are faced with a challenge of stigma from the condition (Baker et al., 2000). The major cause of the stigma is perception that is not based on facts. Spatt et al. (2005) report that some people mistake individuals with epilepsy to be insane. A patient information booklet is designed to create awareness of epilepsy to the communities. According to Baker et al. (2000), individuals who can actively manage their seizures are feel less stigmatized compared to people who are unable to manage seizures. The booklet is intended to enhance the management of the condition to affected persons. It aims at presenting epilepsy condition as a manageable condition, and that people with the condition can still live a full life. Bibliography Baker, G. A., Brooks, J., Buck, D. and Jacoby, A., 2000. ‘The stigma of epilepsy: a European perspective’. Epilepsia, 41(1), pp. 98-104. [Online] Available at: (Accessed 16 May 2015). Beghi, E., 2004. Aetiology of epilepsy (p. 61).The Treatment of Epilepsy.Shorvonet al. (eds). Blackwell Science, Oxford. [Online] Available at: (Accessed 15 May 2015). Broek, I., 2013. Clinical guidlines: Diagnosis and treatment manual. Medecins sans Frontier. [Online] Available at (Accessed 9 June 2015). De Boer, H. M., Mula, M. and Sander, J. W., 2008.‘The global burden and stigma of epilepsy’. Epilepsy & Behavior, 12(4), pp. 540-546. [Online] Available at: (Accessed16 May 2015). Engelborghs, S., D’hooge, R. andDe Deyn, P. P., 2000. ‘Pathophysiology of epilepsy’. Acta neurologicabelgica, 100(4), pp. 201-213. [Online] Available at: (Accessed15 May 2015). Epilepsy Society, 2015. Purple day.-26 March 2015. Epilepsy society. [Online] Available at: (Accessed 6 June 2015). Faught, E., Richman, J., Martin, R., Funkhouser, E., Foushee, R., Kratt, P., ... and Pisu, M., 2012. Incidence and prevalence of epilepsy among older US Medicare beneficiaries. Neurology, 78(7), 448-453. [Online] Available at (Accessed 9 June 2015). Fischer, J., 1998. Drug Therapy of Epilepsy. Phamacotheurapetics. [Online] Available at: (Accessed16 May 2015). Gal, I. and Prigat, A., 2005. Why organizations continue to create patient information leaflets with readability and usability problems: an exploratory study. Health Education Research, 20(4), pp. 485-493. [Online] Available at: (Accessed16 May 2015). Gil, S. and Le Bigot, L., 2014. Seeing Life through Positive-Tinted Glasses: Color–Meaning Associations. PloS one, 9(8), [Online] Available at: (Accessed 6 June 2015). Heaney, D. C., MacDonald, B. K., Everitt, A., Stevenson, S., Leonardi, G. S., Wilkinson, P. and Sander, J. W., 2002. ‘Socioeconomic variation in incidence of epilepsy: prospective community based study in south east England’. Bmj, 325(7371), pp. 1013-1016. [Online] Available at: (Accessed 16 May 2015). Henry, T. R., 2012. ‘Seizures and Epilepsy: pathophysiology and principles of Diagnosis’. Hospital Physician Epilepsy Board Review Manual, 1(Part 1). [Online] Available at: (Accessed16 May 2015). Jacoby, A., Gorry, J., Gamble, C. and Baker, G. A., 2004. ‘Public knowledge, private grief: a study of public attitudes to epilepsy in the United Kingdom and implications for stigma’. Epilepsia, 45(11), pp. 1405-1415. [Online] Available at: (Accessed15 May 2015). Lee, S. A., Yoo, H. J., Lee, B. I. and Korean QoL in Epilepsy Study Group, 2005. Factors contributing to the stigma of epilepsy. Seizure, 14(3), pp. 157-163. [Online] Available at: (Accessed 16 May 2015). MacDonald, B. K., Cockerell, O. C., Sander, J. W. A. S. and Shorvon, S. D., 2000. ‘The incidence and lifetime prevalence of neurological disorders in a prospective community- based study in the UK’. Brain, 123(4), pp. 665-676. [Online] Available at: (Accessed 15 May 2015). NCGC., 2012.The Epilepsies: Phamacological update of clinical guideline 20. National Clinic Guideline cente. [Online] Available at: (Accessed 16 May 2015). NHS, 2015.Epilepsy- Living with. National Health Service. [Online] Available at: (Accessed16 May 2015). patient.co.uk, 2015. Living with Epilepsy. 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[Online] Available at: (Accessed 16 May 2015). Theodore, W. H., Spencer, S. S., Wiebe, S., Langfitt, J. T., Ali, A., Shafer, P. O., ... and Vickrey, B. G., 2006. ‘Epilepsy in North America: a report prepared under the auspices of the global campaign against epilepsy, the International Bureau for Epilepsy, the International League Against Epilepsy, and the World Health Organization’. Epilepsia, 47(10), pp. 1700-1722. [Online] Available at: (Accessed 16 May 2015). Vezzani, A., 2014. ‘Epilepsy and inflammation in the brain: overview and pathophysiology.’ Epilepsy Currents, 14(s2), pp. 3-7. [Online] Available at: (Accessed16 May 2015). Warsi, A., Wang, P. S., LaValley, M. P., Avorn, J. and Solomon, D. H., 2004. ‘Self- management education programs in chronic disease: a systematic review and methodological critique of the literature.’ Archives of Internal Medicine, 164(15), pp. 1641-1649. [Online] Available at: (Accessed 16 May 2015). You, G., Sha, Z. Y., Yan, W., Zhang, W., Wang, Y. Z., Li, S. W., ... and Jiang, T., 2012. Seizure characteristics and outcomes in 508 Chinese adult patients undergoing primary resection of low-grade gliomas: a clinicopathological study.Neuro-oncology, 14(2), 230-241. [Online] Available at: (Accessed 9 June 2015). Appendix 1 MANAGING SEIZURE IN EPILEPSY: PATIENTS AND RELATIVES INFORMATION BOOKLET Contents What is epilepsy? What are the causes of seizures? What are the types of seizures? How can we recognize a seizure? How can we manage seizure in epilepsy? What are the common misconceptions about epilepsy? Available websites for more information about epilepsy What is epilepsy? Epilepsy is a medical condition that affects your brain. It makes you go into fit and sometimes called funny turns. You can have epilepsy at any age. Why do I have epilepsy? Although the cause of epilepsy is not known, any of the following can bring about epilepsy to you: You can be born with epilepsy After an illness Infection Drinking too much alcohol Forgetting to take your medicine Head injury Growth in the brain Feeling stressed or Angry Not sleeping properly or getting overtired Feeling worried and bored Types of seizures The minimal noticing of fine movement of some part of the body that has no great effect on the person The shaking, jerking and falling to the ground that may last within five minutes Having more than one attack of seizure in one occasion What happens when I have seizure? You become unconscious, and your body might become stiff and fall backwards; you may bite your tongue during the seizure, jerk and shake, have difficulty in breathing and you may wet yourself How can I help reduce the chances of getting seizures? Have enough rest and sleep, Avoid alcohol, Avoid being stressed Avoid worries Take your medication as you doctor tells you What to do when someone gets an epileptic seizure It is important to know that the person having seizure cannot help themselves. First aid procedure should be carried out immediately. Move the person away from anything that can cause injury. Protect head so that they do not bang the head on the floor or other object. You can use pillows under their head. Loose clothes such as; collar, tie and belt. Please lay the person on the side and keep reassuring the person. Some seizures could be fearful, but make your best efforts not to be afraid. You can call the ambulance if seizure is more than five minutes and having more than one seizure in one occasion IMPORTANT ADVICE As an epileptic patient, it is good to be prepared because seizure can occur anywhere at any time. It is sensible to tell work mate, school mate, friends and close relatives It is sensible to give them tips of care in the event of seizure and emergency numbers It is wise to keep records of triggers It is wise to wear a Medic Alert® bracelet, or necklace. The ‘accessories’ will give information such as the condition. It not advisable to swim It not advisable to drive It is not advisable to climb to dangerous heights What if I am upset by the epileptic condition? It is common to be afraid, worries and not happy but be courageous I should not let stigma bring me down I should go and see my doctor or talk to a close relative for possible advice What are the Common Misconceptions about Epilepsy? 1. That it is contagious condition 2. That it is caused by witches or a spell 3. That epileptic patients cannot manage pregnancy 4. That the individual is possessed More information The information from this manual was primarily obtained from NCGS, National Health Service (NHS) and patient.co.uk. More information is available at their websites: http://www.nice.org.uk/guidance/cg137/resources/cg137-epilepsy-full-guideline3 http://www.nhs.uk/Conditions/Epilepsy/Pages/living-with.aspx http://www.patient.co.uk/health/living-with-epilepsy Read More