Epilepsy: Some controversies, some knowledge and some experience from Cambodia

Abstract

Epilepsy-related health outcomes remain unacceptably low in much of the developing world. According to us, it is because of the failure since long to see, and address, epilepsy beyond its preset conventional image. The objective of this paper was to highlight the presence, and influence, of these conventional practices and also to demonstrate what happened when a bold unconventional approach to address epilepsy was taken in Cambodia. Data are taken from existing published literature on epilepsy as well as our field experience during several population-based surveys conducted in Cambodia. We complimented this with our knowledge gained over this long period. It is demonstrated that epilepsy is far more important in Asia that it is currently considered to be, and also vis-à-vis other geographic regions. Pregnancy and birth-related factors carry far higher odds for epilepsy than several "highly vocal" infections. A refocus in epilepsy is required to help move from its traditional negative image to an image where epilepsy is considered a "positive-looking" disorder that is full of "opportunities;" such as availability of safe effective inexpensive treatment, etc. Stigma is a two-side entity (i.e., it is present, and it is influential), and diligence should be therefore practiced before using the stigma label. Nevertheless, psychosocial aspects shouldn't be limited to stigma or Jacoby stigma scale alone. Quality of life is a subjective phenomenon, and patients should determine directly what affects them. It is highly desirable that if we want to find newer answers to old problems in epilepsy, we need to shed our conventional approach and preset conclusions. We should choose to move toward "opportunities" visibly present in epilepsy. Our Cambodian experience demonstrates more intimately that opportunities do get identified when preset conclusions are questioned, and an approach that goes beyond expected and by default is taken.

Knowledge and practice of schoolteachers towards students with epilepsy in Khamis Mushate, Southern Saudi Arabia

“…Some believe that epilepsy is contagious or that it may cause learning disabilities. [ 8 9 10 11 ] These and other inappropriate ideas are culturally reinforced and can promote negative attitudes toward people with epilepsy and practice, which can ultimately negatively affect the quality of life of epileptic patients and their families. [ 9 ]…”

Availability and sufficiency of phenobarbital, an essential medication, in Bhutan: a survey of global and neuropsychiatric relevance

“…Generally, PB has a broad anti-seizure (partial and generalised) activity, including neonatal seizures and < 20 min status epilepticus. In resource-poor countries, PB is fundamental, most widely used, and often times the only available or affordable ASM [ 3 , 6 , 11 ]. In developed countries where neurotoxic concerns of PB are reportedly ‘felt’ more, other ASMs have superceded but not necessarily for the right reasons [ 6 , 12 , 13 ].…”

“…The position of PB has also been compromised due to its low retail price (low profit margin) and inappropriate marketing of its safety profile. For instance, discontinuation of PB due to actual occurance of side effects was none over 1 year [ 11 ] or 1.0% over 2 years [ 14 ] or merely 0.6% among children [ 15 ]. Thus, supposed greater withdrawal of PB is merely out of this perceived fear [ 16 ].…”

Knowledge, Attitude, and Practice among Practitioners Regarding Epilepsy in Bhutan: A Rural and a Remote Country

“…[ 11 ] For various reasons, these are important risk scenarios for epilepsy or its services. [ 1 6 ] Bhutan has 100% cost-free medical services, no private service, parallel fully-functional traditional healing system, and 185 basic health units spread throughout this country. Through various efforts, the author is slowly establishing epilepsy information for this country (currently unpublished, D Bhalla 2017).…”

“…[ 4 ] Elsewhere in rural Asia, putting efforts to establish goal-oriented programs has been seen to benefit not only various stakeholders but also helped to establish epilepsy (and its services) systematically in the country. [ 5 6 7 ] However, many countries remain scientifically-silent;[ 1 8 9 ] implying yet-to-experience broad outside attention and challenge less systematic fundamental initiatives. This short communication provides significant field knowledge and perspectives regarding epilepsy among practitioners of Bhutan, a rural and a remote country.…”