National Institute of Mental Health and Neuro Sciences (NIMHANS) and corporate hospitals like BGS Global and Fortis Hospitals, Bangalore among others have put in place a comprehensive epilepsy management system.

According to the WHO Bulletin 2010, there is dramatic global disparity in the care for epilepsy between high and low income countries. Untreated epilepsy is viewed as a critical public health issue. Global incidence  is 50 million with a prevalence rate of 0.7 per cent, of which 80 per cent are from  developing countries.  India has 6 million epilepsy cases. Around 4 per cent of the population would experience a seizure sometime in their life.

Although the most common neurological disorder in India and Karnataka is headache, epilepsy is considered  to be the second major neuro problem with an incidence of  5.7 per thousand in urban population, 11.9 in rural and around 9 per thousand in the total population. Disorders  like stroke, Parkinson's disease, Alzheimer’s, mental retardation, tremors and muscular dystrophy are lower down in the order of conditions, according to a NIMHANS study.

While there are certain advanced drugs to control epilepsy including Lacosamid and Eflicarbazepine with less side effects,  yet there is need for ample research. “This is where our advanced Neurobiology Centre provides  a platform for comprehensive translational research for neurological, psychiatric and clinical problems. The facility within the NIMHANS campus in Bangalore has 11 labs focusing on  EPS (Extrapyramidal Signs) part of neural network in the brain transcranial magnetic stimulation (TMS) and neuro chemistry among others, stated  Prof P Satishchandra, director, vice chancellor, NIMHANS.

“If epilepsy in India has to be effectively tackled at a national level, there is need to pan out expert health services into the vulnerable population  in  rural areas and the poorer socio-economic groups.  Perhaps a networked team of trained Multi-purpose rural health workers along with physician assistants under a trained district level expert in ‘Neurology – Mental Health – Substance Abuse’ on similar lines which WHO is considering, would be relevant.   Healthcare delivery by this group could be  augmented with the use of Electronic Medical Records that are linked to a Clinical Decision Support System on the internet.  This can provide maximum coverage at minimal cost and make a significant impact in epilepsy management, pointed out Dr Chandran Gnanamuthu, senior consultant neurologist,  Fortis Hospital Bangalore.

About 5-10 per cent of epilepsy cases develop several seizures occurring  within an hour, referred to as ‘status epilepticus’, and  requires urgent Intensive Care Unit admission.  Amongst this group,  some are labeled to have ‘intractable epilepsy’, when  all conventional drugs fail to control the seizures and surgery is an option.

An epidemiological statistics being discussed recently is the ‘epilepsy treatment gap’ consisting of a proportion of epilepsy cases who do not receive appropriate treatment which around 60 per cent and goes up to 80 per cent in rural areas.  A significant proportion of childhood epilepsies are the result of peri-natal birth injuries. Therefore, to address epilepsy in India would be prevention, added Dr. Gnanamuthu.

To  ensure early detection, hospitals including Sri Satya Sai Institute of Higher Medical Sciences at Whitefield in Bangalore has installed a long term epilepsy monitoring unit.

BGS Global too has a dedicated Centre of Excellence for Paediatric Neurosciences. A  separate team of epilepsy experts  diagnose and treat the condition which affects 3 per cent pediatrics in a 10 million adult cases in India.  The Centre receives two epilepsy cases out of 20 OPD patients every day. Efforts are on to start a Special Clinic to expand the service, said  Dr Rakesh Jadav, consultant paediatric epileptologist, BGS Global.