Keywords: Epilepsy, mental health, seizures, mental illness, depersonalization, derealization, quality of life, Nigeria.

Introduction.

Epilepsy and Mental Health – Nigeria. Do Nigerians suffer from epilepsy? What are the mental health implications? Is prevention and treatment possible?

Epilepsy, which is a neurological condition, has different types of presentations. They Are actually made up of seizures or abnormal electrical discharges in the brain. There is a link between epilepsy and mental health in Nigeria.

How many Nigerians suffer from epilepsy?

Nigerians do suffer from epilepsy, and some of the actions taken by Nigerians make epilepsy more probable. Any of the seizure types can be found in Nigeria. Due to secrecy, the prevalence rates obtained from different research do not show the true community prevalence.

Some prevalence rates obtained in Nigeria range from 3.1 to 37 per 1000 population. The average range figure is put at 8 per 1000 population. Studies show that the prevalence is highest in the southwestern parts of Nigeria, with 11 per 1000 population.

Epilepsy occur more among children. But can start anytime in life. And it is more among the poor people. 

The link between epilepsy and mental health – Nigeria.

Mental health issues are quite prevalent with epilepsy. About 88% of people who suffer from seizures have psychiatric conditions.

1. The risk to having mental illness in epilepsy:

Not everyone who is living with epilepsy will develop mental health conditions. The risk to developing mental health conditions in epilepsy includes having a family history of mental illness. Being young is a risk factor, because of the damage done to the brain by the seizure to a developing brain. Living in a low socioeconomic country predisposes one to the stress of unemployment, infections, traumas, poor antenatal care. Not having access to treatment, stigma, etc. are all high in poor countries like Nigeria. These can all increase the frequency of epilepsy, which can cause more damage to the brain areas, and thus mental illness.

2.Types of mental health conditions prevalent in epilepsy:

a. Mental illness –

These include depressive, anxiety and bipolar disorders. Depressive disorders have a two way traffic with epilepsy. They can predispose one to epilepsy, and epilepsy can be a predisposing factor to depressive disorders. Depressive disorders and bipolar disorders can come about, depending on the part of the brain that is affected. Both depressive disorders and anxiety disorders can come about due to fear of having another attack or stigma. Certain medications used in treating seizures can predispose one to depressive disorders.

Such people may become derealized and depersonalized. Derealization occurs when a familial environment looks strange. And depersonalization occurs when the person feels being outside himself.

Schizophrenia like symptoms can occur in seizure disorders, especially paranoia. Paranoia is the delusional belief that a person has that someone is out to harm him/her. Psychosis in epilepsy occurs 2 to 7 times more than in the general population. There could also be schizoaffective disorder.

Mental illness occurring in persons with epilepsy can negatively affect treatment. The can predispose to the medications not working effectively or not working at all.

b. Personality issues:

Some of those who suffer from epilepsy have disordered personalities. They are seen more among the dependent and avoidant personalities. This occurs more in those who have suffered from epilepsy for many years.

c. Other disorders:

These include sleep problems, substance abuse, poor self esteem, isolation, etc. Those suffering from epilepsy, may abuse substances like alcohol, cannabis, etc. They use them in an attempt to cope with their problems. Even suicidality like thoughts of death to actual attempts to kill self and actually succeeding in killing oneself are complications of seizures.

d. Cognitive issues:

Those who suffer from seizures can have problems with academics. Seizure disorders can negatively affect intelligence. This is more probable when the seizure starts very early in life. Thus the person’s education is adversely affected and their grades are low. This could be due to the damage the seizure cause in the brain. It could be due to the frequent absenteeism from school due to the disorder or stigma. Most drop out of school. So the early age of onset, long duration of the disease, and delay in treatment can affect intelligence negatively. Those with epilepsy also have problems with memory. Due also to stigma, many children suffering from epilepsy do not attend school.

Actually, epilepsy is very probable in children who suffer from learning disabilities. This is especially when the seizures start very early. Actually, issues that can lead to epilepsy are also risk factors for learning disabilities. 

e. Other associated neurological disorders:

These include dementia. Dementia occurs more when the seizure is not properly treated or controlled.

f. Socioeconomic impacts:

Epilepsy can drain the pocket due to hospital and drug fees. Due to stigma, it can lead to denial of job and even reduced productivity, if the person is working.

g. Quality of life:

Having epilepsy reduces one Quality Of Life (QOL). Quality of life is the extent one is satisfied with all aspects of life. This includes health, family, academics, employment, freedom, etc. Those suffering from epilepsy are not satisfied with their life. Epilepsy affects physical and psychological health. It also affects social health and even daily functioning.

h. The family:

Family members of those with epilepsy are frequently under stress. This stress could emanate from watching the attacks and frequent hospital visits. So anxiety is common here. They too suffer stigma. And their jobs could be on the line. The family members also suffer stigmatization.

Prevention of epilepsy.

Epilepsy is genetic, but the environmental factors that can make it more probable for seizures to occur can be prevented. The frequency of occurrence of the seizures can also be reduced.

1. Traumas:

When a pregnant woman has good antenatal and delivery care, there is low risk for trauma to the baby’s brain. Also there is low risk for reduced oxygen supply to the baby’s brain.

Wearing protective head gears while driving or riding can also prevent head trauma to the older child and adult. Also the wearing of seat belts are of immense help.  

2. Control of medical conditions:

There is need to have good control of medical conditions such as hypertension, diabetes, obesity, etc. There is need to prevent or promptly treat infections, etc.

3. Avoid substances and other risk factors:

There is need to avoid the use and abuse of substances such as alcohol, cannabis, etc. If noise brings about the seizures, prevent being in noisy areas.

Should also avoid being in excessively illuminated areas. So a keep away from disco rooms where there is excessive noise and flashing lights. Also keep decorations with flashing lights away. While using computers reduce the lights by using screen filters, etc.

Epilepsy and pregnancy.

1. Frequency:

Not every woman who suffer from epilepsy do have attacks during pregnancy. Actually, most women who suffer from epilepsy do not have seizures during pregnancies. But some women do have seizures during pregnancy which may even be more than normal. This could be due to the weight increase, stress of pregnancy or hormonal changes.

2. Medications:

But it is very important to let your doctor know that you are planning a pregnancy. There is need for the doctor to check the medicines the woman is already on, so as to make adjustments if possible. But the woman must take her medications as prescribed by her doctor.

There is need for the woman to start on folic acid before the pregnancy begins. Some medications affect the baby, physically and behavior wise. And that is the reason the doctor must be involved every step of the way.

3. Effects on the baby:

Most often most types of epilepsy are quite harmless to the baby in the womb. For some pregnancies, the baby may die due to unknown reasons. Some babies may develop issues with their hearts, etc. But most of these issues are actually rare. Folic acid helps to reduce these problems.

4. Delivery:

In 95% of the cases, delivery is normal. But some can come with complications, such as bleeding, hypertension, and even excessive bleeding after delivery, etc. There may be need to do a caesarian operation.

5. Breast feeding:

There is need to breast feed the baby, because the medications will not harm the baby.

6. Generally:

Get the doctor involved, have good antenatal visits and care. Never stop your medications.

There need to eat a balanced diet. Get adequate rest during the day and good sleep at night. It is very important to reduce stress during pregnancy.

Treatment of epilepsy.

It is important to know that a great majority of epilepsy can be treated and the individuals become seizure free. There are different types of treatment procedures that can be used. These include medications, surgery, brain implants, etc.

In surgery, the part of the brain where the seizure activities takes place can be removed entirely. The use of implants send electrical stimulations to the brain area to reduce the seizure. But these methods of treatment take place when medications have failed.

Different medications are used for the different types of epilepsy. And sometimes different medications are combined. Medications are used for many months to years. When the individual has no seizures for ten years and off medicines for 5 years, the epilepsy has resolved. But it may or may not reoccur.

For those who also have mental illness, the appropriate medications are added to the seizure medications. The medications to add will depend on the type of associated mental illness. For those with dementia, the appropriate medicines are added. The doctor will make his or her decisions depending on what is found during the interview and investigations.

There is need to eat a balanced diet. Foods such as fish, vegetables, eggs, fruits, avocados, etc. are good. Taking Omega fish oil daily is also good.

Home care.

When the seizure occurs, safeguard the person’s head. Open the buttons or zippers on the clothes. If possible remove jewelries or loosen them. Then immediately turn the person to one side. This will prevent the tongue and saliva blocking the airways.

Never press the person down, press close the eyes, or place a spoon in the mouth. Doing these will cause a lot of harm.

Watch the person and note how long the seizure lasts. Also watch to know how the seizure presents. This will enable the doctor know the type of seizure and the medication to give. Get help as soon as possible.

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