Understanding Epilepsy: An African Perspective

Introduction

Epilepsy is the most common chronic neurological disorder, affecting approximately 50 million people worldwide, of whom 40 million are estimated to live in developing countries (World Health Organisation (WHO, 2004). Several studies have reported that over 90% of People with Epilepsy (PWE) in developing countries do not receive appropriate treatment for their condition, a phenomenon known as the Treatment Gap (TG) (Diop et al., 2003). Epilepsy is under-treated worldwide (Meyer et al., 2010; Newton & Garcia, 2012). Both because of this treatment gap and because there are many indigenous cultural explanations for epilepsy in different countries, some authors have suggested that traditional healers may have an important role to play in epilepsy management (Birbeck, 2010; Njamnshi et al., 2010; WHO, 2004). This burden is predominantly the result of traditional beliefs which holds that epilepsy is contagious and/or caused by supernatural factors (Jacoby, et al., 2005; Angwafor, 2010). However, Meyer et al., (2010) and Newton & Garcia (2012), state that Epilepsy is under-treated worldwide.

Epilepsy is a condition characterised by recurrent and unprovoked seizures, which are temporary neurological abnormalities that result from unregulated electrical discharges in the brain (Shorvon, Guerrini, & Andermann, 2011).

Epilepsy is a clinical diagnosis defined by an enduring predisposition to generate epileptic seizures (Fisher, et al., 2014). To diagnose epilepsy, epileptic seizures must be differentiated from provoked seizures and other paroxysmal events. Childhood epilepsy has a large spectrum of clinical manifestations, and many other conditions may resemble epilepsy. This often makes the diagnostic process challenging, with a considerable risk of misdiagnosis (Chowdhury et al., 2008).

In South Africa, epilepsy management is reported to be poor in the public health sector (Keikelame, et al., 2012) and access to neurologists is difficult (Eastman, 2005). In rural African communities, there are widespread beliefs that epilepsy is due to the possession of evil spirits through bewitchment by the devil. There is also a belief that the transmission of the disease is by physical contact, such as by saliva (Osuntokun, 1990:106). In central Africa, as well as in Sub-Saharan Africa, epilepsy is believed to be attributed to the presence of a lizard in the brain, and epileptic fits occur whenever the lizard moves (Haddock, 1993:118 ; Nyame, 1997:143). Such perceptions towards epilepsy and a person with epilepsy, in indigenous Africa, are invariably unfavourable and unfounded as they reflect mythical beliefs about the disease.