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Compliance with medication, right drug, and right dose at right time will control seizures – Dr. Aisha Aziz

HCPs should prescribe cost effective drugs to
ensure patience compliance – Prof. Abdullah

KARACHI: Rabia Moon Memorial Institute of Neuro Sciences organized a meeting to celebrate World Epilepsy Day at its premises on February 12th2024. The speakers included Dr Sadia Mubarak, Dr. Khalid Ahmad and Dr. Aisha Aziz. Prof. Abdullah a noted Neurologist under whose supervision this institution is functioning was also present on the occasion.
Dr. Shazia Kiran Head of Research and Development at the center in her welcome address said that the objective was to create awareness, dispel misconceptions, and educate the public as well as the healthcare professionals including nurses, paramedics, Lady Health Visitors and the society at large about this disease. The center was also involved in advocacy because when the patient is diagnosed, one should know what to do next and which are the institutions where treatment and rehabilitation facilities are available where these patients can be appropriately managed. Once the seizures are controlled for a period of two years, the patients can live a normal life, she added.

Dr. Farida Kamran gave details regarding the functioning of the center. She pointed out that about one hundred fifty patients visit the institute daily in the Out Patients Department while about three hundred patients avail the rehabilitation facilities. There is no difference in treatment between affording and non-affording patients. We have Gymnasium facilities for the patients which help in their rehabilitation. Since its inception, our Vision and Mission is to serve every one coming to the center with compassion, respect and dignity and no one should go un-attended. Many people come here and serve as volunteers. We have a psychiatric OPD as well besides facilities for treating children with neurological disorders.
Dr. Aisha Aziz said that all efforts should be made to remove the stigma associated with epilepsy which is a great hindrance in patients seeking treatment. Once the seizures are controlled, these people can live a happy active normal life.

Dr. Sadia Mubarak gave a historical background to epilepsy which she said was known for the last over four thousand years. There are various myths and misconceptions about this disorder and for too long it was not considered a disease. Hens Berge was the first to describe brain activity. At present over fifty million people suffer from epilepsy all over the world. Its prevalence is about four to six per thousand (4-6/1000). The prevalence in India is reported to be 2-14/1000 while the prevalence in Paksitan is reported to be ten per ten thousand population. Asia has one of the highest prevalence of epilepsy. Speaking about the advances in management she talked about CBD derivatives, Vagus Nerve Stimulation, Deep Brain Stimulation, Responsive neuro stimulation, Gene therapy for genetic epilepsy. She also referred to the use of different implants to control seizures while surgery is also useful in some focal lesions. When the patient is in aura, they can take some preventive measures to check that seizures do not occur. Gene therapy is currently under trials in animals. Patients can lead a normal life with seizure control. There have been many famous world renowned personalities who suffered from epilepsy which included Charles, Napoleon the French leader, she remarked.

Dr. Khalid’s presentation was on Epilepsy in Children. Epilepsy, he said, was a chronic brain disorder. Its prevalence is about 5-8/1000 population and recurrent seizure account for 0.5%. He then discussed classification of seizures and mentioned partial seizures, generalized focal seizures, Myoclonic seizures, complex partial seizures, absence seizures, tonic colonic seizures etc. EEG, he said, is highly specific but not highly sensitive. Many patients can have normal EEG. Seizures lasting for five minutes or more is considered epilepsy. Infantile spasms are of two type’s i.e primary and idiopathic some of which result due to birth injury. Delayed diagnosis leads to poor prognosis. Absence seizures has good prognosis. Treatment is usually life long and steroids are required for speech development.
Dr. Aisha Aziz shared the details of a cross sectional observational study undertaken at the Rabia Moon Memorial Institute of Neuro Sciences.

It included one hundred fifty five patients of which eighty five were male. Forty eight were less than ten years of age while forty nine were between the age of eleven to eighteen years and fifty eight were more than ten years old. Male presented early. Seventy two had some education, sixty six patients had non-compliance with therapy. Some of the precipitating factors included mistime dose, not taken the drug on time, sleep deprivation, using sub optimal dose of the drug, one hundred forty six had history of vomiting and diarrhoea, thirty nine had excessive screen use, some skipped meal, emotional stressors, fever and change in the trade name of the drug. Compliance with therapy, use of right drug at the right time and in right dose is essential to control seizures, she added.

This was followed by a video in which some patients described their disease and how they were being efficiently managed at the Rabia Moon Memorial Institute of Neuro Sciences. All the speakers and Mr. Altaf Hussain participated in the panel discussion which was moderated by Dr. Aisha Aziz. It was pointed out that once seizures are under control one can drive, go for swimming under observation. One can consider stopping drug treatment if the patient has remained seizure free for two years. It is advisable to first control seizures before the women gets pregnant.

Mr. Shaukat Ali Jawaid commended all those behind this initiative of setting up this facility which was providing diagnosis and treatment facilities to a large number of non-affording patients. He suggested that while teaching and training the GPs/Family Physicians, it will be much better if Videos are used to show them the different types of seizures.

Prof. Abdullah in his concluding remarks urged the healthcare professionals to prescribe cost effective drugs which will ensure patient compliance. Pharma industry representatives, he opined, should not influence their prescribing habits. The first line conventional anti-epilepsy drugs are still very safe and effective. One does not have to opt for new expensive medications which can be used in those who can afford it.

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