The World Health Organisation has just embarked on the second phase of a global campaign against epilepsy. Eighty five per cent of the 50 million people affected worldwide live in developing countries, the majority of whom receive no treatment at all. In sub-Saharan Africa, for example, there is one neurologist for four million people.
There is a widely-held belief in many countries that a person with epilepsy is seized by a supernatural force or power. The name of the disorder reflects this belief: epilepsy is derived from the Greek word epilambanein which means to seize or attack.
We now know that seizures are the result of a sudden excessive electrical discharge in a group of brain cells. The effects of seizures will depend on where in the brain the disturbance first starts and how far it spreads. They vary from temporary absences (lapses of attention), to muscle jerks, to prolonged convulsions.
In some patients with epilepsy, there are definite factors which trigger an attack. Flashing lights, over-breathing, alcohol, loss of sleep and emotional and physical stress may stimulate a seizure.
Some people experience a warning of an impending attack. Called an "aura", it can be any type of feeling or movement, such as a feeling in the pit of the stomach. For those who do experience an aura, it allows them to sit or lie down before the seizure begins.
Presumably the aura is related to the very beginning of electrical activity deep within the brain. Whether such activity is related to another phenomenon, whereby some pets seem to be able to anticipate human seizures, is purely speculative.
However, the fact that such extra-sensory communication between pets and humans can occur is described by Rupert Sheldrake in his book Dogs That Know When Their Owners Are Coming Home and Other Unexplained Powers of Animals. He describes the case of Dennis, an epileptic, whose dog is able to anticipate when he is about to have a fit. The dog, Sandy, barks and nuzzles his master just before a seizure. He then runs off to find Dennis's wife and barks at her until she comes to her husband's assistance.
Nor can dogs such as Sandy be fooled. One owner pretended to have a fit to see what would happen and was "politely ignored". Other dogs are known to anticipate a diabetic "hypo" - where the blood sugar falls too low - even before the onset of its symptoms of sweating and feeling faint. A recent study in The Lancet by a group of French doctors, reported evidence of electrical changes in the brain for seven minutes before an epileptic fit occurs. By analysing the electrical brain signal (ECG readings) of patients with temporal lobe epilepsy, they were able to detect a prefit pattern in 25 out of 26 volunteers.
Presumbably it is this electrical activity that the dogs can detect, although how they might do this defies explanation. But it does offer some exciting possibilities. Will there be devices available in the future to warn patients of an impending attack? Could further research eventually provide treatment interventions for preventing seizures during the pre-fit phase? Might patients with epilepsy in the future be fitted with implantable recording devices combined with drug delivery systems?
While patients in the developed world can look forward to such breakthroughs, their fellow sufferers in most of Africa, Asia and parts of South America are unable to avail of current treatments.
The WHO estimates that the basic anti-epileptic drug phenobarbitone could be made available to patients for as little as $5 per person per year. And with several studies confirming that 70 per cent of newly diagnosed patients with epilepsy will be successfully treated using modern drugs, many people are having to endure seizures which could otherwise be completely controlled.
The social implications of this are significant. Unemployment is much higher in epileptic patients of working age, with rates of 40-60 per cent reported. Misunderstandings and the stigma associated with epilepsy are undoubtedly contributing to these statistics.
WHO's campaign, called "Out of the Shadows", is focusing on the stigma and discrimination associated with epilepsy in both the community and workplace. WHO's director general, Dr Gro Harlem Brundtland, says: "Our aim is to improve treatment, prevention and social acceptance of epilepsy, the world's most common - yet treatable - brain disorder".
Dr Muiris Houston, Medical Correspondent, can be contacted at mhouston@irish-times.ie or leave messages on tel 01-6707711, ext 8511, but he regrets he cannot reply to individual medical problems.