COMMENTARY

A Neurologist's Commitment to Improving Epilepsy Care

Rahul Guha, MD

Disclosures

March 07, 2019

This transcript has been edited for clarity.

Rahul Guha, MD: Thank you for joining me.

Nirmal Surya, MD: Thank you, Rahul.

Guha: Please introduce yourself to the audience.

Surya: I'm Dr Nirmal Surya. I'm the treasurer of the Indian Academy of Neurology and I am founding trustee and chairman of the Epilepsy Foundation of India.

Guha: You just gave a really wonderful presentation where you spoke about your work, and it really brought a lot of things into perspective for me. What is the experience of someone in India who is living with epilepsy?

Surya: It is very bad. It depends on what gender you are. If it is a female, it is worse. If it is a male, they are prioritized and receive early treatment. If it is a female, the people often hide [the patient] and don't seek treatment or visit a doctor. They only [seek treatment] when the female is around 14 or 15 years old, they know the seizures are not controlled, and they want her to be married. That is the time they come, but it is too late. If a boy has a seizure early in life, they [immediately seek] treatment.

[It is very difficult] being a female in India, being from a lower community or from a poor background. There is a lot of stigma. Basically, you need awareness. People need to know that epilepsy is a disease of pain and it is not only the generalized tonic-clonic seizure, but also there are other kinds of epilepsy, which require treatment and can be treated safely.

Guha: That is a good transition to the work that you're doing, because as difficult as it is for patients, it's also probably difficult to treat the patients. As a neurologist and a physician, what kind of work are you doing to address this issue in this disease?

Surya: I believe that it is not only the treatment of the patient. We have to give the patient confidence. If the patient is an adolescent or a child, we need to see that they go back to college or school and participate in their activities regularly. If somebody is working in the office or going to college or something else, we really need to see that they are engaged in their activity because that is what is important.

Also, it is not only medical treatment [that patients need]. We really need to get them back into society. They need to get back to work. I'm pushing people toward a total holistic treatment, which includes, besides medicine, yoga, music, dance, and other treatments, in which the patient should continue to participate.

Guha: You had two posters that you mentioned briefly, which had some pretty interesting findings. Can you describe what your research showed?

Surya: We have presented one poster, which investigated public awareness using questionnaires to determine whether epilepsy is a disease of the brain and whether there needs to be more awareness about epilepsy.[1] These questionnaires were administered to my patients and their caregivers during the camps. [We analyzed the data and presented the results] today.

The second poster we presented was describing the 7-minute EEG, which we are doing in the rural area in the camp.[2] We are trying to accommodate as many people as possible during that particular day because our camps are 1-day camps and we have up to 500 patients. We need to do about 50-80 EEGs in a day, so we have devised this 7-minute EEG system, which takes a total of 15-20 minutes, and we are able to do about 60-70 EEGs per day.

The yield is as good as a 30-minute EEG. Our data say that it's about 45%-48% yield, which is very good. I think the 7-minute EEG in a rural situation would be as good as a 30-minute EEG.

Guha: I think, speaking to not only the diagnosis but also the treatment, you mentioned that you have done work with the government to expand the options and formulary that you offer to patients. Can you tell us what you were able to do to expand treatment options for your patients?

Surya: We have mobilized government to include the essential antiepileptic drugs in the essential medical list so that all of the newer medicines are available to patients. Ultimately, if you have the right diagnosis and the right medicines, 70% of patients are going to get better.

We have also involved the government in the awareness and the regular training of doctors in the district hospital because the neurologists are not available everywhere. These are the people who need to treat the patients, and that is what we have done.

Guha: Excellent.

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