Note: This is the third of a series on Epilepsy Awareness–an effort to help the Philippine League Against Epilepsy.
Like any other condition or ailment, epilepsy should be accurately diagnosed so that a proper and effective treatment program can be administered.
The diagnosis should be done by a doctor who is familiar with epilepsy in order to be able to achieve good clinical evaluation. In addition, other tests like an EEG (electroencephalogram) may be requested to confirm and classify the epilepsy; as well as a CT Scan or MRI of the brain, to find out what is actually causing it. In the Philippines, an EEG costs from between P800 to P2500 pesos while an CT scan costs P5,000 to P6,000. Meanwhile, an MRI is between P7,000 to 12,000.
Once epilepsy is diagnosed, it is important to begin treatment as soon as possible. Research suggests that medication and other treatments may be less successful in treating epilepsy when delayed and when seizures and their consequences have become established so proper diagnosis at the onset could not be stressed enough.
The doctors who treat epilepsy come from many different fields of medicine. They include neurologists, pediatricians, pediatric neurologists, internists, and family physicians, as well as neurosurgeons and doctors called epileptologists. These are the ones who specialize in treating epilepsy.
Patients who need specialized or intensive care for epilepsy may be treated at large Epilepsy centers (like at St Luke’s Medical Center, Philippine General Hospital, Medical City, Makati Medical Center, or Philippine Children’s Medical Center) and neurology clinics at hospitals or by neurologists in private practice.
Medications and other treatments help manage seizures. There are now more than 12 different anti-epileptic drugs now on the Philippine market, all with different benefits as well as side effects. The choice of which drug to prescribe and the dosage depends on many different factors, including the type of seizures a person has, the patient’s lifestyle and age, how frequently the seizures occur, and, for a woman, the likelihood that she will become pregnant. People with epilepsy should follow their doctor’s advice and share any concerns that they may have regarding their medication.
For most people with epilepsy, seizures can be controlled with just one drug at the right dose, taken at the right time. Using a combination of too many drugs can usually worsen or aggravate side effects, such as fatigue and decreased appetite, so doctors usually prescribe monotherapy, which is the use of just one drug, as much as possible. In rare cases, combinations of drugs are prescribed if monotherapy fails to effectively control a patient’s seizures.
Patients have to take medications 1-3x/day, everyday, for several years and other cases, for their entire lifetime. Some 20-30% of patients, however, may continue to have seizures that impact their daily lives in spite of medications. People taking epilepsy medication should be sure to check with their doctor and/or seek a second medical opinion if their medication does not appear to be working or if it causes unexpected side effects.
Side Effects of Anti-epileptic Drugs
In the Philippines we have 12 antiepileptic drugs available and there are several generic versions of these drugs, which make treatment more affordable for patients.
Most side effects of anti-epileptic drugs are relatively minor. These are fatigue, dizziness, or weight gain. However, severe and life-threatening side effects such as allergic reactions may also occur.
Epilepsy medication also may predispose people to developing depression or psychoses. That is why people with epilepsy should consult a doctor immediately if they develop any kind of rash, or if they find themselves depressed, or otherwise unable to think in a rational manner while on medication.
If the seizures are controlled within two to five years of continuous treatment, the medications are eventually tapered and discontinued upon the advise of the doctor to prevent any more side effects.
Doctors Who Can Treat Epilepsy
Currently, there are 358 certified neurologists in the country. Yes, each one is numbered and registered. These are doctors who are specially trained to handle diseases of the brain, such as epilepsy. Given the population in the Philippines, this tells us that there is neurologist to patient ratio of 258,000 Filipinos/neurologist. If you take the estimated number of persons with epilepsy for each neurologist, the ratio would be 2,568 epilepsy patients/neurologist.
However, the distribution of specialists/neurologists in the country is uneven, as most specialists practice in the NCR region. This leaves a lot of areas in the country with no access to a neurologist. In these areas, government doctors, internists, pediatricians or family or general practitioners are the ones who handle epilepsy and most of them admit to lacking confidence in handling the condition.
Meanwhile, there are 20 epileptologists, neurologists/neurosurgeons with special training / interests in epilepsy care and management .
Only two neurosurgeons in the country are specially trained in epilepsy surgery. It comes as no surprise then that epilepsy surgery is underutilized in the country. Utilization rate is only at 18%.
Epilepsy has received very little government attention in the past decades mainly due to high priority being given to urgent problems like heart disease, cancer, dengue fever, PTB and other infectious diseases.
Thankfully, there are several organizations that actively work to educate, advocate, and facilitate epilepsy care in the country namely, the Philippine League Against Epilepsy, Epilepsy Awareness and Advocacy Inc, Philippine Neurological Association, and Child Neurology Society of the Philippines.
Epilepsy was included among the six diseases of concern under the National Mental Health Policy formulated by the Dept of Health in 2002.
CURRENT STATE OF EPILEPSY CARE IN THE PHILIPPINES
The Philippine League Against Epilepsy launched the National Epilepsy Campaign in 2001. This is an active and ongoing campaign that consists of:
1. Promoting public awareness of epilepsy by:
a. Multimedia campaign
b. Working for the declaration of National Epilepsy Awareness week and a National Declaration on Epilepsy and guaranteeing its yearly implementation
2. Enhancing training of health workers involved in the care of epilepsy patients
a. Giving lectures and training to primary health care physicians and barangay health workers on epilepsy
b. Organizing high level scientific meetings/congresses to update the level of understanding of neurologists and other professionals who work in the field of epilepsy
c. In depth one-year training of selected/volunteer primary health care physicians in pilot areas under the “Epilepsy Manager Program”
There are ,however, areas where focused effort and resources are still needed to close the treatment gap:
1. Costs of diagnostic examinations
2. Cost and availability of antiepileptic drugs
3. Promotion of epilepsy surgeryas an alternative treatment
4. Funding for population based research on epilepsy