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Dealing with epilepsy

BAVINA SOOKDEO World Brain Day, observed annually on July 22, aims to raise awareness about brain health and neurological disorders. This year, the theme Brain Health for All Ages highlights the importance of protecting the brain at every stage of life, and one epilepsy neurosurgeon is urging the public to “prioritise your brain health and of those around you – our brain defines who we are.” Dr Wesley T Ramcharan noted that epilepsy remains a significant concern in Trinidad and Tobago. According to the Pan American Health Organization (PAHO), the local prevalence is estimated at 400 to 600 cases per 100,000 people, aligning with international statistics. “While this represents a small segment of the population, it is nonetheless a significant one, with a mortality rate of just under two deaths per 100,000 population attributable to the condition. We see cases across all demographics, from children to the elderly.” Ramcharan, 36, began his academic journey in 2007 at the UWI, and after spending a few years in neurosurgery in TT, he moved to the UK where he spent a substantial number of years in adult and paediatric neurosurgical speciality training and sub-speciality training in epilepsy neurosurgery, key-hole skull base surgery and surgical neuro-oncology. He was trained in both Bristol and Oxford in the UK. Ramcharan said the complexity of the human brain ignited his interest and “It drove me to deepen my understanding of its mechanisms.” He explained that neurosurgery transcends basic procedures like drilling and tissue removal; it’s a meticulous process of mapping brain functions to protect vital regions, skilfully navigating intricate neural pathways and ultimately aiming to restore function for significant patient improvement. As for his fascination in epilepsy surgery, that fire was lit during his time in Bristol where he had the privilege of being trained by Michael Carter, the senior consultant paediatric epilepsy surgeon who leads the southwest supra-regional children’s epilepsy surgery service in England. “Witnessing the remarkable improvements in children’s cognition and development after successful epilepsy surgery was profoundly rewarding,” Ramcharan recalled. This direct experience deeply inspired him to specialise in this field, driven by a strong desire to bring similar life-changing help to those in need in TT. “My mission is to provide exceptional, first-world healthcare in the area of neurosurgery and to improve access to high quality neurological care in our country.” When asked to explain epilepsy, Ramcharan said, “Imagine your brain as a magnificent orchestra, where every instrument plays in perfect harmony, creating a beautiful symphony. Epilepsy is like a sudden, unprompted burst of chaotic noise from a section of that orchestra – an electrical ‘short circuit’ that temporarily overwhelms the normal brain activity. This disruption can manifest in various ways – from a brief moment of staring blankly to dramatic convulsions, all depending on where in the brain this ‘storm’ occurs.” Epilepsy can be caused by a variety of factors, but Ramcharan said, “Sometimes, there’s no clear cause, which is called idiopathic epilepsy.” Other common causes include head injuries, strokes, brain tumours, infections like meningitis or encephalitis, and even developmental abnormalities present from birth. Certain genetic predispositions also play a role. As for triggers, Ramcharan explained they vary widely among individuals but can include stress, lack of sleep, flashing lights (photosensitivity), alcohol, certain medications or even hormonal changes in women.” He said brain disorders in general, including stroke, neurodegenerative diseases and neurological complications of chronic non-communicable diseases, represent “a significant public health burden here.” [caption id="attachment_1167795" align="alignnone" width="695"] Epilepsy neurosurgeon Dr Wesley T Ramcharan. -[/caption] Ramcharan said there are many conditions that can cause seizures, such as trauma, fevers, brain infections, tumours and inflammatory disorders. He noted that epilepsy is a brain disorder which predisposes someone to have repeated seizures. For a person to be diagnosed with epilepsy, he/she needs to have had at least two seizures that weren’t caused by something specific (like a very high fever), and these seizures must have happened more than 24 hours apart. “It can also mean having one seizure that wasn’t provoked, but there’s a very high chance of having more (like the chance after two seizures) or being diagnosed with a specific type of epilepsy. So just because someone has one seizure, it doesn’t automatically mean they have epilepsy,” he stressed. In TT, diagnosis usually involves a detailed medical history, physical and neurological exams and key diagnostic tools such as electroencephalography (EEG) and magnetic resonance imaging (MRI). He emphasised that early diagnosis is incredibly important as it allows for prompt initiation of treatment, which can help control seizures, prevent injury and minimise the long-term impact on brain development and cognitive function, especially in children. He advised parents or individuals to look out for: · Repetitive, uncontrolled movements of the limbs or body. · Staring spells or brief periods of unresponsiveness. · Sudden falls for no apparent reason. · Confusion or disorientation followed by unusual behaviour. · Jerking movements or muscle stiffening. · Brief, inexplicable changes in awareness or sensation. Any recurrent, unusual neurological event should prompt a medical consultation. While Ramcharan is working tirelessly to improve access to healthcare and the lives of those with epilepsy, stigma associated with the disorder remains widespread. “Misconceptions and fear can lead to isolation, discrimination in employment and educational barriers.” Another challenge some epileptic sufferers face is access to certain medications. “While some anti-epileptic medications for the initial treatment of epilepsy are available on CDAP, fourth- and fifth-line medications may be unavailable and quite costly to purchase privately. Diagnostic delays can also lead to worsened morbidity.” [caption id="attachment_1167797" align="alignnone" width="1024"] Diagnosing epilepsy usually involves a detailed medical history, physical and neurological exams and key diagnostic tools such as electroencephalography and magnetic resonance imaging. -[/caption] The neurosurgeon also pointed out that while diagnostic tools are available, access can sometimes be a challenge as there is a lack of specialised EEGs (like video-EEG monitoring, crucial for complex cases) and MRI availability can vary, sometimes leading to wait times, particularly in the public sector. “A significant investment in upgrading and expanding these diagnostic capabilities is essential,” he emphasised. “There is also a desperate need for staff such as neuropsychologists, neurophysiologists, occupational therapists, speech and language therapists and rehabilitation specialists.” Ramcharan also believes there is a significant gap in public understanding and awareness about epilepsy locally, as many harmful myths and misconceptions persist. To remedy this, he suggested “improved, widespread and sustained public education campaigns geared towards demystifying epilepsy – explaining what a seizure looks like, how to provide first aid safely – and emphasising that epilepsy is a treatable medical condition, not a spiritual curse or a sign of weakness.” He thinks it is especially important to train teachers to recognise epilepsy in children. “This has been a successful programme which we started in Bristol and would be very beneficial in our local schools.” Some epilepsy myths he has heard as a medical practitioner include: - Myth: You should put something in someone's mouth during a seizure. Fact: “Never do this! It can cause serious injury to the person having the seizure or to the helper. Instead, clear the area, gently turn them on their side, and protect their head.” - Myth: Epilepsy is a mental illness or contagious. Fact: “Epilepsy is a neurological condition of the brain, not a mental illness, and it is not contagious” he said. - Myth: People with epilepsy are intellectually disabled. Fact: “Most people with epilepsy have normal intelligence and lead productive lives.” - Myth: All seizures involve convulsions. Fact: “Seizures can take many forms – from subtle staring spells to sensory changes, without any visible convulsions.” There are a wide range of anti-epileptic drugs or AEDs available on the market, he said. “For many patients, these medications effectively control seizures. For those whose seizures are not controlled by medication (drug-resistant epilepsy), surgical evaluation for respective surgery or device implantation (like vagus nerve stimulation) is an option.” When it comes to epilepsy in children, Ramcharan said doctors have started to look at surgical management as the primary treatment “to prevent propagation of the seizure pathway and development of secondary seizure foci (a brain region outside the primary seizure focus that becomes involved in the seizure process).” Unfortunately, local neurosurgical options remain limited. “We are however still far from international best practices as other common procedures are not performed locally, like complete corpus callosotomies and hemispherotomies. Depth electrode placement, which can be used to break seizure pathways, is also unavailable, stemming from a lack of proper equipment.” He said public hospitals critically lack fundamental resources for neurological procedures, and to bring the healthcare system up to an acceptable standard, he advocates for substantial investment in neurological care. “This includes broader access to vital diagnostic tools like EEGs, PET CTs, and MRIs. Furthermore, we desperately need functional and accurate microscopes, neuro-navigation systems, neuro-physiological monitoring equipment, neuropsychologists for awake brain testing, functional intra-operative ultrasounds, and seizure monitoring. The unmet needs extend far beyond this list.” Asked what this year’s theme means to him, Ramcharan explained that as both an adult and paediatric neurosurgeon, he treats brain conditions from the foetal stage through to old age. He emphasised that brain health begins not at birth, but in the womb, and requires lifelong attention. “For me, it means advocating for preventive measures from childhood, ensuring early diagnosis and intervention for neurological conditions at any age and providing equitable access to care regardless of socio-economic status. A healthy brain is fundamental to a healthy life. "Don’t take it for granted. Educate yourselves, support your friends and family with brain conditions and seek medical advice early. The healthier our collective mind, the healthier the population.” He said healthy brain function is supported by: - Pre-natal vitamins for proper foetal brain development. - Correct nutrition for babies and children. - Avoidance of smoking, alcohol and drugs as these impair the development of the brain. - Staying physically active, eating balanced meals and getting adequate sleep to boost working memory and concentration. - Taking omega 3 fatty acids and keeping mentally engaged with puzzles, hobbies and instruments (especially in old age). Proper social interaction can also ward off cognitive decline and depression. - Managing stress and chronic conditions like hypertension, diabetes and high cholesterol, which can lead to strokes and other brain damage.   The post Dealing with epilepsy appeared first on Trinidad and Tobago Newsday.