Many Epileptics Suffer in Silence, Study Finds

In 2005, some time after Horn Chamnap had turned 16 years old, the teenager from Prey Veng City started to experience violent nighttime convulsions during which he would lose consciousness.

“When it came to me, it made my hands shake, and then I went unconscious for about 15 to 30 minutes,” Mr Chamnap said. As the seizures became more frequent, sometimes occurring 20 nights in a month, he grew more worried about his future.

“I was afraid, and I could not go far from my house,” he said Tuesday. “It felt dramatic and I thought I was born with this disease and might never be able to get cured.”

His family sought treatment at a local health clinic, but without success. “They gave me medicine, but it did not work,” he said.

So Mr Chamnap went without effective treatment until early last year, when researchers conducting a field study on the prevalence of epilepsy diagnosed him with the neurological disorder and he finally received medication. “Now, I am OK, and I am happy,” Mr Chamnap said.

According to the researchers, who published their study in medical journal Epilepsia this month, an estimated 85,000 Cambodians live with epilepsy, and like Mr Chamnap, most struggle to get treatment, as about 85 percent receive no effective medicine or simply go untreated.

“Because of poverty people don’t seek treatment, or when they go to primary health centers they don’t know how to treat them,” Chan Samleng, chief of neurology at Phnom Penh’s Calmette Hospital, said in an interview on Tuesday.

Epilepsy–called “Cha’kuot Chrouk” or mad pig disease in Khmer language–is a chronic condition in which episodes of abnormal electrical activity in the brain lead to seizures.

It is one of the most common neurological disorders among Cambodians yet there are no health programs targeting the condition and until recently medical professionals received little training about epilepsy treatment, Dr Samleng said, adding that few people know that treatment is freely available.

To address the issue researchers from Calmette Hospital, the University of Health Sciences and the University of Limoges in France starting in 2009 conducted the first large-scale study on the prevalence of epilepsy in Cambodia by screening 16,510 people in Prey Veng province.

They found that 58 out of every 10,000 people had the disorder, which amounts to an estimated 85,629 epilepsy patients nationwide, most of whom are under 20 years old.

Although this group is large, epilepsy is less common in Cambodia than in the rest of the region, according to researcher Devender Bhalla from the University of Limoges, who said that studies in Vietnam and Thailand had found 107 cases and 72 cases of epilepsy per 10,000 people, respectively.

Dr Bhalla said one reason that might explain the lower epilepsy prevalence in Cambodia was that due a difference in eating habits Cambodians are less frequently infected by a pork tapeworm called taenia solium, which can have neurological effects. Other reasons, he added, could be relatively low rates of drug and alcohol use in Cambodia.

However, compared to that of Western countries, Cambodia’s epilepsy prevalence is still high, he said, and it often results from preventable causes, such as head trauma, common complications during childbirth and a high frequency of infections that go untreated because of poor healthcare facilities.

Epileptic seizures often have severe social implications, Dr Bhalla said, and Cambodians suffering from epilepsy often try to hide the condition out of shame or because a patient is considered an unfavorable marriage partner.

Health risks of untreated epilepsy include a spread of lesions in the brain that can affect other neurological functions, while sudden seizures can also lead to accidents, such as drowning or traffic accidents.

“We had three cases [in Prey Veng] of people drowning in the rice field during the seizure. This is a very important risk,” he said.

However, the study also found that, unlike in many other countries in Asia and Africa, Cambodians do not have taboos or spiritual beliefs about epilepsy, but recognize it as a medical illness that needs treatment.

“They don’t think it’s supernatural disorder. It is very particular to this Cambodian population,” Dr Bhalla said. “But the problem is people are not aware that the treatment is available…and free of cost.” He stressed that low-cost, effective anti-epilepsy medicine was already available in the healthcare system.

To address epilepsy in Cambodia, researchers said they were trying to work with the Health Ministry and other organizations to develop a national epilepsy program, which would train medical professionals about the condition and spread awareness about available treatment among the public.

“It’s a treatable disorder. If we put in a little effort, we can control it more significantly than other disorders,” Dr Bhalla said.

Officials at the Health Ministry this week declined to comment on government efforts to combat epilepsy in Cambodia.

 

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