Question 1

What is epilepsy?

Accepted Answer

Epilepsy is a chronic neurological disorder characterised by recurrent unprovoked seizures — caused by abnormally excessive or synchronous electrical activity in the brain. It is not a single disease but rather a group of disorders with diverse causes, seizure types and treatments. Epilepsy affects approximately 50 million people globally — one of the world's most common neurological conditions, occurring in all ages, sexes, ethnicities and geographies.

Question 2

What causes epilepsy?

Accepted Answer

Structural causes: stroke, traumatic brain injury, brain tumours, cortical malformations. Infectious causes: neurocysticercosis (Taenia solium — the most common preventable cause), meningitis, HIV, cerebral malaria. Genetic causes: various ion channel and receptor mutations. Metabolic causes: hypoglycaemia, hyponatraemia. Immune causes: autoimmune encephalitis. In approximately 50% of cases, the cause is unknown ("idiopathic").

Question 3

What is the epilepsy treatment gap?

Accepted Answer

The epilepsy treatment gap is the proportion of people with active epilepsy not receiving appropriate treatment — approximately 75% in LMICs and up to 90% in parts of Africa. Causes: unavailability of antiseizure medicines in primary care; high cost; lack of trained healthcare workers to diagnose and manage epilepsy; cultural and religious beliefs attributing epilepsy to supernatural causes; and stigma preventing treatment-seeking.

Question 4

Can epilepsy be treated effectively?

Accepted Answer

Yes — 70% of people with epilepsy can become seizure-free with appropriate antiseizure medication. First-line medicines (phenobarbital, carbamazepine, valproate) are inexpensive and on the WHO Essential Medicines List. For drug-resistant epilepsy (30%), surgical resection, vagal nerve stimulation or dietary therapies (ketogenic diet) offer additional options. Primary health care integration of epilepsy management — as promoted by WHO IGAP — can close the treatment gap.

Question 5

What is the WHO IGAP 2022-2031?

Accepted Answer

The WHO Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders 2022-2031 provides a comprehensive framework for addressing epilepsy through: promoting epilepsy research; improving surveillance; strengthening health systems to include neurological care in primary health care; reducing treatment gaps; and addressing stigma. It targets a 50% reduction in the epilepsy treatment gap by 2031.

Question 6

What is neurocysticercosis?

Accepted Answer

Neurocysticercosis — from Taenia solium (pork tapeworm) larvae migrating to the brain — is the most common preventable cause of epilepsy in endemic regions (Latin America, Sub-Saharan Africa, South Asia). It accounts for up to 30% of epilepsy in endemic areas. Prevented by improved pig management, latrine use, meat inspection and community treatment. Treated with albendazole and praziquantel plus anti-inflammatory steroids.

Question 7

What is SUDEP?

Accepted Answer

Sudden Unexpected Death in Epilepsy (SUDEP) occurs in approximately 1 in 1,000 people with epilepsy per year — making it a significant cause of premature death. It typically occurs unwitnessed during or after a nocturnal convulsive seizure. The mechanism involves cardiac and respiratory dysfunction following a seizure. Seizure control through medication is the most important preventive measure; night-time monitoring and CPAP for sleep apnoea may also help.

Question 8

What is stigma in epilepsy?

Accepted Answer

In many cultures, epilepsy is attributed to supernatural possession, witchcraft or contagion — leading to stigma, social exclusion, discrimination in education and employment, and barriers to marriage. Stigma is a leading reason why people with epilepsy do not seek treatment. People touched by someone having a seizure may be unnecessarily prevented from doing so by fears of contagion. Anti-stigma education and community-based epilepsy programmes are essential components of IGAP.

Question 9

What is first aid for a seizure?

Accepted Answer

For generalised tonic-clonic (grand mal) seizures: stay calm; time the seizure; keep the person safe by cushioning the head and removing dangerous objects; turn them on their side (recovery position) when convulsions stop; stay until they are fully alert. Do NOT: hold them down; put anything in their mouth; give water until fully alert. Call emergency services if: the seizure lasts >5 minutes; the person doesn't regain consciousness; there are multiple seizures; or the person is injured.

Question 10

How does epilepsy affect children?

Accepted Answer

Epilepsy begins in childhood or adolescence in approximately 60% of cases. Childhood epilepsies include: absence seizures (brief staring spells); juvenile myoclonic epilepsy; infantile spasms (West syndrome — requiring urgent treatment to prevent developmental regression); and febrile seizures (seizures associated with fever in young children — usually benign). Uncontrolled epilepsy in children causes neurocognitive effects and disrupts education.

Question 11

What is drug-resistant epilepsy?

Accepted Answer

Approximately 30% of people with epilepsy have drug-resistant (pharmacoresistant) epilepsy — seizures persisting despite adequate trials of two tolerated, appropriately chosen antiseizure medicines. These patients should be evaluated for epilepsy surgery — resecting or disconnecting the seizure focus — which achieves seizure freedom in 60-80% of suitable candidates. Other options: vagal nerve stimulation, deep brain stimulation, ketogenic diet, newer ASMs.

Question 12

How does GMJ News cover epilepsy?

Accepted Answer

GMJ News covers WHO IGAP progress, antiseizure medicine access in LMICs, neurocysticercosis as a preventable cause, anti-stigma campaigns and SUDEP awareness. Epilepsy management quality in Georgian hospitals — including antiseizure medicine availability and neurological consultation access — is relevant to PHIG's healthcare quality work.

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