Epilepsy organization established in Yemen

In Yemen, as in many other developing countries, there is an absence of community surveys indicating the prevalence of epilepsy. However, clinical observations of medical practices show that it is as common as in most other countries.

The Yemeni Epilepsy Organization was established June 6, 2007, as the first organization working for the cause of epilepsy in Yemen. Its aim is to improve medical services provided to epilepsy patients, to increase awareness of the disease among doctors, the public and relatives of patients, to manage neurologists’ scientific and practical activities, and to prepare educational programs for the mass media as well as students in schools and universities. Membership to the organization includes more than 70 neurologists and psychiatrists. “We support this organization using our own money because we have not found anybody or any organization to support us,” said Dr Hesham Awn, Chairman of the organization. “We plan to establish a charitable organization supervised by patients and their relatives to combat this disease.”  

A seizure occurs when a brief, strong surge of electrical activity affects part or all of the brain. Approximately one in 10 adults will experience a seizure sometime during their life. Seizures can last from a few seconds to a few minutes and affect a variety of mental and physical functions.  Epilepsy, however, is formally defined as a medical condition in which sufferers experience two or more seizures. This is also called a seizure disorder and affects about 0.5 percent of the population. 

Epileptics can have many symptoms -  from convulsions and loss of consciousness - to some that are not always recognized as seizures by the person experiencing them or even by healthcare professionals.  These more difficult to recognize symptoms include blank staring, lip smacking or jerking movements of the arms and legs. Due to cultural beliefs and myths about the treatment of epilepsy, the majority of Yemeni patients seek help first from national healers and secondly from health care professionals. Most of them are seen by general practitioners who lack sufficient knowledge, skills and experience in the pharmacological and psychosocial management of epilepsy. 

There is a great shortage in the number of neurologists working in Yemen, with only 10 neurologists for a population of 20 million. More importantly, they are present in only four governorates, while the remaining 17 are deprived of any neurological services. There are no specialized hospitals or centers for inpatient epileptic or neurological cases. Such cases are usually admitted to the medical wards of general hospitals. 

There are many problems encountered by healthcare professionals involved in epilepsy care in Yemen. Cultural beliefs about epilepsy, a shortage of professional staff with applicable training, lack of sufficient free drugs supplied by the Ministry of Public Health and Population and an absence of social and occupational rehabilitation services for epileptic patients are some of the many challenges faced in treatment. 

A study was conducted of 479 epilepsy cases in three Sana’a city medical centers over one year, from January to December 2003. The study, the first of its kind in Yemen, examined socio-demographic and diagnostic features of a sample of epileptic patients attending neuropsychiatric out-patient clinics.  

The study was published in volume 41(2) July 2004 of The Egyptian Journal of Neurology, Psychiatry and Neurosurgery and was conducted by Dr Abdul-Rahman Sallam and Dr Abdul-Elah al-Eryani from the Department of Neuropsychiatry at Sana’a University. 

The study showed that the majority - 54 percent - of epileptic cases were found in the 15-29 age group, and that males had a higher incidence than females. The sex distribution of epileptic cases in the study revealed a predominance of male cases (272) over female (207). About 43 percent of patients had a family history of the condition and another 35 percent of them had a previous history of physical illnesses related to epilepsy, with febrile convulsions being the most common, occuring in 15 percent of individuals in the study.  

The study also found the most common type of epilepsy among Yemeni patients to be partial epilepsy, at 53 percent. A partial seizure begins in one specific part of the brain and may spread to other areas. Results also showed that about 44 percent of patients were not taking medication according to their doctor’s instructions. 

Another study was conducted by researchers in the Faculty of Medicine and Health Science at Sana’a University in 2005 to estimate the rate of epilepsy among people in the Azal district of Sana’a governorate. About 14,000 families, including more than 100,000 people, participated in the study. Researchers found 1.3 percent of participants to be suffering from epilepsy, including 1.5 percent of males and 1.2 percent of females. Just over two percent were found to be in the 21-30 age group according to the study which was supervised by Dr Awn, a professor in the Department of Neuropsychiatry at Sana’a University. “Azal district does not necessarily reveal the real rate of epilepsy in Yemen,” said Dr Awn. “I hope to conduct a future survey which includes the whole of Yemen in order to establish more reliable statistics on the rate in the entire country.”  There are many different types of seizures. The kind of seizure a person has depends on which part and how much of the brain is affected by the electrical disturbance that produces seizures.

Sometimes seizures are related to a temporary condition, such as exposure to or withdrawal from drugs or abnormal levels of sodium or glucose in the blood. In such cases, repeated seizures may not recur once the underlying problem is corrected.

In other cases, injury to the brain (for example a stroke or head injury) causes brain tissue to be abnormally excitable. In some people, an inherited abnormality affects nerve cells in the brain, which leads to seizures.

Some seizures are idiopathic, which means the cause cannot be identified. Such seizures usually occur in individuals between the ages of 5 and 20 years, but can occur at any age. People with this condition have no other neurological problems, but often have a family history of seizures or epilepsy.

“In Yemen, males are more prone than females because they are more likely to suffer from head traumas caused by fighting, falling and the like,” said Dr Mahfoud al-Khulaidi, an epileptic consultant. “The absence of care required for pregnant women has negative effects on babies and may lead to epilepsy. A lot of pregnant Yemeni mothers take medicines which are not prescribed by doctors, or they may be left without proper treatment for diseases during pregnancy,” he said. “Most epileptic Yemeni children are found to have a positive family history of the disease. Epidemic diseases, such as malaria, are another cause of the condition in many Yemeni children.”

According to Dr al-Khulaidi, about 50 percent of epileptic patients received are children, with 30 percent being boys and 20 percent girls. 

There is no cure for epilepsy, but medication is usually very successful in its treatment. In four out of five cases, proper medication can reduce the number of seizures a person has. Sometimes, treatment can stop seizures happening altogether. 

“There is a very serious problem related to the treatment of this disease  in Yemen,” said Dr al-Khulaidi. “Many doctors who are not neurologists do not transfer epileptic patients to specialists, but try to treat them using known medicines on their own. There are no statistics [to refer to] because there is no center established for the treatment of this type of disease in Yemen.”

“The situation of the treatment of neurotic and psychiatric diseases in Yemen is very bad and is disappointing,” said Dr al-Khulaidi. “All countries support diseases of this sort except Yemen. Many poor patients stop taking medicine after a short time because neuropsychiatric medicines are very expensive. We also cannot prescribe the best medicines because of their expensive costs.” Dr al-Khulaidi added that in Yemen there are only private medical centers specializing in the treatment of such conditions, not public government facilities, which restricts access to treatment for much of Yemen’s population.

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