Wholesome approach needed to treat disability from epilepsy

METHODOLOGY ASPECT: (From left) Mile Kerr, professor of learning disability, Cardiff University; N.S. Murali, secretary, VHS; C.V. Krishnaswamy, head, diabetology, VHS; Krishnamoorthy Srinivas, in whose name an oration was delivered; Ann Jacoby, professor of medical sociology, University of Liverpool; and Gus Baker, head, neurosciences, University of Liverpool, at a workshop in Chennai on Saturday.   | Photo Credit: — Photo: N. Sridharan

Special Correspondent

“Neuro-psychiatric illness adds to disease burden”

CHENNAI: Integrating medical aspects of treating a disability of the brain and mind with the psychological and social perspectives is essential to treat it through the entire course.

Speaking on all three aspects of treating disability caused by epilepsy at the invitation of the Neurosciences India Group, specialists agreed that a wholesome approach would be ideal.

Delivering the Appa Rao Endowment Oration on ‘The Disabled Brain and Mind-A Neuropsychiatric Perspective,’ Mike Kerr, professor of learning disability, Cardiff University’s School of Medicine, Wales, said neuro-psychiatric illnesses contributed greatly to the burden of disease, thereby disability. The social model, on the other hand, considered that the restrictions and attitudes of society led to impairments, causing the disability.

He pointed out that the medical model viewed disability as a result of internal impairments caused by neurological and psychiatric conditions. The impact of epilepsy would be mortality, injury, hospitalisation, emotions, cognitive impairment, social impact, stigma, unemployment and high risk of suicides. Treating the seizures could improve mortality and reduce injuries, and treating the psychiatric co-morbidities had shown to reduce suicidal tendencies, depression and anxiety.

Delivering the Dr. Lakshminarayanan Oration on ‘The Disabled Brian and Mind-A Psychological Perspective,’ Gus Baker, head, division of neurosciences, University of Liverpool, said the understanding of epilepsy as a disorder of the brain had evolved considerably. However, less progress had been made in understanding how and why the individual reacted to such a condition. Since all behaviour could not be explained simply by brain dysfunction, the changes must be viewed in the context of the internal self and the social being.

In epilepsy, there were higher rates of aggression, hypo-sexuality, psychosis, emotionality, depression, anxiety, low self-esteem and self-efficacy and cognitive problems such as reduced attention/concentration and impaired memory. Studies had shown that those who were seizure-free were less likely to be anxious, indicating that control of seizures was important. However, he said, it was equally important to identify the nature of the neuropsychological problem, conduct assessments and provide feedback to patients and family to ameliorate these problems.

Ann Jacoby, professor of Medical Sociology, University of Liverpool, focused on the ‘Social Perspective.’ She dwelt on the social meaning of conditions of ill-health and its relation to the stigma and discrimination of being associated with such conditions. In the Dr. Krishnamoorthy Srinivas Endowment Oration on Saturday, Dr. Jacoby indicated that incorporating the sociological and psychological perspectives, along with the medical, could help in a total understanding.

Societal stigma and discrimination severely impacted the quality of life of persons with epilepsy. Those feeling stigma showed helplessness and were insecure because of unemployment, the resulting financial instability and social adjustability issues. The desire to conceal their condition prevented people from managing it.

C.V. Krishnaswami, head, Diabetes Department, Voluntary Health Services; N.S. Murali, secretary, VHS; and E.S. Krishnamoorthy, director, the Institute of Neurological Sciences, VHS, spoke. Neeradha Chandramohan, director, National Institute for Empowerment of Multiple Disabilities, chaired the sessions.