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Central nervous system infections are common causes of epilepsy in tropical areas, where many low- and middle-income countries are concentrated. Elimination of parasites in these environments and education on how to avoid infections can be effective ways to reduce epilepsy worldwide, for example those cases due to neurocysticercosis. Epilepsy accounts for 0.5% of the global burden of disease, a time-based measure that combines years of life lost due to premature mortality and time lived in less than full health. Epilepsy has significant economic implications in terms of health-care needs, premature death and lost work productivity. The economic impact of epilepsy varies significantly depending on the duration and severity of the condition, response to treatment, and the health-care setting.

Out-of-pocket costs and productivity losses create substantial burdens on households. An economic study from India estimated that public financing for both first- and second-line therapy and other medical costs alleviates the financial burden from epilepsy and is cost-effective (1) . Although the social effects vary from country to country, the stigma and discrimination that surround epilepsy worldwide are often more difficult to overcome than the seizures themselves. People living with epilepsy can be targets of prejudice. The stigma of the disease can discourage people from seeking treatment for symptoms, so as to avoid becoming identified with the disease. People with epilepsy can experience reduced access to educational opportunities, a withholding of the opportunity to obtain a driving license, barriers to enter particular occupations, and reduced access to health and life insurance. In many countries legislation reflects centuries of misunderstanding about epilepsy. For example: In both China and India, epilepsy is commonly viewed as a reason for prohibiting or annulling marriages.

In the United Kingdom of Great Britain and Northern Ireland, laws which permitted the annulment of a marriage on the grounds of epilepsy were not amended until 1971. In the United States of America, until the 1970s, it was legal to deny people with seizures access to restaurants, theatres, recreational centres and other public buildings. Legislation based on internationally-accepted human rights standards can prevent discrimination and rights violations, improve access to health-care services, and raise the quality of life for people with epilepsy. WHO and its partners recognize that epilepsy is a major public health concern. WHO, the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE) have led the Global Campaign Against Epilepsy to bring the disease “Out of the Shadows” to provide better information and raise awareness about epilepsy and to strengthen public and private efforts to improve care and reduce the disease’s impact. These efforts have contributed to the prioritization of epilepsy in many countries, which resulted in regional declarations in all six WHO regions. The WHO Region of the Americas endorsed the Strategy and Plan of Action on epilepsy in 2011 and the World Health Assembly (WHA) resolution on the global burden of epilepsy (WHA68.20) was approved in 2015. The Resolution urges Member States to take coordinated action against epilepsy and its consequences. Projects have been carried out in many countries to reduce the treatment gap and morbidity of people with epilepsy, to train and educate health professionals, to dispel stigma, to identify potential prevention strategies, and to develop models integrating epilepsy care into local health systems. Combining several innovative strategies, these projects have shown that there are simple, cost-effective ways to treat epilepsy in low-resource settings. The WHO Programme on reducing the epilepsy treatment gap and the mental health Gap Action Programme (mhGAP) seeks to achieve these goals in Ghana, Mozambique, Myanmar and Viet Nam. These projects focus on expanding the skills of primary care and nonspecialist health providers at the community level to diagnose, treat and follow up people with epilepsy. These four pilot programmes have led to a considerable increase in access, such that 6.5 million more people have access to treatment for epilepsy should they need it. Learn about our expanded patient care options for your health care needs. Tonic seizures cause a stiffening of muscles while clonic seizures are characterized by jerking or twitching. A seizure that originates in both halves (hemispheres) of the brain simultaneously, causing stiffness or twitching throughout the body, is known as a generalized tonic or clonic seizure. A tonic or clonic seizure can also begin in one area of the brain (called a partial or focal seizure), affecting only one part of the body such as an arm or a leg. Tonic or clonic seizures can start as partial and become generalized. Tonic (stiffness) Clonic (twitching/jerking) Generalized: starting all over the brain Generalized tonic seizures Generalized clonic seizures Partial (Focal): starting in one half of the brain Partial (focal) tonic seizures Partial (focal) clonic seizures. A tonic seizure causes a sudden stiffness or tension in the muscles of the arms, legs or trunk. The stiffness lasts about 20 seconds and is most likely to happen during sleep. Tonic seizures that occur while the person is standing may cause them to fall. After the seizure, the person may feel tired or confused.

People with Lennox-Gastaut syndrome or other types of epilepsy with mixed seizures are most likely to have tonic seizures, but they can happen to anyone. Clonic seizures are characterized by repeated jerking movements of the arms and legs on one or both sides of the body, sometimes with numbness or tingling. If it is a focal (partial) seizure, the person may be aware of what’s happening. During a generalized seizure, the person may be unconscious.

Clonic seizures can occur in people of all ages, including newborns and infants. First aid for a person having a tonic or clonic seizure involves protecting the person from injury, such as moving furniture or other items out of the way. It is important not to attempt to restrain the person or put anything in their mouth — “swallowing the tongue” is impossible.


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