Study of prevalence and management of epilepsy in Oman

A seizure represents the clinical manifestation of an abnormal uncontrolled electrical discharge from a group of neuron in the cerebral cortex. The signs and symptoms vary according to the site of neuronal discharge in the brain. Epilepsies are not hereditary diseases; they cannot be passed on from one generation to the next. Nevertheless there can be a cluster of cases of epilepsy in certain families. This is because as with many diseases, for instance diabetes or rheumatism the illness itself is not hereditary, but the predisposition to it is. Any additional disorder, e.g. complications during pregnancy or at birth, a serious illness or a head injury, can trigger the onset of epilepsy. It is, however, not always possible to find the actual trigger of the disease. Such a type of epilepsy, which is mainly caused by genetic disposition, is known as genetic epilepsy. In around one third of all epilepsies, the cause of the disease remains unknown. It is clear, therefore, that anyone can get epilepsy at any time in their life. Aim: The aim of the work was to study the prevalence, awareness and management of Epilepsy cases in Oman. Methodology: The study was conducted at the department of Neurology at SQU hospital, Royal hospital, Sohar hospital, Saham poly clinic by distributing a questionnaire to the doctors and patients. Also we took prescription from some hospitals, to identify which gender, age and type of drug is most common in our practice. Conclusion: Result of the study showed that number of males with epilepsy is more than females by 54% and most of them are treated by special drug management in ND using different types of antiepileptics depending on their condition. Correspondence to: Dr. Alka Ahuja, Professor of Pharmaceutics, Oman Medical College, Oman, E-mail: alkaahuja@yahoo.com Received: June 02, 2016; Accepted: June 27, 2016; Published: June 30, 2016 Introduction Epilepsy is caused by abnormal activity in brain cells and seizures can affect any process of your brain coordinates. Seizure signs and symptoms may include temporary confusion, a staring spell, uncontrollable jerking movements of the arms and legs, loss of consciousness or awareness and psychic symptoms. The goal of treatment is to manage and control symptoms, and to limit the number of seizures. Up to 70% of people could have their epilepsy controlled with medication (anti-epileptic drugs). Drug can be classified depending upon the type of seizures [1-5]. Wael M. Gabr et al. conducted a study and concluded that the assessment of medication adherence among epileptic patients should be a routine part of the management process to improve the health care and quality of lives of those patients [6]. The results show that from a total of 116 patients who were clinically examined during the study period in the Neurology Department at Riyadh National Hospital, Riyadh, Saudi Arabia, only 94 patients (81.0%) fulfilled the inclusion criteria within the study period. Abdullah Al-Asmi, et al. conducted a study and concluded that the semi-structured interview revealed the prevalence rate of 27% for depressive disorder and 45% for anxiety disorder [7]. The best compromise using, the cut-off score of 7 or 8, gave a sensitivity of 99% for depression and 83-91% for anxiety and a specificity of 87.5100% for depression and 85-94% for anxiety. Findings suggest that the Hospital Anxiety and Depression Scale (HADS) is a useful screening tool for this particular population. This finding is discussed from the socio-cultural perspective of Omani society. Samir al_adawi et al. conducted a study and concluded that epileptic patients who were attending tertiary hospital were found to have limited knowledge about their condition and as other chronic disorders; people with epilepsy in Oman should receive systemic health education about how to manage the condition most effectively [8]. Mahoko Furujo conducted a study and concluded that any patients with DHPR deficiency and seizures of partial onset can be treated successfully by increasing the dosage of Levetiracetam up to 2000 mg/ day which shows reduction in seizures without any adverse effect [9]. Amira Masri et al. conducted a study that showed children with afebrile seizure in the age between 1 and 12 months and control group of healthy children to determine the risk factors for epilepsy. From their study they classified the etiology of epilepsy to 3: symptomatic, cryptogenic and idiopathic. They concluded the study with the risk factors of epilepsy which is parental consanguinity, a family history of a global developmental delay, a family history of epilepsy and a positive perinatal history [10]. Ghaydaa A. Shehata and dalia G. Mahran conducted a study that showed the prevalence of epilepsy in Egypt. In high school students they did questionnaire for guardians students to know about their knowledge of epilepsy. After analyses of the questionnaire they concluded that all guardian students had the knowledge of epilepsy. Finally, they predicted that patient with epilepsy having more knowledge about epilepsy than other patient [11]. Al-Quraini AA (2016) Study of prevalence and management of epilepsy in Oman Volume 1(2): 32-38 Ment Health Addict Res, 2016 doi: 10.15761/MHAR.1000109 Renzo Guerrinia conducted a study and concluded that topiramate is effective and well tolerated when used as initial or second monotherapy. They also suggest that in a naturalistic setting, seizure freedom are observed at low doses in a broad spectrum of epilepsies [12]. Mohammad Ali Yadegarya conducted a study that showed that psychosocial variables can have incremental significance over biomedical variables in the health-related quality of life of patients with epilepsy. There was no significant difference in the two groups before the intervention and after the intervention [13]. Roshan Koul et al. conducted a study in forty-four children with diagnosed West syndrome (infantile spasms, mental retardation/ regression and hyperarrhythmia). They reported children constituting the symptomatic group, and still continuing their follow-up with them. Developmental delay before the onset of infantile spasms was reported. Brain computed tomography was abnormal. Sodium valproate and vigabatrin were the most often used drugs. Nine children achieved good seizure control. Out of which five have normal development. Only one child could be weaned off antiepileptic drugs completely. There was one death in the whole series, related to aspiration pneumonia [14]. Abdullah Al Asmi and his colleagues conducted a study and examined the use of CAM among people with epilepsy (PWE) in Oman. The majority of PWE attending tertiary care had utilized CAM. CAM users had not disclosed its use to their allopathic health-care provider(s). Spiritual healing and herbal concoctions are the most frequently used types of CAM. The use of CAM was highly associated with specific sociodemographic factors [15]. Objectives of the study The main objective of the present work was to study some epilepsy cases in Oman. Since this study has not been done in Oman and there is no data available about its prevalence, the aim of the study was to distribute the questionnaires to community, doctors and patients and to know about its prevalence and treatment in Oman. Hypothesis Epilepsy is one of the most common diseases in Oman. It is not much reported. Methodology The study was conducted at the departments of Neurology at SQU hospital, Royal hospital, Sohar hospital and Saham poly clinic in Oman. The study participants were patients with epilepsy who visited Neurology department. They were in the age group of 10-40 years. The prescriptions were used to extract the data. The collected data was analyzed using excel program in order to see which gender and age the patients belonged to and which drug was prescribed the most. The results were presented in a graph and table format: The following questionnaires were prepared


Introduction
Epilepsy is caused by abnormal activity in brain cells and seizures can affect any process of your brain coordinates. Seizure signs and symptoms may include temporary confusion, a staring spell, uncontrollable jerking movements of the arms and legs, loss of consciousness or awareness and psychic symptoms. The goal of treatment is to manage and control symptoms, and to limit the number of seizures. Up to 70% of people could have their epilepsy controlled with medication (anti-epileptic drugs). Drug can be classified depending upon the type of seizures [1-5].
Wael M. Gabr et al. conducted a study and concluded that the assessment of medication adherence among epileptic patients should be a routine part of the management process to improve the health care and quality of lives of those patients [6]. The results show that from a total of 116 patients who were clinically examined during the study period in the Neurology Department at Riyadh National Hospital, Riyadh, Saudi Arabia, only 94 patients (81.0%) fulfilled the inclusion criteria within the study period.
Abdullah Al-Asmi, et al. conducted a study and concluded that the semi-structured interview revealed the prevalence rate of 27% for depressive disorder and 45% for anxiety disorder [7]. The best compromise using, the cut-off score of 7 or 8, gave a sensitivity of 99% for depression and 83-91% for anxiety and a specificity of 87.5-100% for depression and 85-94% for anxiety. Findings suggest that the Hospital Anxiety and Depression Scale (HADS) is a useful screening tool for this particular population. This finding is discussed from the socio-cultural perspective of Omani society.
Samir al_adawi et al. conducted a study and concluded that epileptic patients who were attending tertiary hospital were found to have limited knowledge about their condition and as other chronic disorders; people with epilepsy in Oman should receive systemic health education about how to manage the condition most effectively [8].
Mahoko Furujo conducted a study and concluded that any patients with DHPR deficiency and seizures of partial onset can be treated successfully by increasing the dosage of Levetiracetam up to 2000 mg/ day which shows reduction in seizures without any adverse effect [9]. Amira Masri et al. conducted a study that showed children with afebrile seizure in the age between 1 and 12 months and control group of healthy children to determine the risk factors for epilepsy. From their study they classified the etiology of epilepsy to 3: symptomatic, cryptogenic and idiopathic. They concluded the study with the risk factors of epilepsy which is parental consanguinity, a family history of a global developmental delay, a family history of epilepsy and a positive perinatal history [10].
Ghaydaa A. Shehata and dalia G. Mahran conducted a study that showed the prevalence of epilepsy in Egypt. In high school students they did questionnaire for guardians students to know about their knowledge of epilepsy. After analyses of the questionnaire they concluded that all guardian students had the knowledge of epilepsy. Finally, they predicted that patient with epilepsy having more knowledge about epilepsy than other patient [11].
Renzo Guerrinia conducted a study and concluded that topiramate is effective and well tolerated when used as initial or second monotherapy. They also suggest that in a naturalistic setting, seizure freedom are observed at low doses in a broad spectrum of epilepsies [12].
Mohammad Ali Yadegarya conducted a study that showed that psychosocial variables can have incremental significance over biomedical variables in the health-related quality of life of patients with epilepsy. There was no significant difference in the two groups before the intervention and after the intervention [13].
Roshan Koul et al. conducted a study in forty-four children with diagnosed West syndrome (infantile spasms, mental retardation/ regression and hyperarrhythmia). They reported children constituting the symptomatic group, and still continuing their follow-up with them. Developmental delay before the onset of infantile spasms was reported. Brain computed tomography was abnormal. Sodium valproate and vigabatrin were the most often used drugs. Nine children achieved good seizure control. Out of which five have normal development. Only one child could be weaned off antiepileptic drugs completely. There was one death in the whole series, related to aspiration pneumonia [14].
Abdullah Al Asmi and his colleagues conducted a study and examined the use of CAM among people with epilepsy (PWE) in Oman. The majority of PWE attending tertiary care had utilized CAM. CAM users had not disclosed its use to their allopathic health-care provider(s). Spiritual healing and herbal concoctions are the most frequently used types of CAM. The use of CAM was highly associated with specific sociodemographic factors [15].

Objectives of the study
The main objective of the present work was to study some epilepsy cases in Oman. Since this study has not been done in Oman and there is no data available about its prevalence, the aim of the study was to distribute the questionnaires to community, doctors and patients and to know about its prevalence and treatment in Oman.

Hypothesis
Epilepsy is one of the most common diseases in Oman. It is not much reported.

Methodology
The study was conducted at the departments of Neurology at SQU hospital, Royal hospital, Sohar hospital and Saham poly clinic in Oman. The study participants were patients with epilepsy who visited Neurology department. They were in the age group of 10-40 years. The prescriptions were used to extract the data. The collected data was analyzed using excel program in order to see which gender and age the patients belonged to and which drug was prescribed the most. The results were presented in a graph and table format: The following questionnaires were prepared For the patients: The patients were given the following questionnaire and were asked for their opinion about certain points (Figure 1).

For the doctors:
The doctors were given the following questionnaire and were asked for their opinion about certain points (Figure 2).
For the community: Following questions were asked to the community people ( Figure  3). They were told to reply and were assured that their replies would be kept confidential (Figure 4).
Following questions were asked and the people were requested to give their opinion about the disease.

Result and discussion
According to the response to the community questionnaire that     was distributed in different regions in Oman namely Saham , Bahla, Nakhal and Suaqu, to a total of 100 people, following responses were obtained.
Out of 100 people, 77% knew person with epilepsy while 23% said No. 43% of people had seen someone having seizure but on the other side 57% said they had not seen anyone having a seizure. About 60% of people had no idea what to do if there was someone with seizure while 40% of people had an idea of what to do. Most of the people, approximately 64% disagreed to employ a person with epilepsy while 36% agreed. Majority of Omanis, about 98% thought that this disease is not contagious disease and 2% felt that it's contagious. About 58% said Yes that epilepsy patients must avoid flashing lights while 42% said No. Approximately 42% of people thought that all seizures involved falling to the ground followed by jerking movements. 77% of Omanis said No and about 23% answer Yes when they were asked if all seizures required immediate medical intervention or not. About 39% Omanis thought that epilepsy could affect the person's intelligence while 61% answered with No. About 39% said there is social stigma attached to those who have epilepsy while 61% of people disagreed with that ( Figure 4).
For comments questions 1. Majority of the people, about 43% felt that Epilepy is hereditary, about 36% said that it is Neural and 17% felt that it could be psychological causes and 4% thought that there might be spiritual reason behind that ( Figure 5).

2.
Regarding its treatment about 65% felt that treatment with medicines is needed while 27% answered herbal or massage and about 4% suggested Holy Quran could be the treatment and (4%) of people said there's unkown treatment ( Figure 6).
3. About 86% think people with epilepsy should be employed in jobs like other people while about 14 % disagreed (Figure 7). 4. About 58% of people answered that the patients should be taken to the hospitals while 25% said they can be treated at home and about 17% did not know what to do (Figure 8).

Patient's respones to the questionnaires
According to 50 patient's questionnaires that were distributed in different polyclinics and Health centers such as Saham polyclinic and Nizwa hospital.etc., the results are as such: Out of 50 patients, 21 (42%) had primary school education, 10 patients (20%) were at the university, about 9 patients (18%) had high school education and 10 patients (20%) were illiterate.
The answers to the questions are as follows: 1. Do you feel comfortable telling your friends and family members that you have epilepsy? (Figure 9) 2. According to your experience with disease epilepsy, do you think that has to do with spiritual reasons related to harm and the jinn? (Figure 10) 3. Do you think that friends and family member's attitude towards you changed after you told them that you have epilepsy? (Figure 11) 4. Do you feel that the family has a role in alleviating the symptoms of the disease? 5. Do you think that you receive appropriate treatment and care    Pie chart shows that the percentage of those who agreed was 50%, 33% disagreed and 17 % were uncertain.
Q2. Patients with epilepsy are less able than others to establish close relationships.     17% agreed, 67% disagreed and 17% uncertain Q20. Patients with epilepsy should not get married.

100% disagreed
Total number of epileptic patients in the study was 74 in number. The study was conducted on 43 patients. Questionnaires were distributed for patient in different hospitals namely Saham polyclinic, Royal and SQU hospital. 33 (77%) of patients were males and 10 (23%) were females (Table 1).
Patients with epileptic disease who visited neurological department in different age groups were as shown in Table 2. The pattern of medication use for epileptic patients was shown in Table 3. Number of patients who took single antiepileptic agent like Sodium valproate was 4(33.3%) ( Table 4). Patients who took Carbamazpine were 3(25%) and levetiracetam had same percentage. Two patients (16.6%) took Lamotrigine. All two combinations had the same percentage (Table 5).

Summary and conclusion
The main objective of this study was to study some epilepsy cases in Oman by distributing questionnaires to community, doctors and patients. Main aim was to study about its prevalence and treatment in Oman and to analyze the results of questionnaires. All the objectives of this study were achieved. Results of the study showed that epileptic patients were provided by a special drug management in ND by different types of antiepileptics depending on their condition. The most common drug was sodium valproate. On the other side we found that Omanis had Knowledge about this disease but they do lack the

Number of males Number of females
Number of patients in each gender 33 10 Percentage 77% 23%  experience on how to deal with this kind of disease. Also we concluded that the number of male patients in Oman is more than female by 54% difference.