CHAPTER ONE
INTRODUCTION
1.0 Background of the study;
 Epilepsy is the most common non-infectious neurologic disease in developing African countries, including Nigeria and it remains a major medical and social problem. Historically, epilepsy was believed to be a sacred disease that is the result of the invasion of the body by a god. It was thought that only a god could deprive a healthy man of his senses, throw him to the ground, convulse him and then rapidly restore him to his former self again. The word `lunatic' was first applied to sufferers of epilepsy as gods were thought to occupy heavenly spheres, one of which was the moon. In contrast, mad people were referred to as maniacs' whose madness was a result of invasion of the body by devils or evil spirits. The ‘Dictator Perpetuus’ of the Roman Empire, the great Julius Caesar likely had epilepsy on the basis of documented four attacks that were probably complex partial seizures. Also, it is possible that he had absence attacks as a child and as a teenager. His son, Caesarion, and his great-great-great grandnephews Caligula and Britannicus also had seizures. The etiology of epilepsy in this Julio-Claudia family is probably linked to inheritance. [1]
This historical legacy has continued to influence public attitude to epilepsy making it a dreaded disease. These beliefs have resulted in patients with epilepsy (PWE) being ostracized, stigmatized and misunderstood. The social implications are serious. For instance, in Madagascar, patients with epilepsy are refused burial in the family grave. In many African countries, the PWE is an out-cast 6 as Africans believe that the disease results from visitation of the devil, effect of witch-craft, the revenge of an aggrieved ancestral spirit or consumption of something harmful in uterus. Suicide or attempted suicide is not uncommon among Nigerians who suffer from epilepsy. The patient with epilepsy is likely to drop out of school, lose his job, finds it Benin Journal of Postgraduate Medicine A. Ogunrin Olubunmi 28 impossible to marry, loses his wife or her husband, and be tormented to the extent of becoming a vagrant vagabond. The remarkable issue raised by Hippocrates' famous treatise on the `Sacred Disease' was his belief that epilepsy was not sacred, that the brain was the seat of the disease. In the latter half of the nineteenth century, Hughlings Jackson defined epilepsy on the basis of a neuronal theory. About three decades later, William Gowers observed a link between epilepsy and cognitive deterioration. He noted that defective memory, especially for recent acquisitions and weakened capacity for attention are frequently encountered cognitive impairments in epileptic patients. This observation was not novel as Tissot in 1770 in his `Traite' de L`Epileptic' wrote that he had never seen a patient with epilepsy whose fits were not very rare not complaining about a weakening of memory.[1][2]
1.1 Statement of the problem;
 Definition According to the World Health Organization dictionary of Epilepsy, epilepsy is defined as a `chronic disorder of the central nervous system of various etiologies characterized by recurrent seizures due to excessive discharge of cerebral neurones. Single or occasional seizures as well as those occurring during an acute illness should not be classified as epilepsy. Epidemiology At a conservative estimate, 50 million people worldwide have epilepsy with an annual incidence ranging from 20 to 70 cases per 100,000 15 and the point prevalence of 0.4 to 0.8 percent16. The incidence rates are highest in childhood, plateaus from the age of 15 to 65 years, and rise again among the elderly. Most patients suffering from epilepsy in African countries prefer anonymity and are reluctant to disclose their condition because of the stigma attached to the disease. This factor affects the prevalence rates hence there is likelihood that most of the reported prevalence rates represent a `tip of the ice-berg' as the chances of under-reporting are high. The prevalence rates of epilepsy reported in Africa are based on surveys of defined communities and hospital admissions. The prevalence of epilepsy is particularly high in developing countries especially in Latin America and several African countries, notably Liberia, Nigeria and United Republic of Tanzania 1 compare with the prevalence rates of between 4 and 6 per 1000 which have been reported among Caucasians16. In Nigeria, its prevalence, based on defined communities, varies from 15 to 37 per 1000. However one of the early publications17 on the prevalence of epilepsy in Nigeria reported a prevalence of between 8 and 13 per 1000 inhabitants in the urban communities of Lagos, but with a computed rate of 3.1 per 1000. Osuntokun et al18 reported a prevalence rate of 5.3 per 1000 among the inhabitants of Igbo-ora, a community with comprehensive health facilities, with the highest age-specific prevalence ratio occurring below the age of 20 years i.e. within 5 to 14 years age group. This prevalence rate is lower than what obtains in most rural African communities and similar to that of Western countries. The lower prevalence rate is probably due to the improved health facilities in this community.[1][2]