However, accurate data to deduce the degree of the problem and required medical equipment to treat the disorder are lacking

Medical: Some 67 new cases of epilepsy were registered with the Jigme Dorji Wangchuck National Referral Hospital’s psychiatry department in Thimphu last year.

Since 1999, the hospitals registered 3,178 new cases until the end of 2015.

Meanwhile, records with the hospital show that 1,559 patients from across the country are being treated for epilepsy. Diagnosis of epilepsy is a clinical diagnosis.

Professor and head of neurology with the All India Institute of Medical Sciences (AIIMs), Dr Manjari Tripathi, said that epilepsy is common and so are neurological disorders, during a seminar at the Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMSB) on July 25.

Dr Tripathi spoke to the participants on diagnosis of epilepsy and its treatment course.

“What you see is what you get and what the patient’s care giver tells you is what you diagnose,” Dr Manjari Tripathi said. “Neurological disorder will occur in every family.”

The biggest hidden epidemic, which people aren’t even aware of, is that of neurological disorders, Dr Manjari Tripathi added. The commonest neurological disorder causes migraines and headaches but the next most common one is epilepsy.

About 60 million people worldwide have epilepsy, of which 80 percent are living in the developing nations.

Psychiatrist with the referral hospital in Thimphu, Dr Damber Kumar Nirola, said that for epilepsy patients in the country, the doctors are the last resort because epilepsy comes with stigma.

“Sometimes the patients are brought to the hospital by somebody and many times, the patients come to hospitals because they failed to get treatment from elsewhere,” Dr Nirola said. “Most of the time when epilepsy patients come to hospital for treatment it becomes late.”

However, Dr Nirola pointed out that the country doesn’t have any medical person who is specialised in epilepsy.

“The epilepsy patients in Bhutan are treated by all the doctors and in primary health care units, the health assistance treats the patients,” he said.  “The pediatric epilepsy cases are looked after by the pediatrician doctors, not by any of the psychiatrists.”

The referral hospital had magnetic resonance imaging (MRI) and computed tomography (CT) scan facilities only after 2006.

Anti-epilepsy medications such as Phenobarbital and Phenytoin are available in different levels of health centres across the country. While medicines such as Carbamazepine and Sodium Valporate are available in district and referral hospitals, and Lamotrigine and levetiracetam are available at the referral hospital in the capital.

A study on epilepsy, the Bhutan epilepsy project, that started in 2014 is under way in the country.

Dr Nirola also pointed out that Bhutan doesn’t have a neurologist and someone trained to treat epilepsy. The hospital also lacks equipment to monitor anti-epileptic drug levels.  “We don’t have any epidemiology to study how big our epilepsy problem is.”

Dr Nirola suggests that a medical team in the country develop guidelines to use in different levels of hospitals. He added that the guideline made for the national referral hospital may not be practical for the basic health units.

The hospital doesn’t have any guidelines that the doctors follow strictly while treating patients with epilepsy, Dr Nirola added.

However, the hospital has a dedicated MRI protocol.

Radiologist with the referral hospital, Dr Dechen Nidup, said that radiology plays an important role in treating epilepsy.

Of a total of 2,384 MRI cases last year, about 277 or 11.6 percent were epilepsy cases.

Dr Dechen Nidup said that the number is huge for the country.

Currently, there are only four radiologists in the country.

Dechen Tshomo