Seminar held on ‘Marriage in People with Epilepsy’    19th April,2015

DMCH in association with University College,London today organized a one day seminar on ‘Marriage in People with epilepsy.’The seminar is supported by the UCL Grand Challanges Initiative.Represnting the UCL  were Prof John Duncan,Clincial Director,National Hospital for Neurology and Neurosurgery,London and Dr Caroline Selai,In-charge Medical Education Unit at UCL London.A number of neurological experts from across the country deliberated on the issue.Ms.Vini Mahajan,Principal Secretary,Finance and Health & Family Welfare deliverd a keynote address and inaugutrated the meeting.She dwelled on the topic ‘What can be done by the Health Care System in this matter.’     

Epilepsy (known in vernacular language as  Mirgi) is one of the commonest neurological disorders. Today, despite huge number of scientific advances in its diagnosis and treatment, many myths and and misconceptions are attached to it. Our studies in the community performed by the Department of Neurology at DMCH, Ludhiana and PGIMER,Chandigarh indicate a prevalence of 7-10/1000 population. In lay terms, it means that approximately one percent of the population suffers from epilepsy, making it more common than most cancers  

Although epilepsy appears relatively straightforward to treat,the management of social and personal issues  associated with epilepsy is cinsidered complex.People with epilepsy (PWE) are more often ‘seized by’ the difficult social environment and negative attitudes rather than by epileptic seizures.The negative attitudes lead to problems in education,marriage and employment.Until recently,marriages were either forbidden or invalidated because of epilepsy.Before 1999,epilepsy was equated with insanity and it was a ground for divorce or annulment of marriage according to the Hindu Marriages Act. In 1999,on the basis of PIL filed in the Supreme Court, the Ministry of Women’s affairs moved an amendment and epilepsy was no longer ground for divorce in the amended act passed by the parliament.However, epliepsy continues to remain a stigmatizing condition and when disclosed during marital negotiations,it leads to failure of the marital negotiations.As a result,people with epilepsy often conceal the fact that they have epilepsy during marital negotiations.

People with epilpesy who hide their illness during marital negotiations are left witht the options of either stopping their epilepsy medications at the time of marriage or continuing to take the medications covertly.Some indeed stop their medications on their own only  to risk having a seizure at the time or soon after the marriage.Though accurate supporting data is not available,it is estimated that the majority prefer to take the epilepsy medications in a clandestine manner as they would not like to take the risk of having a seizure during or soon after marriage.How the regular use of medications in a surreptitious manner is possible within the intimate environment of marriage is possible remains unclear.Some people with epilepsy might disguise their epilepsy medications as vitamin pills by taking them out of their strips and putting them in vitamin bottles.This os often done after seeking approval from the treating physicians.Perhaps,the limited communication between the bride and the groom befor marriage persists in the early period after marriage and this is permissive to use of medications without many questions being asked.Morever,if the partner is not literate enough,he or she will have little knowledge about the nature of the medications.

The covert use of epilpesy medications might potentially lead to poor compliance,which can not be monitored in the home environment and hence might lead to breakthrough seizures.Hiding a diagnosis of epilepsy from the spouse  and the in laws makes visit to health care providers difficult and less frequent at a time (post-marriage,pregnancy and post-pregnancy) when specialised advice is much required for issues such as fertility,contraception and teratogenesis.Hiding might also lead to increased anxiety and a variety of psychosocial effects. Often,it is the felt stigma that is repsonsible for concealing a diagnosis of epilepsy but when epilepsy is revealed as the result of a seizure happening,or by intended disclosure by self or others,this leads to enacted stigma adding to distress.Furthermore,concealing the condition were associated with higher rates of divorce and seperation in two small studies based in Japan and South India.