In Context

www.thelancet.com/neurology Vol 13 March 2014 245

Epilepsy is one of the most common neurological disorders in India, with a prevalence of fi ve cases per 1000 people. This fi gure translates into a burden of more than fi ve million cases. Despite the diagnostic and treatment options available, many cases are either undetected, misdiagnosed, or end up with unqualifi ed doctors or those who practice alternative medicine. Prevailing myths, cultural beliefs, and low awareness are the main reasons for this situation. Typical symptoms of seizure, such as rhythmic movement of arms and legs, are often construed as possession of the patient’s body by an evil spirit or ghost. Patients with epilepsy, especially women and children, also suff er social stigma. Ek Naya Din (A New Day), a feature fi lm conceptualised by Vijaya Nath Misra, a practicing neurologist, has tried to bust the myths and misconceptions surrounding epilepsy through the story of an educated family caught between superstitious beliefs and modern values.

The fi lm is set in the present decade, and its protagonist is a young girl, Preeti, born into a typical joint family (ie, an extended family in which two or more generations live together) in Varanasi, north India. She develops epileptic seizures at 6 years of age, which manifest as aura of fl ashing lights or bizarre cyclic movements. Her parents take her to see a doctor but her grandparents are not convinced that the problem is medical. Preeti’s strange behaviour, such as slapping someone during epileptic attacks, leads them to conclude that she is under the spell of an evil spirit. They secretly consult a witchcraft practitioner to rid Preeti of this so-called spirit, but the consultation causes her mental and physical trauma. The episode also creates discord in the family, as a result of which Preeti’s parents decide to move to Delhi to get treatmen for Preeti. Her problem is diagnosed as generalised tonic-clonic seizure and she is prescribed drugs. In school, her classmates make fun of her as she slaps one of them and then falls to the ground during a seizure. With sustained eff orts by her mother, Preeti’s classmates and school authorities realise her problem and begin to cooperate. Like the family drama genre of Bollywood fi lms of the 1970s and 1980s, the fi lm has a happy ending, with Preeti winning the ”best student of the year” award in her tenth grade.

The 1-hour fi lm has attempted to raise several issues surrounding epilepsy, such as delayed or incorrect diagnosis, dependence on unqualifi ed doctors even by educated people living in cities, need for treatment compliance, the quality of life of patients with epilepsy, and methods to address social stigma. This endeavour has been done through a simple plot and with ordinary characters. No medical terms have been used nor is any celebrity actor featured. Owing to the general popularity of fi lms in India, the producers have used

the format of a feature fi lm (rather than a documentary or educational fi lm) to deliver complex social messages.

The story of the fi lm is based on a real patient who was seen a few years ago by Vijaya Nath Mishra (Department of Neurology, Institute of Medical Science at Banaras Hindu University, Varanasi, India), who conceptualised the fi lm. “I wanted to make this fi lm because I come across several cases where educated people have also resorted to black magic or witchcraft to treat epilepsy. Once, an 18 year old girl was brought to the hospital shackled in iron chains. In Varanasi and surrounding areas, there are at least a dozen witchcraft practitioners who claim to cure epilepsy,” Mishra explained.

“Epilepsy has a wide treatment gap with high discontinuation rates due to various myths, misconceptions, and superstitions associated with this disorder. Awareness of the fact that accurate diagnosis and diligent therapy can control epilepsy is very low in the community,” said Satish V Khadilkar (Editor, Annals of Indian Academy of Neurology). The cost of allopathic medicines is another deterrent, he added. Moreover, patients’ dependence on alternative medicines could be linked to the fact that India has just 1200 neurologists, a third of whom are based in four metropolitan cities.

The fi lm has been received well at initial screenings in schools, colleges, and village gatherings, which were arranged in collaboration with the Nav Drishti Vibhuti Foundation and other voluntary groups. “We did a dipstick survey among 750 students and members of general public before and after the fi lm was shown to gauge their knowledge about epilepsy. Before the screening, 63% thought epilepsy is due to evil spirits and the best treatment is black magic. This number fell to 18% after screening of the fi lm,” Mishra said. In a country where doctors and scientists rarely engage with the general public to raise awareness about medical issues, this fi lm is a laudable eff ort to focus on a neglected health concern.

Dinesh C Sharma

FilmIndian fi lm on epilepsy busts myths

Ek Naya DinDirected by Parveen Sood2013, 63 min

For more information see http://www.eknayadin.com/

Published OnlineNovember 26, 2013http://dx.doi.org/10.1016/S1474-4422(13)70286-2