ABSTRACT
One of the major problems of epilepsy in Africa are its social implications. Prejudice against the disease is common and epileptics are marginalised. Epilepsy is concealed from all non-family members. The very pronunciation of the word "falling disease" (as epilepsy is called) is taboo, the disease being regarded as supernatural. This unfavourable context introduces considerable bias in hospital and population-based studies. Traditional doctors are consulted by patients especially when they have such a "supernatural" disease. Traditional scarifications are used for the treatment of epileptics in Togo. We examined the skin of 36,000 patients in the neurological department of Lomé's teaching hospital between 1985 and 1995 and conducted a similar, population-based study on about 20,000 inhabitants in the Kloto district of south-western Togo and on 10,000 inhabitants in the Tone district of northern Togo. Interviews with 40,000 traditional doctors revealed that forehead scarifications are characteristic of epilepsy treatment. More than 80% of epileptics have forehead scarifications. When the seizures are rare, scarifications are slim, short (1-3 mm), near the roots of hair on the forehead and concealed; but when they are frequent, known by many people, scarifications are large, long, visible on forehead, the patient showing the sign of his social sentence.. On the skin of epileptics in Togo, is written the diagnosis of his affection. It only needs to look at it.
