Bloodletting as a harmful and misguided first-aid response to seizures in sub-saharan Africa: a case-based review

Epileptic seizures are common neurological events whose sociocultural interpretations have long been linked to supernatural causes or biomagico-symbolic beliefs. Depending on the region, blood may be regarded as the cause, seat, vector of evil, or even a therapeutic agent. These misconceptions continue to influence treatment choices in rural communities and large urban centers, leading to unnecessary or harmful first-aid measures. To date, the use of bloodletting as an inappropriate first-aid intervention has not been documented in sub-Saharan Africa. We report an unprecedented event that occurred in a suburban area of a large West African city, involving a 42-year-old man who presented with inaugural generalized tonic seizures, symptomatic of a lobar intracerebral hemorrhage. In response to these seizures, members of the surrounding community performed bloodletting by making deep incisions on the soles of both feet, believing that "letting the blood flow" would stop the convulsions. These inappropriate traditional practices have led to hemorrhagic, ulceronecrotic, and superinfected lesions, compromising the patient's prognosis. This case highlights the severe impact of magico-biological misconceptions on seizure management in West Africa and emphasizes the urgent need for culturally tailored public health education, leveraging digital tools to deliver personalized awareness to communities and patients.