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Knowing about Epilepsy
 
Epilepsy is a common neurological disorder. Around 12 million people are living with epilepsy in India. It is estimated that around 8% population develop seizure in their life time. Around 1-2 % of emergency admissions are with seizures. But still a large number of persons with epilepsy are not identified and treated. Main reasons for this are lack of knowledge, social stigma, unavailability of medical care and lack of proper information regarding the treatment. Treatment of epilepsy has evolved over years with advent of newer drugs and development of epilepsy surgery.

What is epilepsy? What is the difference between seizure and epilepsy?

Brain consists of a large number of neurons and they communicate with each other through electrical impulses. If there is an abnormal and excessive synchronised production of electrical impulses by a group of neurons, it leads to a sudden transient change in the behavioural, motor or sensory symptoms. This is commonly called seizure or fits. Epilepsy is a disease of the brain having an increased tendency to have recurrence of seizures. If the networks of neurons in both sides of the brain excites almost simultaneously then it leads to generalized epilepsy. If only a part of brain excites then it leads to focal epilepsy. The division is important in view of the treatment.

What are the symptoms?

Generalized seizures usually presents with violent movements of hands and legs with frothing from mouth, tongue bite and loss of consciousness. Sometimes it can present as absent mindedness for few seconds with a staring look. In others it can present as behaving abnormally without awareness of the surroundings. In some it can occur focally as paraesthesia or movements in one side of the body without losing consciousness.

What are the causes of seizures?

There are numerous causes for seizures such as low or high sugars, variations in sodium or calcium levels in the blood. Sometimes seizures can be the presenting symptom of serious brain infections or underlying brain tumours. Seizures can also occur in the setting of a stroke.

The causes of epilepsy can be broadly categorized as genetic, structural, metabolic, immune, infectious, and unknown.


What is the management of seizures?

We need to do the required blood investigations, EEG and appropriate brain imaging in such situations so that we can arrive at a proper diagnosis and identify the type of epilepsy.

Treatment of seizures depends on the cause. Most importantly, we need to identify the correctable causes, like changes in sodium or sugar levels and in such situations, the treatment is to correct the biochemical abnormality. In seizures with correctable causes, continuous antiseizure medications are not required.

In other cases, after diagnosing the type of epilepsy, we need to start appropriate anti-seizure medications.

How effective is epilepsy treatment?

In 70 % of persons with epilepsy, definite medical treatment is available. Complete seizure control is possible with medications. Usually, treatment starts with single medication and dosage is titrated according to the response. Sometimes a change in medication or addition of another anti-seizure medicine is required. Persons with epilepsy can have a normal life like others. Epilepsy can be treated just like any other disease.

In almost 30 % of persons, partial control of seizures can be achieved with medications. In most of them, epilepsy is due to focal lesions in the brain. In these situations, treatment often requires combination of multiple anti-seizure medications for satisfactory control of seizures. Those persons who are still refractory to medication can be evaluated for epilepsy surgery. So even in this group of persons there is hope for seizure freedom and they can have a normal life.

What are the precautions to be taken for persons with epilepsy?

In persons with epilepsy, around 70% of them can be treated with complete seizure freedom. But in some persons, there will be seizures in between and these are called break through seizures. Around 50% of such situations are provoked by missing the medications. Proper adherence to the medication is very important for seizure control.

Lack of sleep is another important provoking factor for breakthrough seizures. Nowadays, over use of mobile phone and internet and addiction to computer games most often leads to sleep deprivation. Adherence to healthy life style and proper sleep hygiene are very important in seizure control.

Mental stress, depression and professional pressure are all very important in causing breakthrough seizures. Maintaining a healthy life style, proper exercise or yoga and meditation help persons with epilepsy to maintain balance of mind and body. These issues need to be addressed with empathy, and they should be encouraged to take medical help without hesitation.

Another important area we often neglect is the taking of over-the-counter medications and herbal pills as and when required and this may provoke breakthrough seizures.

What can we do during the time of seizure?

During the time of seizure always turn the person to one side as this will help in the flow of saliva and froth out of the mouth. Prevent falls from the bed. There is no role in putting any kind of metallic instruments like keys inside the mouth. Most of the seizures including violent jerky movements subside by itself within 2-3 minutes. If the seizures persist for more than 5 minutes, then there is a possibility of seizures prolonging for a longer time. This condition is called status epilepticus and needs injectable medications to stop the seizure. In such situation it is important to take them urgently to the hospital.

Social stigma in epilepsy

In society due to the lack of knowledge a lot of social stigma and neglect is seen towards persons with epilepsy. On hearing the diagnosis itself, fear and panic often grips the patient and the caregivers. There are huge concerns regarding the medications, its side effects, how long to take treatment and whether the condition is curable or not. Medications are safe and need to be taken strictly and need to continue for a period as advised by doctor. If there is seizure freedom for 2-3 years, we can successfully taper and stop anti-seizure medication in 70% of persons.

Regarding women with epilepsy there is concern regarding the marriage, pregnancy and health of the new-born. With proper counselling and appropriate selection of medications, most of the time treatment is reassuring without complications.

Epilepsy treatment has evolved over time with advent of newer medications and advancements including epilepsy surgery. Most of the times anti-epileptic treatment is rewarding and person with epilepsy can lead a normal life. With proper awareness and understanding about epilepsy social stigma towards them can be avoided. Always encourage them to take a proper medical care as this improves their quality of life.

Dr ASHOK VP
CONSULTANT NEUROLOGIST, KIMSHEALTH, TRIVANDRUM


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