Epilepsy

Epilepsy an Overview

Types

Causes

Management

Living with Epilepsy

Do's & Don'ts

Myths & Realities

Introduction

Understanding Epilepsy

What is Epilepsy ?

The English word epilepsy has Greek origin - epilepsia, meaning 'taking hold of' or 'seizing'. It is a disorder of the brain.

While we are awake or asleep, walking or talking, reading or watching TV, all our actions are controlled by our brain. Our brain is an extremely sensitive and complex organ. It consists of millions of tiny cells called neurons. These neurons generate 'electric current' and all the activity of the brain is in the form of these 'electric charges'.

As long as the brain functions normally, all is well and all our actions are well synchronized. But there are times when suddenly, a group of nerve cells become hyperactive and produce excessive 'electric charge'. Such a sudden excess of electrical discharge by the neurons results in brief moments of confusion or minor spasm. People use different words to describe this spasm. Some refer to it as a 'fit', others call it a 'convulsion' still others call it a 'seizure'.

The tendency to have repeated seizures or fits or convulsions is called EPILEPSY.

Types Of Epilepsy

Epilepsy is not a single disorder. It covers a wide spectrum of problems. Though most seizures are broadly classified under the following two main categories:

1. Partial (or Focal) Seizures, and
2. Generalised Seizures.

(There are some seizures that cannot be classified under these two categories, hence they appear as Other Seizures).

Partial Or Focal Seizures

Under this category there are further 2 sub-categories:

1. Simple Partial Seizure: (also called Jacksonian epilepsy) : is the result of the neurons in only a certain part of the brain ( as compared to the full brain) becoming hyperactive. Such a seizure is characterized by the person experiencing confusion, jerky movements, a tingling feeling, odd mental/emotional events, mild hallucinations, or extreme response to smell and taste.

   The seizure lasts for a brief while and after the seizure the patient usually has temporary weakness.

2. Complex Partial Seizures : About 80% of this type of seizure originates in the temporal lobe of the brain. Which means the part of the brain that is located close to the ear. Disturbance in this part of the brain results in loss of judgement, involuntary or uncontrolled behaviour or even loss of consciousness.

Whereas in the balance 20% of cases, the disturbance originates in the frontal lobes of the brain. In this type of epilepsy the person sometimes experiences a warning sign before the onset of the seizure. Such a warning is called an 'aura'. Aura can take the form of odd 'smell' or 'visual' or 'sound' related hallucination. Under such a seizure a person may become unconscious for a brief while, appear (to others) as motionless with a vacant stare. Then after a few seconds, the epileptic starts performing repetitive movements like chewing, smacking of lips, licking of the tongue, jerking the head etc. This kind of a seizure generally lasts for 2 -3 minutes.

Generalised Seizures

1. Absence (Petit Mal) Seizures:A person experiencing this kind of a seizure, becomes (physically) motionless and loses attention. During this kind of seizure, if the person does not lose consciousness then the seizure may even go unnoticed by others. These are brief seizures, each lasting for 3 - 30 seconds. However, there may be as many as 50 -100 such seizures in a day.

   About 25% of patients with Absence Seizure develop Tonic-Clonic seizure (described below).

2. Tonic-Clonic Seizures: There are 2 phases in this type of seizure. The Ist phase is called Tonic Phase. (The word Tonic in this case should not be confused with its more common usage, meaning a group of products that stimulate growth/appetite etc.) During Tonic Phase, the muscles suddenly contract, causing the patient to fall and lie rigidly. Most people under this kind of seizure lose consciousness. In some cases (of affected larynx - sound box) there may be a high-pitched musical sound when the patient inhales. Typically such a seizure would last for 10 -30 seconds.

After which, the patient enters the next phase. The Clonic Phase. In this phase the muscles begin to alternate between relaxation and rigidity. The patient tends to lose some control and may pass urine or stools.

The Tonic-Clonic Seizure lasts for about 2 - 3 minutes. The patient however, generally remains unconscious for much longer and awakens to confusion and extreme fatigue.

Other Seizures

Apart from the ones described above, there are other kinds of epilepsies like:

1. Myoclonic Epilepsy : This is a rare genetic seizure that can be either mild or severe in nature. In its milder form, the patient experiences brief periods of jerkiness in limited parts of the body (typically restricted to the face or the trunk). In more severe cases, it can take the form of Tonic-Clonic seizure. Severe form of seizures can cause loss of hearing or can result in damage to the brain or heart.

2. Atonic (or Akinetic) Epilepsy: This is also called drop attack because during this seizure, a person loses control on the muscle tone. Sometimes the seizure affects only one part of the body (jaws slackens or head drops) and at other times the seizure may affect the whole body. In which case the person suddenly falls.

Causes of Epilepsy

There are many known causes of epilepsy. Some of them are listed below:

In Children

• Fever
• Birth defects (difficult delivery)
• Brain defects
• Infections (meningitis)
• Head injuries (fall/accident)
• Rapidly flickering light / colours (in TV)
• Hot water head-bath.

In Adults

• Drug interactions
• Excessive alcohol intake
• Head injuries
• Brain tumours
• Lack of sleep
• Starvation
• Emotional upset
• Menstrual periods

Despite the long list of known causes, in nearly 70% of the cases, there may not be any known cause that could be held responsible for triggering the seizure.

Symptoms

Different types of epilepsies have different symptoms.

Simple Partial Seizures

• Tingling sensation, hallucinations (or repetitive movements)
• No loss of consciousness

Complex Partial Seizure

• Involves repetitive movements
• Patient is often in a semi-conscious state of mind
• Presence or absence of a warning in the form of an 'aura'

Absence Seizures

• Most common in children
• No convulsive movements
• Blank stares, rapid blinking (for few seconds)
• Rapid return to normalcy

Tonic Clonic Seizures

• Involvement of the full body
• Often accompanied with a loud cry
• Muscular contractions
• Attacks last for 1 or 2 minutes
• Tongue bite, urination, frothing (at the mouth), passing of stools

Management of Epilepsy

A diagnosis is often made during an emergency visit (because of a seizure) to the doctor. Sometimes the person may be seeking help for a previous episode of a seizure or a suspected seizure. The doctor generally takes a complete history of the patient, including a history of the seizures (either from the patient or the parent). Even a simple thing like how the patient wipes his/her nose can help a trained professional to make an accurate judgement as to where the origin of the seizure is located in the brain.

While diagnosing a patient for epilepsy, a doctor first and foremost tries to rule out any short-term causes like alcohol withdrawal, infections, head-injuries, drug abuse etc.

Next, a very widely used (though not the most sensitive) diagnostic tool - the electroencephalogram (EEG) is employed. Routine EEG may sometimes not be adequate to reliably prove or disprove the diagnosis of epilepsy. In which case the doctor may require confirmations with brain scans (CT Scan) or other advanced imaging techniques like the Magnetic Resonance Imaging (MRI) or Positron Emission Tomography (PET). These images are used to determine the nature of the disorder, or scarred locations in the brain where from partial seizures are triggered.

Future course of treatment may depend on these findings.

Treatment

Treatment and managing epilepsy is the job of a highly trained professional. Treatment of epilepsy is 'person specific'. Which means, treatment of epilepsy will differ from person to person.

Good news is that all kinds of seizures are treatable and 90% of people respond well to medication.

The group of medicines that are used to treat epilepsy are called anticonvulsants. Some of the more frequently used (or front-line) drugs are carbamazepine, phenytoin, valproate, phenobarbital, ethosuximide and clonezepam. Most treatments start with a single medicine.

The doctor needs to monitor the drug and the dosage depending on its efficacy and side-effects. The doctor aims to achieve the best balance. That is, maximum seizure control with minimal side-effects.

In case the seizures are not effectively controlled then the doctor may prescribe a combination of drugs. But in cases where even the combination does not produce the desired result, the doctor may move to what are called the second-line drugs like gabapentin, lamotrigine, topiramate, vigbatrin. Finally even some hormonal treatment may have to be administered.

(ALL VISITORS TO THIS SITE ARE CAUTIONED, NOT TO ATTEMPT ANY SELF-MEDICATION OR CHANGE OF MEDICINE/DOSAGE WITHOUT CONSULTING THEIR DOCTOR)

Beside proper medication, regular food habits and sleep habits also help in reducing the seizures.

Living With Epilepsy

Childhood and Epilepsy

To diagnose a epilepsy syndrome, a doctor usually proceeds along the following lines:

• Thorough history of age of onset
• Developmental milestones
• Congenital malformations
• Abnormal movements etc.

This list is merely indicative and far from exhaustive. However, once a child is found to have epilepsy, with proper medications:

• It is critical to encourage a child with epilepsy to learn to live with it like an essential nuisance.
• The child should be told that having epilepsy is neither shameful nor something extraordinary.
• Other children would not be harmed in any way.
• If a child is having problems at school (academic or social) the teacher must be requested to help.
• It is essential for the self-esteem of the child to be involved in most of the normal activities in the school. Including sports.

The child should participate without restrictions in most of the activities, in the same manner as a child without epilepsy. However, it is advisable for children with epilepsy, not to go for unaccompanied swims or ride bicycles in traffic conditions. Not for any other reason but to prevent the child from being exposed to unnecessary and potentially dangerous situations.

Adult & Elderly

Epilepsy in adults is not very different from the one in childhood. In fact about 70% of adult epilesies have their onset in the paediatric (children) age group.

Therefore while most of the & signs symptoms would be the same as mentioned elsewhere, some new causes may get added for example, brain tuberculosis, head injuries, brain tumours, lack of sugar in blood, use of intoxicants, insomnia (sleeplessness), glaring lights, watching TV for long hours etc.

Marriage and Motherhood

Contrary to popular belief, myth, practice, epilepsy is not a deterrent to a happy married life.

However 'motherhood' needs to be properly planned and discussed with the doctor. The doctor will want to either change the medication or alter the dosage during the days of conception and during the different stages of pregnancy so as to minimize the effect of the medicine of the developing foetus.

In fact most women have no change either in the frequency of seizures nor in their intensity during pregnancy. 90% of women who are on anti-convulsant medicines during their pregnancy deliver perfectly healthy babies.

Like a planned pregnancy, a nursing mother on anti-convulsant medicines should consult with the doctor. These drugs are known to be secreted to the baby during breast feeding and may cause drowsiness in the infant. Cases are rare when the doctor may advise an epileptic women not to have a child.

Life - Style Adjustment

Coming To Terms : While epilepsy is a medical problem, the first challenge is the acceptance of its diagnosis. Often, people refuse to accept and admit the same. They may even hold the doctor responsible for wrong diagnosis. But with information and support, most develop a positive attitude towards their condition. Some of these problems become simpler to handle when the newly diagnosed epileptic discusses the condition with friends and relatives.

Activities best avoided : It is a commonly accepted fact that medicines are very useful in seizure control and epileptics lead a normal life. However certain activities are best avoided. For example, not to drive a motor car till the completion of at least one year from the last epileptic episode. Or avoid swimming alone or ride a cycle in traffic.

Even in terms of their job, a little caution would help. Avoid jobs where dangerous machines are involved and the job also requires intense concentration over long periods of time. Or again places where machines tend to heat the surrounding atmosphere

Do's & Don'ts

Those with epilepsy can and, in fact do lead a normal life.

• The best preventive measure is to strictly follow the doctor's instructions.
• Do not change the prescribed medicine/dose
• Do not stop taking the medicine unless advised by the doctor.
• Do not change regular food habits
• Do not change regular sleeping time/hours
• Avoid unnecessary excitement
• Avoid known triggers for seizures
• Avoid alcohol consumption and do not smoke.

Those around an epileptic

• It is important that children with epilepsy are treated as normally as possible. Both by parents and siblings.
• Children should be assured that they will not die because of this problem
• In adults and elderly, ensure they get support, warmth and understanding
• Ensure that they take proper medicines
• They must sleep at regular time and not indulge in potentially dangerous activities like unaccompanied swimming or driving soon after taking anti-convulsant medicines.

Besides, if you come across a person in the clutches of a seizure:

1. First of all keep calm and turn the patient to the side and loosen any tight clothing
2. Drain saliva from tightly held teeth
3. Move away any objects that are likely to cause hurt to the patient
4. Do not restrain convulsive movements
5. Do not force anything between tightly clenched teeth or fingers
6. Allow free breathing without crowding and if the seizure continues for a long time, get a doctor.

Above all everyone with epilepsy and those around them should realise that it is a nuisance that has to be overcome. Others with epilepsy have not only surmounted their condition but have moved on to become some of the greatest achievers of their times. Alfred Nobel, Isaac Newton, Pythagoras, Tony Greg, Leo Tolstoy, Napoleon Bonaparte, Alexander the Great just to name a few.

It would do well to keep in mind at all times that: Epilepsy is not the curse of a demon, Epilepsy is not a handicap, Epilepsy is not contagious. Epilepsy is a brain disorder and people with such disorders are more than capable of leading a perfectly normal life. If they so wish and desire.

Myths and Facts about Epilepsy

Myth: Epilepsy is not common.

Fact: False. The prevalence of epilepsy is nearly 4-10 per 1000.

Myth: Epilepsy is contagious.

Fact: Epilepsy is not capable of transmitting infection.

Myth: Epilepsy is a psychological condition.

Fact: Epilepsy is not a psychological condition. Seizures are caused by a transient, excessive and abnormal discharge of nerve cells.

Myth: An object should be put in the mouth of a person having a seizure to keep him/her from biting his/her tongue.

Fact: Nothing should be placed in the person's mouth. The person should be placed on his side so the tongue falls away and to the side.

Myth: A person having a seizure should be held down.

Fact: Do not try to restrain the person; this may cause injury. Anything hard or sharp should be moved out of the way, and something soft should be placed under the person's head.

Myth: The person suffering from epileptic seizures has to be born with epilepsy.

Fact: Although epilepsy often first appears in children and young adults, although anyone can develop epilepsy at any time.

Myth: Epilepsy is curable.

Fact: There is no known cure for epilepsy. However, modern treatment methods can achieve full or partial control of seizures in a majority of cases.

Myth: Persons with epilepsy are "epileptics."

Fact: Persons with epilepsy are individuals who experience chronic, recurrent seizures.

Myth: Epilepsy is a sign of low intelligence.

Fact: Epilepsy is a physical condition, not a mental illness or handicap.

Myth: You cannot tell what a person might do during a seizure.

Fact: Seizures commonly take a characteristic form and the individual will do much the same thing during each seizure episode.

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