Epilepsy is a common neurological disorder characterized by recurrent seizures. Seizures result from the sudden abnormal electrical activity of a part or whole of the brain. A single seizure does not mean epilepsy.
Depending on whether a part of the brain or the entire brain is affected, seizures are classified as ‘focal/partial’ seizures and ‘generalized’ seizures.
Focal seizures are characterized by one or more of the following:
Aura- a peculiar sensation that occurs in some patients prior to the actual seizure.
Unresponsiveness and unawareness.
Blank stare, repetitive actions of limbs, lip-smacking, chewing.
Repetitive jerking of any part of the body.
Generalized seizures are characterized by one or more of the following:
Loss of consciousness, with jerking of limbs and uprolling of eyes (convulsions).
Tongue bite, passing urine and/or stools without awareness.
Sudden abrupt falls with rapid recovery (atonic seizures).
Brief stare with unresponsiveness and unawareness (absence seizures).
Isolated jerks of limbs usually with preserved consciousness (myoclonic seizures).
During these jerks objects may fall out of the hand or patients may lose balance. Focal seizures may develop into generalized seizures (secondary generalized seizures). Seizures usually last for 1-2 minutes and may be followed by a period of confusion. Seizures can occur in all age groups irrespective of gender, social or educational status.
In many patients, no definite cause can be identified. Common causes include infections, tumors or injuries of the brain, stroke, drug addictions or withdrawal and chemical disturbances in the blood. Genetic or hereditary causes are extremely uncommon.
‘Stress is not a cause of seizures’.
Causes may be acquired during any point in life starting from the intrauterine period.
All ‘first-time seizures’ require medical consultation. The doctor may ask for certain tests like EEG, CT or MRI scan of the brain depending on his assessment.
Some seizures like ‘simple febrile seizures’ in children do not need regular medications. In other seizure types, it is better to treat even the first attack because:
Seizures are unpredictable and can cause physical injury and even death depending on the circumstances of occurrence.
Recurrent seizures may strengthen the epileptic circuits within the brain.
Recurrent seizures result in social stigma, impacts employment and education.
Very effective and safe medications are available. Medications are chosen depending on the type of seizure, age, gender, reproductive status, pregnancy and the presence of other illnesses. Dosage is based on body weight and is started at a low dose.
Medications should be started and stopped very slowly. Usually, a single type of medicine is sufficient. Uncommonly multiple medicines may be used simultaneously to obtain seizure control.
Injections and nasal sprays are used only in emergency situations.
Most patients can successfully stop medicines. To do so they should be ‘seizure free’ for at least 3 years while on medicines. Medicines should be tapered very slowly as advised by the doctor. Rarely, prolonged treatment lasting several years may be required.
Epilepsy medications do not cure epilepsy but only control it.
Epilepsy surgery offers the promise of cure and even freedom from medicines.
Only patients who have failed medical therapy (with 2 or more medicines) are considered for surgery. Patients with a well-defined point of origin of epilepsy signals in the brain can be considered for surgery. This requires further tests like the recording of seizures with Video EEG.
Epilepsy surgery is expensive and entails a certain risk of complications. However, the complication rate is very low in most centres including ours.
Vagus nerve stimulation (VNS)
Responsive neurostimulation (RNS)
Missing medicine dose or irregular timing of dose (most common cause)
Inadequate sleep or poor food intake
Alcohol or smoking.
Interaction of epilepsy medicines with other medicines.
No. Seek consultation in the following situations:
More than one seizure in a day.
Prolonged seizures (more than 5-minute duration).
Unusual type (non-habitual) seizure.
Prolonged unconsciousness/ unresponsiveness even after cessation of seizures.
Seizure with fever.
Seizures during pregnancy
Ensure that the patient does not strike the walls or furniture while jerking.
Lay the patient flat onto one side so that secretions from the mouth drain out.
Do not insert fingers, cloth or other objects into the patient’s mouth to prevent tongue bite. This can injure the patient or even endanger life. Tongue bite is a minor injury and will heal completely in a few days.
Do not feed the patient until complete recovery of consciousness occurs.
Do not attempt to control the limb jerking with excessive force as it can result in injuries including muscle tears and joint dislocations.
Adequate sleep and regular meals.
Each medication dose has a specific duration of action. So be regular with your medications.
Do not drive or swim until permitted by your doctor.
Seizures are unpredictable and can sometimes occur even while on regular medicines. Hence always assess your safety with regards to your surroundings.
Avoid smoking, alcohol consumption.
Inform all your doctors about your epilepsy and its medications in order to avoid medication interactions.
An overwhelming majority of women with epilepsy have a normal pregnancy and deliver healthy babies with normal physical and mental development.
Plan your pregnancy in consultation with your neurologist.
Relatively safe and effective medications are available for use in pregnancy.
The probability of the child developing medication side effects is very low (2-5%) and of epilepsy occurring in the child is remote.
Medication side effects can usually be detected by ultrasound scans.
The risk to the child is more if a mother is on multiple medicines or if she has frequent seizures during pregnancy.
Isaac Newton, Julius Caeser, Alfred Nobel, Alexander the Great, Napolean Bonaparte, Vincent Von Gogh, Jonty Rhodes!
Hence no major restrictions are applicable either in academics, physical activity or professional responsibilities unless specified by your doctor.
Consultant, Neurology, Manipal Hospitals Bangalore
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