Clearing the air around Epilepsy

Dr Boby Varkey Maramattom,
Consultant, Neurologist
Aster Medcity, Kochi

One of the most misunderstood conditions is epilepsy. Commonly known as ‘fits’, epilepsy is actually a group of neurological diseases characterized by epileptic seizures, also known as ‘seizure disorders’. Epilepsy is the fourth most common neurological disorder and affects people of all ages.

There are 50 million people living with epilepsy worldwide, and about 10 million in India. Many people with active epilepsy do not receive appropriate treatment for their condition, leading to large treatment gap. The lack of knowledge of available treatment options, poverty, cultural beliefs and stigma contribute to the treatment gap. To clear misconceptions and promote a clearer understanding of epilepsy, National Epilepsy Day is observed on November 17 every year in India.

Symptoms of Epilepsy

Characterized by unpredictable seizures that can cause other health problems, epilepsy is a spectrum condition with a wide range of seizure types varying from individual to individual. Public perception and misunderstanding of epilepsy causes challenges often worse than the seizures

Epilepsy is a chronic disorder, the main feature of which is recurrent seizures which may be without any apparent cause. Patients with epilepsy may have more than one type of seizure and may have other symptoms of neurological problems as well. It is when clinical and family history, EEG testing, and outlook are similar among a group of people with epilepsy that the condition can be defined as a specific epilepsy syndrome.

The starting place of epilepsy is the brain. Although the symptoms of a seizure may affect any part of the body, the electrical episode that leads to the symptoms occurs in the brain. The short term effects and long term consequences depend on the location, method of spread, area of the brain affected and length of the episode. Having seizures and epilepsy can affect one's safety, relationships, work, driving and much more.

Diagnosing Epilepsy

Diagnosing epilepsy is like putting the pieces of a jigsaw puzzle together with information from the patient, his family and a few key tests. Recurrent unprovoked seizures that were not caused by some known and reversible medical condition like alcohol withdrawal or very low blood sugar is one indication of epilepsy.

The seizures in epilepsy may be related to a brain injury or a family tendency, but often the cause is completely unknown. Details of the seizure, the type and other information about the event, followed by more information through a detailed medical history and examination, blood tests, EEG tests, and brain imaging tests such as CT and MRI scans, help the physician reach a proper diagnosis. The tests give information about the electrical activity of the brain, what the brain looks like and possible causes of seizures. All the information is put together with how the individual is feeling and how the seizures may be affecting the way the brain works. It should be noted that the word "epilepsy" does not indicate anything about the cause of the person's seizures or their severity.

Risk Factors of Epilepsy

Risk factors for epilepsy include babies who are born small for their age, babies who have a seizure in the first month of life, brain injury, brain tumors, abnormal blood vessels in the brain, infections of the brain like meningitis or encephalitis, cerebral palsy, stroke resulting from blockage of arteries, conditions with developmental disabilities, late stage Alzheimer’s disease, febrile seizures that last a long duration, use of illegal drugs and a family history of epilepsy.

Patients may notice some triggers that precipitate or provoke seizures. It is important to recognize these triggers if they exist as patients can learn how to modify their lifestyle or environment to lessen the risk of triggers. These triggers may include lack of sleep, missed medications, psychological stress, alcohol, poor eating habits, flashing lights or specific foods.

Treatment

The aim of treatment for epilepsy is to achieve ‘No seizures and no side effects’. Treatments are available that can stop or control seizures for most people with seizures and epilepsy.  Medicine is the most common way of treating epilepsy and is almost always the first treatment tried which will successfully control seizures in 70% of patients. The first step is to find the right medicine for each person. While the majority of people can do well with the first one or two medicines tried, others find that medications don’t work. And for others, seizure medication may cause bothersome side effects.

There are many different medicines that can prevent or stop seizures. Some medicines work better for certain kinds of seizures than for others. If one medicine fails, another may work better. The medications work to stop seizures from occurring. Surgery is an alternative for some people whose seizures cannot be controlled by medications. Epilepsy surgery can be especially helpful to people who have seizures from structural brain problems such as benign brain tumors, strokes or malformations of blood vessels.