Epilepsy

What is epilepsy?

Epilepsy, sometimes referred to as seizure disorder, is a general term that refers to a tendency to have recurrent seizures. A seizure is a temporary disturbance in brain function in which groups of nerve cells in the brain signal abnormally and excessively. Nerve cells or neurons normally produce electrical impulses that act on other nerve cells, muscles, or glands to create awareness, thought, sensations, actions, and control of internal body functions. During a seizure, disturbances of nerve cell activity produce symptoms that vary depending on which part (and how much) of the brain is affected. Seizures may produce changes in awareness or sensation, involuntary movements, or other changes in behavior. Usually, a seizure lasts from a few seconds to a few minutes.

What are seizures?

There are many types of seizures. These can be classified into two broad groups:

Primary generalized seizures—seizures begin with widespread involvement of both sides of the brain.

Partial seizures—seizures begin with involvement of a smaller, localized area of the brain. With some partial seizures, the disturbance can still spread within seconds or minutes to involve widespread areas of the brain (secondary generalized seizure).

Some people have seizures that are hardly noticeable to others. Sometimes, the only clue that a person is having an absence seizure—a type of primary generalized seizure sometimes called petit mal—is rapid blinking or a few seconds of staring into space.  In contrast, a person having a complex partial seizure may appear confused or dazed and will not be able to respond to questions or direction for up to a few minutes. Finally, a person having a generalized tonic-clonic seizure, sometimes called grand mal, may cry out, lose consciousness, fall to the ground, and have rigidity and muscle jerks lasting up to a few minutes, with an extended period of confusion and fatigue afterward.

Is having a seizure the same as having epilepsy?

Not necessarily. In general, seizures do not indicate epilepsy if they only occur as a result of a temporary medical condition such as a high fever, low blood sugar, alcohol or drug withdrawal, or immediately following a brain concussion. Among people who experience a seizure under such circumstances, without a history of seizures at other times, there is usually no need for ongoing treatment for epilepsy, only a need to treat the underlying medical condition.

What causes epilepsy?

Epilepsy may arise when there are disruptions to the normal connections between nerve cells in the brain (much like disruptions in wiring of a complex electrical circuit), when there are imbalances of natural chemicals or neurotransmitters that are important to the signaling among nerve cells, or when there are changes in the membranes of nerve cells, including proteins called ion channels, that alter their normal sensitivity. Some of these disruptions, imbalances, and changes may develop early in life, sometimes related to hereditary factors and sometimes related to early exposures and events. Others may be acquired later. Among known conditions and events that may lead to epilepsy are:

• Oxygen deprivation (e.g., during childbirth).
• Brain infections (e.g., meningitis, encephalitis, cysticercosis, or brain abscess).
• Traumatic brain injury or head injury.
• Stroke (resulting from a block or rupture of a blood vessel in the brain).
• Other neurologic diseases (e.g., Alzheimer disease).
• Brain tumors.
• Certain genetic disorders.

In nearly two-thirds of the cases of epilepsy, a specific underlying cause is not identified. In these instances, the cause may be labeled cryptogenic if the cause is unknown or idiopathic if the epilepsy is not associated with other neurologic disease but is consistent with certain syndromes that may be inherited.

Can epilepsy be prevented?

Sometimes epilepsy may be preventable.  Considering the causes of epilepsy listed above, there are several opportunities for prevention.  Some of the most important are:

Complications of pregnancy and childbirth- Proper prenatal care to avoid problems during pregnancy and childbirth may lessen complications that could lead to epilepsy.

Infections- Proper immunization (vaccination) against certain diseases of childhood and adolescence or young adulthood may lessen the likelihood of infections that can sometimes involve the central nervous system and lead to epilepsy.  A parasitic infection called cysticercosis is a common cause of epilepsy in some developing countries and some U.S. immigrant populations.  Cysticercosis can be prevented through public health screening and early treatment as well as proper practices of hygiene and food preparation.

Traumatic brain injuries- Brain injuries, often due to motor vehicle crashes or falls, are a frequent cause of epilepsy. There are effective ways to reduce the occurrence and severity of motor vehicle and traffic injuries: consistently using safety belts (and safety seats for small children), airbags, bicycle helmets, and motorcycle helmets.

While older adults have an increased risk of brain injuries due to falls, there are effective measures to reduce this risk as well.

Stroke- Reducing or treating risk factors such as physical inactivity, high blood pressure, obesity, diabetes, high cholesterol, and smoking will lessen the likelihood of stroke and heart disease, which may help to reduce the possibility of developing epilepsy later in life.

How is epilepsy treated?

Before a person begins treatment, the first step is to ensure that the diagnosis of epilepsy is correct and to determine, if possible, the type of epilepsy and whether there are any underlying conditions that also need treatment.  This will require a careful review of the person’s medical history and a neurological examination.  Other tests may be recommended as well, usually including an electroencephalogram (EEG) and often a brain scan such as computed tomography (CT) or magnetic resonance imaging (MRI).  The medical decision about how best to treat the epilepsy is based on this evaluation.

Drugs- Antiepileptic drugs are the mainstay of treatment for most people. Early in treatment, adjustments in dosage are often required.  Sometimes, because of continued seizures or significant side effects, it is necessary to change to a different drug. For about two-thirds of people with epilepsy receiving optimum treatment, drugs are successful in fully controlling seizures.

Surgery-With certain types of partial epilepsy, especially when it can be determined that seizures consistently arise from a single area of the brain (the “seizure focus”), surgery to remove that focus may be effective in stopping future seizures or making them much easier to control with medication. Epilepsy surgery is most commonly performed when a seizure focus is located within the temporal lobe of the brain.

Other options- Other supplemental treatments are sometimes beneficial when medications alone are inadequate and surgery is not possible.  These include vagus nerve stimulation, where an electrical device is implanted to intermittently stimulate a large nerve in the neck, and the ketogenic diet, a high fat, low carbohydrate diet with restricted calories.

Who treats epilepsy?

A neurologist—a specialist in the brain and nervous system—is the right person to confirm the diagnosis and recommend treatment. People whose seizures are difficult to control or who need specialized or intensive care for epilepsy may be referred to epileptologists or to specialized epilepsy centers. Epilepsy centers have advanced diagnostic and treatment capabilities and are staffed by epileptologists and other physicians, psychologists, nurses, and technicians specializing in epilepsy care. Epilepsy center staff or consultants often also include neurosurgeons specializing in epilepsy surgery. Many epilepsy treatment centers are associated with university hospitals that perform research in addition to providing medical care.

What issues are unique for women with epilepsy?

Women with epilepsy can experience difficulties arising from hormonal changes during their reproductive cycle that sometimes can affect the tendency to have seizures. Pregnancy brings some special considerations for women with epilepsy, because seizure occurrence and certain drugs taken during this time may sometimes carry a risk of harm to the developing fetus.  Usually these risks can be minimized by several precautions women can take before and during pregnancy.

Can epilepsy be fatal?

Most people with epilepsy live a full life span.  Nevertheless, the risk of premature death is increased for some, depending on several factors:

Sometimes epilepsy is a symptom of a more serious underlying condition such as a stroke or a tumor that carries an increased risk of death.

People with some types of epilepsy who continue to have major seizures can experience injuries during a seizure from falling or hurting their head that may occasionally be life-threatening.

Very prolonged seizures or seizures in rapid succession, a condition called status epilepticus, can also be life-threatening.  Status epilepticus can sometimes occur when seizure medication use is stopped suddenly.

Rarely, people with epilepsy can experience sudden death (SUDEP).  The risk of sudden death is not increased for all types of epilepsy, but occurs more among people with major seizures—especially generalized tonic-clonic seizures—that are not well controlled.

To a great extent, it appears that optimal seizure control and some safety measures can reduce the risk of epilepsy-related mortality.

Can people who have epilepsy drive?

Most states will not issue a driver’s license to someone with epilepsy unless it can be documented that he or she has gone a specific amount of time without a seizure. The seizure-free period ranges from a few months to over a year. Some states rely on a physician’s recommendation and may allow a license to be issued when a person has seizures that don’t impair consciousness, occur only during sleep, or have long auras or other warning signs that allow the person to avoid driving when a seizure is likely to occur

Does epilepsy run in family?

In a great majority of cases the answer is “No”. In certain types of epilepsies (eg.
juvenile myoclonic epilepsy), the tendency to develop epilepsy is inherited.

Is epilepsy contagious?
No. You cannot catch epilepsy from another person.

Can epilepsy be prevented?
Epilepsy can be prevented by proper antenatal care, reducing accidents, improving
environmental sanitation and reducing the risk for stroke, infection etc.

Does the drugs used for epilepsy have side effects?

The drugs used for epilepsy need to be taken for a long time. Generally these
medicines do not cause serious side effects. Minor side effects like excessive sleep, gum swelling, excessive hair growth or loss of hair, change in body weight etc can occur.

Is epilepsy a hindrance to studies?
Tests in people with epilepsy generally show a normal intelligence. Most people
with well-controlled epilepsy can have normal studies including, professional education.

Is epilepsy a hindrance to marriage?
No. People with epilepsy can have normal married life. Women with epilepsy can
give birth to healthy babies. But social taboos cause hindrance to marriage.

Is epilepsy a hindrance to employment or actively engaging in sports and other activities?
Research suggests that people with epilepsy are likely to have fewer seizures,
when actively occupied. People with epilepsy can be valuable employees when
placed in right jobs. But it is better to avoid accident-prone jobs or sports.

What should be done during the fits?

• Keep the person lying on one side to allow the secretion from the mouth to flow out.
• Remove any object in the surroundings that may hurt the patient.
• Loosen tight clothing and remove spectacles
• Do not give anything to drink till the patient regain full consciousness
• Do not over react to a seizure event but give assurance to people around

What are the lifestyle modifications required for effective seizure control
and better quality of life?

• Take your medication regularly as advised by your doctor
• Identify your seizure triggers and try to avoid them
• Follow regular sleep pattern and avoid sleep deprivation
• Maintain regular food habits and avoid fasting.
• Avoid undue stress, alcoholism, smoking and weight gain.
• Develop a positive mental attitude, be active, and be happy as much possible.