Epilepsy
Epilepsy is a chronic brain condition having unique characteristics. One of the characteristics of people with epilepsy is the recurrence of seizures. That is why epilepsy is commonly known as seizure disorder.
The roots of epilepsy have been traced as far as 3000 years ago. Because of its disturbing and dramatic features, back then epilepsy was feared and was thought to be a result of some sort of supernatural force or evil influence. Today we are in the 21st century, yet people with epilepsy are not free from the social stigma, discrimination and isolation. In many rural parts of the country, it is still believed that people with epilepsy are mentally challenged and cannot be treated or lead a normal life. Women with epilepsy face problems in getting married because of the belief that they cannot have children or if they do their children will also be affected. (Read: World Epilepsy Day 2012: Top myths about epilepsy busted)
This clearly shows a lack of understanding of the disorder. Epilepsy doesn’t mean being mentally challenged or having an abnormal life. A person with epilepsy can lead a normal life, get married and have children as well. All you need is a better understanding of the disorder and ways to treat and prevent it.
Causes
The brain functions with the help of millions of neurons that transmits and receives signals. Epilepsy is caused when the normal pattern of transmission of signals to and from the brain is disturbed. This results in seizures that affect consciousness, body movements and sensations in the affected person for a short period of time until the electric impulses settle. Physical changes that occur during an epileptic seizure may arise either from disturbance in one part of the brain (partial seizure) or in nerve cells from different parts of the brain (generalized seizures). (Read: Epilepsy patients’ brain activity to be monitored)
The exact cause of epilepsy is not found in most cases. Since epilepsy involves the brain function at the neuronal level, several events or conditions that affect the brain may cause epilepsy.
- Trauma to the brain or head injury
- Lack of oxygen supply to the brain during birth
- Brain tumors
- Infections such as meningitis and encephalitis which affect the brain.
- Stroke caused by damage to a blood vessel in the brain
- Neurological diseases such as Alzheimer disease
- Genetic conditions
- Lead poisoning or carbon monoxide poisoning can cause epilepsy
- Drug addiction and overuse of certain antidepressants
Risk factors
Dr Arjun Srivatsa, renowned neurosurgeon and founding trustee of Spine Trust India says, ‘Epilepsy is statistically more prevalent in older population. In children, nearly 30 percent of cases are reported in the first 5 years of age.' ‘There is no particular group of people who have greater chances of getting epilepsy,’ he adds further.
Symptoms
Several physical changes take place during an epileptic seizure. Although nothing can describe what the person going through an epileptic attack feels, but the following signs may be seen during an epileptic seizure:
- Sudden jerking movements or twitches in the arm, legs and facial muscles (clonic movements)
- Rapid movement of the eye balls and head
- Altered consciousness or complete loss of consciousness
- Abdominal discomfort
- Tendency of tongue biting and incontinence.
- Later the patient may feel confused, drowsy and weak
What is the difference between seizures and epilepsy?
Seizure is just a sign of epilepsy. All patients with epilepsy have seizures but all people having seizures may not have epilepsy. An episode of a single seizure doesn’t indicate that the person is suffering from epilepsy.
Seizures can also be triggered by synchronised activity of neurons in the brain occurring in different conditions like high fever, lack of oxygen supply to the brain and hypoglycaemia. Epilepsy is a condition that makes a person susceptible to seizures.
Diagnosis
According to the Indian Guidelines of Epilepsy, diagnosis of epilepsy requires a detailed medical history of the patient. Dr Srivatsa mentions that epilepsy is usually well described by an eye witness. Therefore, family members and friends of the patient may be required to describe the event and the physical changes observed. The guidelines suggest video recording of the epileptic event can be useful for correct diagnosis.
The doctor will then examine pulse rate and blood pressure of the patient. Presence of subcutaneous nodules and other neurological signs are also examined.
Confirmation of epilepsy is done through various brain imaging procedures.
EEG: An electroencephalogram (EEG) is a common diagnostic tool used to detect signals from the neurons in the brain and classify the type of epilepsy.The waves resulting from these signals may show a specific pattern which helps the doctor to confirm epilepsy as the cause of seizures.
CT scan or MRI: A CT scan or MRI scan may be taken to detect other conditions that may be causing seizures.
PET: A positron emission tomography (PET) scan may be performed to analyze which centers in the brain are involved in seizures. (Read: World Epilepsy Day: Epilepsy more disabling than acknowledged)
Treatment
The aim of treatment in epilepsy is to control seizures through anti-epileptic drug (AED) therapy and surgery.
Anti-epileptic drug (AED) therapy: AED is the most common form of treatment given to patients with epilepsy. A single AED (monotherapy) is first given to the patient. Drugs like phenytoin, oxcarbazepine, valproate, phenobarbitone and carbamazepine are conventional drugs used for monotherapy. A combination of these drugs may be given if monotherapy shows no effect on reduction in seizure events. Complete withdrawal of drugs is considered only when the patient is seizure-free.
Usually the dosage of drug is reduced gradually and over a period of 3–6 months (or longer) the patient may be free from seizures. Dr Srivatsa says ‘A small group of patients having seizures may need life long medications because of chances of relapse’ (Read: Scientists cure epilepsy in mice)
Surgery: ‘There is a small population of patients, who do not respond to drug treatments at all. Such patients are termed as refractive to treatment,’ Dr Srivatsa says. ‘However, in such patients, if appropriate diagnosis is done and the areas of the brain which are prone to seizures are mapped using advanced EEG, surgery can be considered,’ he mentions.
- Removal of seizure focus:It is the most common type of surgery where a small part of the brain where disturbance in signals is observed is removed.
- Multiple Subpial Transection: Sometimes, when the affected part cannot be removed, the surgeon may introduce series of incisions to prevent the signals from the affected part to reach other parts of the brain.
- Lesionectomy: Epilepsy caused by the presence of a lesion can be treated by surgical removal of the legion.
‘There are newer methods like Vagus nerve stimulation (VNS) which are considered in patients who are not fit for surgeries,’ says Dr Srivatsa. In this method, a device called vagus nerve stimulator is implanted under the skin of the patient in the chest. The device remains attached to the vagus nerve that delivers electrical signals to the brain thereby reducing seizures by 20-40 percent.
Diet: Researchers believe that diet rich in fats and low in carbohydrates (ketogenic diet) may help to reduce the frequency of seizures.
Prevention
Because the cause of epilepsy is not known, it cannot be prevented. However, childhood epilepsy can be prevented with good care during pregnancy. Genetic screening may help the mother to identify the chances of epilepsy in her child. Preventing head injuries can be taken as a preventive measures since they can lead to epilepsy.
People with epilepsy can control the frequency of their seizures by:
- Adhering to recommended prescribed medication
- Following a regular sleep cycle
- Avoiding stress
- Modifying diet
- Undergoing regular medical checkups and adhering to their follow-up schedule.
The content has been verified by
Dr Arjun Srivatsa
, renowned neurologist.
91 – 22 – 2490 0302.