Epilepsy

Epilepsy is a nervous system disorder characterized by recurrent episodes (not a single attack) of seizure or convulsion. A seizure is an abnormal electrical discharge in the brain cells resulting in a temporary disturbance of sensory, motor or mental functioning. 

Depending upon the specific area of the brain affected, a particular type of seizure may occur. There are mainly two types of seizures: generalized seizures which affect the whole brain and focal or partial seizures which affect just a small area of the brain. 

The exact cause of epilepsy is not known; however, there are a number of risk factors which play a role in their causation.

1. Genetics-patients who have parents or siblings with history of epilepsy.

2. Head injury-a serious injury to the head increases the risk of epilepsy.

3. Infection-infections such as meningitis, encephalitis and AIDS can increase chances of epilepsy.

4. Medical conditions-brain tumors, stroke, Alzheimer’s or disorders of blood vessels can cause epilepsy.

5. Medical conditions during pregnancy-infections during pregnancy or trauma to the baby during birth can cause epilepsy in children.

Few people with epilepsy have noticed that certain triggers can provoke an episode of epilepsy such as:

1. Lack of sleep

2. Fever or any sickness

3. Stress

4. Bright flashing lights

5. Drugs

6. Skipping meals

Depending upon the types of seizures the symptoms can present as:

Generalized seizures:

All areas of the brain are affected and these are known as Grand mal seizures.

1. Rhythmic movements of the arms and legs.

2. Eyes are generally open.

3. Person may appear as if he/she is not breathing.

4. Return of consciousness is gradual.

5. Involuntary passage of urine, tongue biting and frothing at mouth may occur.

6. Confusion after the seizures is common.

Seizure is a sign of a serious medical condition. Immediate medical advice is required. A complete personal and family history will be taken by your doctor with physical examination.

1. A complete blood count and other blood tests will be done to detect presence of any infection, liver or kidney disease. Blood sugar levels will be checked. 

2. Electroencephalogram (EEG) will be required to diagnose epilepsy.

3. Imaging tests such as:

a. CT scan

b. MRI

c. PET scan

Treatment options include:

1. Anti-epileptic or anti-seizure drugs e.g. phenytoin, phenobarbital

2. Vagus nerve stimulator-a device is placed under the skin on the chest to stimulate the nerves. This helps reduce the chance of seizures.

3. Ketogenic diet-a high fat and low carbohydrate diet may help in reducing the number of seizures.

4. Surgery- the affected area of the brain might be surgically removed in severe cases.

1. Complications in pregnancy.

2. Injury during an attack of a seizure, e.g. tongue bite and severe bleeding.

3. Depression and mood swings.

4. Sudden unexpected death in epilepsy – this happens more so in people who do not respond to medications. 

You must visit a doctor after: 

1. The first episode of seizure.

2. When seizure lasts for more than 5 minutes.

3. Associated difficulty in breathing.

4. Unconsciousness or confusion lasting for long.

5. Injuries during a seizure.

The outlook of epilepsy usually depends upon the cause. If the cause is discovered, prognosis is good. Seizures related to brain tumors and medical conditions have a poor outcome. 

Prevention of epilepsy is done by treating the underlying medical condition which is the cause. Take the prescribed anticonvulsant medication regularly. If there are any known triggers, avoid them as far as possible. Sleep deprivation and stress are leading causative factors. Enough sleep, timely and proper diet should be encouraged.