CONDITIONS
Epilepsy
Epilepsy is a brain condition that causes recurring seizures. Seizures are abnormal movements or behavior that happen due to unusual electrical activity in the brain.
Epilepsy is the fourth most common neurological disorder in the world and India contributes to nearly one-sixth of the global burden because out of the 70 crore persons with epilepsy (PWE)worldwide, nearly 12 crore PWE reside in India.
What are the symptoms of Epilepsy?
Symptoms depend on the type of seizure. Because epilepsy is caused by certain activity in the brain, seizures can affect any brain process. Seizure symptoms may include:
- Temporary confusion.
- A staring spell.
- Stiff muscles.
- Uncontrollable jerking movements of the arms and legs.
- Loss of consciousness.
- Psychological symptoms such as fear, anxiety or déjà vu (feeling of an incidence having happened before).
People with epilepsy may also have psychosis. Generally, people with epilepsy have similar type of seizure and symptoms in each episode.
Other life-threatening complications of epilepsy are not common but may happen. These include:
- Status epilepticus:
- A person present in a continuous seizure activity lasting more than five minutes.
- May also occur if seizures are present without regaining full consciousness
- This increases risk of permanent brain damage and death.
- Sudden unexpected death in epilepsy (SUDEP): May occur in people with frequent tonic-clonic seizures or seizures that remain uncontrolled by medicines
What are the types of seizures?
Depending on the location of brain activity, seizures are classified as either focal or generalized.
Focal seizures:
- Focal seizures without loss of consciousness (simple partial seizures):
- These seizures don’t cause a loss of awareness (consciousness).
- Focal seizures with impaired awareness (complex partial seizures):
- These seizures cause a change or loss of consciousness and generally seems to a person that they are in a dream.
- Focal seizures may come from any lobe of the brain and are classified accordingly –
- Temporal lobe seizures.
- Frontal lobe seizures
- –
Generalized seizures:
These type of seizures may occur or involve all areas of the brain. These are:
- Absence seizures (petit mal) – typical to children and seizures may occur in clusters, happening as often as 100 times a day, and cause a brief loss of awareness.
- Tonic seizures – causing stiff muscles
- Atonic seizures – loss of muscle control
- Clonic seizures – rhythmic jerky movements of the muscle
- Myoclonic seizures – sudden jerks or twists
- Tonic-clonic seizures (grand mal) – cause a sudden loss of consciousness and body stiffening, twitching and shaking
What are the causes and risk factors of Epilepsy?
In 50% of the people there is no identifiable cause of epilepsy. In the other half, following causes may be identified –
- Genetic influence
- Head trauma (injury) – eg in a car accident, etc.
- Factors in the brain – forming of the blood vessels in the brain
- Pre-birth injury
- Infections like meningitis
- Developmental conditions – people with another disorder where the child’s development is not proper like autism or attention-deficit/hyperactivity disorder (ADHD) may cause epilepsy
The risk factors in epilepsy:
- Premature birth or low birth weight
- Trauma during birth (such as lack of oxygen)
- Seizures in the first month of life
- Abnormal brain structures at birth
- Bleeding into the brain
- Brain tumors
- Stroke resulting from blockage of arteries
- Other medical conditions such as Cerebral palsy, or Mental disabilities, Alzheimer’s disease (late in the illness)
- Family history of epilepsy or fever-related seizures
- Lengthy fever-related (febrile) seizures
- Alcohol or drug abuse
How is Epilepsy diagnosed?
Epilepsy diagnosis based the occuring symptoms, physical signs and the results of some of the tests such as an electroencephalogram (EEG), computed tomography (CT or CAT scan) or magnetic resonance imaging (MRI), Positron emission tomography (PET), or Neuropsychological tests.
Along with your test results, a combination of other techniques may be used to help pinpoint where in the brain seizures start:
- Statistical parametric mapping (SPM): Areas of the brain with increased blood flow during seizures is assessed and compared to the same areas of the brains with people not having any seizures.
- Electrical source imaging (ESI): A technique where data is taken and extrapolated onto the MRI of the brain to show the location of seizures. More-accurate detail is provided in this technique compared to EEG alone.
- Magnetoencephalography (MEG): Measures the magnetic fields produced by brain activity and aids in finding the initiation of tumours.
A proper diagnosis of the type of epilepsy and the type of seizures are important for accurate treatment regimen.
What are the treatment options for Epilepsy?
Treatment in people with epilepsy may lead to fewer seizures or even lead to cessation of treatment. Possible treatments include:
- Medicines: Anti-epileptic medications may result in cessation of seizures and if not completely, then there might be a decrease in the number and intensity of seizures by taking more than one medicine.
- Surgery: Surgery is only done when the tests show that the seizures start in a small, well-defined area of the brain and if the surgery does not affect vital functions.
- Therapies: These therapies usually stimulate the brain using a device. Such therapies are:
- Vagus nerve stimulation
- Deep brain stimulation.
- Responsive neurostimulation.
A ketogenic diet: In this type of treatment, people with epilepsy are prescribed a diet high in fats and low in carbohydrates, which leads to reduction in seizures.
What should one do in case of seizure?
A person with epilepsy or people around them should know how to handle a seizure. These suggestions help:
- Stay calm during the seizures.
- The person should be carefully rolled on one side to prevent choking.
- Something soft should be placed under the person’s head.
- Loosen tight neckwear.
- Any kind of object or fingers should not b inserted into the person’s mouth as people with epilepsy dol not “swallow” their tongues during a seizure.
- A person having a seizure should not, in case be restrained.
- Dangerous objects should be cleared in case the person is moving.
- Stay with the person until medical staff arrive in case immediate help is needed.
- The person should be observed closely to provide all details later.
- Seizures should be timed.
References
- Lindsay Modglin. Epilepsy statistics 2024. May 2024. https://www.singlecare.com/blog/news/epilepsy-statistics/
- Amudhan S, Gururaj G, Satishchandra P. Epilepsy in India I: Epidemiology and public health. Ann Indian Acad Neurol. 2015 Jul-Sep;18(3):263-77.
- Mayo Clinic. May 2024. https://www.mayoclinic.org/diseases-conditions/epilepsy/diagnosis-treatment/drc-20350098
- What Is Epilepsy? WebMD. May 2024. https://www.webmd.com/epilepsy/treating-epilepsy