THIRUVANANTHAPURAM: Epileptic seizures or ‘fits’ in common parlance, refers to the short lasting signs or symptoms that occur due to abnormal and excessive misfiring of brain cells. It can be characterized by brief episodes of involuntary movements that may involve a part of or the entire body, and can be accompanied by loss of consciousness and control of bowel or bladder function.
Latest WHO numbers reveal that about 50 million people are living with epilepsy worldwide with nearly 2.5 million new cases being diagnosed each year. It is a major public health problem and uncontrolled epilepsy can have serious consequences with neurological, psychological and social disabilities that adversely affect the quality of life of the person and their families and even can cause unexpected sudden deaths.
Causes of seizures and epilepsy:
There are a number of different causes which trigger the abnormal electrical firing or storms inside the brain network. In the acute setting, medical conditions such low sodium or sugar level, stroke, trauma, alcoholism related, certain infections and inflammations that affect the brain all can cause seizures. There are a group of epilepsies which occur in a particular age with no apparent causes, some of which can have high seizure load, adversely affecting child’s development and can have devastating consequences.
Depending on the nature of events that occur during the attacks, seizures can be broadly divided into focal and generalised seizures. In focal seizures, usually one part of the body may be involved but can progress to involve all four limbs wherein they are called generalised seizures.
Things to do and not to do during seizure:
First and foremost do not panic and lose your presence of mind. The sensible actions of the bystanders may at times save the patient from significant injury and can assist in recovery. The falls sustained during seizures can result in serious injuries much more dangerous than the effect of seizures. In case of generalised seizures, protect the patient from injuries by helping them to floor or if in bed take necessary measures to prevent a fall.
Gently turn the patient to one side so that whatever froth and saliva that may collect may flow out. One should try to loosen any tight or constricting clothing that may block his or her breathing. Do not press down on the patient in order to subdue the jerks. Unless specifically mentioned by the doctor do not attempt to give any medication or attempt to give drinks until patient is fully conscious and awake.Do not leave the patient unprotected; be with the patient till he or she recovers which usually occurs in ten to fifteen minutes.
Patients may have confusion, headache or vomiting. Gentleness, empathy and reassurance will give them confidence and would assist in recovery.
During your initial consultation the doctor may be more interested in your description of the event and physical examination. Accordingly the physician would decide on relevant investigations. These include routine blood tests, Electroencephalogram (EEG) with or without sleep and Magnetic Resonance Imaging(MRI) of the brain with particular focus from epilepsy point of view.
These are neither exclusive nor mandatory and are tailored to each patient’s nature of seizure. Vision assessment, speech and language assessment, psychological review all form necessary tools of investigations in select cases.
There are many myths and misconceptions abound regarding pharmacological treatment of epilepsy. Often, it is the unwarranted and unjustified phobia regarding antiepileptic medications, their potential side effects and duration of treatment.
Epilepsy continues to evoke emotions of fear and misunderstandings regarding its treatment still exist in the community. With advances in science, treatment options are available that can help a person with epilepsy lead an essentially normal life. Times are long gone, when people with epilepsy were forced to be marginalised from the mainstream society.
The views expressed by the author are his own.
The author is a Consultant Neurologist at KIMS Hospital, Trivandrum.