Epilepsy is a chronic disease of the human brain characterised by recurrent seizures or “fits”. These are short periods of abnormal electrical activity in the brain, causing symptoms ranging from mild to severe. They may include impaired consciousness, abnormal limb movements, forceful turning of head, visual, psychological, and sensory experiences. In some cases, the seizures can last for hours. It’s called status epilepticus, a serious medical condition which requires emergency hospitalisation and treatment.
Three pillars of diagnosis
Taking note of history: An eyewitness account of the episode will help the clinician make a diagnosis of epileptic seizure and differentiate it from conditions that mimic seizures. The patient’s history, starting from the antenatal period and also the medical history of the family are also highly relevant to make a diagnosis.
EEG (Electroencephalogram): This is the single most important investigation in epilepsy. A carefully performed awake and sleep record (total 45 minutes) EEG will detect abnormalities in the majority of cases. However, in some cases, especially when the patient does not respond to medications, a longer recording (8 hours to a few days) may be required.
Neuroimaging: A special protocol MRI Brain and other forms of neuroimaging are useful to find any structural brain abnormalities which could result in epilepsy. Investigative modalities like PET.
Treatment
The most important and commonly used form of treatment for epilepsy is medication, which has been scientifically proven to be effective with a good safety profile. However, adverse effects which occur in a minority of cases, instil fear among some, this stops them from taking long-term medications. In such scenarios, both the patient and family require constant reassurance from the treating doctor. Along with medications, it is also important to ensure a healthy lifestyle and daily routine (especially good sleep and reduced screen time).
Surgery is the next option. This is reserved for patients who do not respond to anti-epileptic medications, and it is potentially curative in about 70 per cent of patients. Epilepsy surgery is a life-changing treatment option which must be performed only in a centre with a comprehensive epilepsy surgery programme.
Those patients who cannot be considered for epilepsy surgery can be given neurostimulation. Stimulation of the vagus nerve in the neck or deep brain structures are the two procedures that are now available to reduce the seizure burden.
The author is the senior consultant- neurology at Meitra Hospital, Kozhikode