KOCHI: 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.
The term epilepsy has a different connotation, pointing to an ongoing predisposition for repeated seizures and also to the ensuing physical, psychological and social consequences of this condition. 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.
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 as low sodium or sugar level, stroke, trauma, alcoholism-related, certain infections and inflammations that affect the brain all can cause seizures.
A major proportion of childhood, adolescent and even adult-onset seizures are consequences of injuries sustained to highly vulnerable fetal brain during and after childbirth. 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.
Recent research shows that many such epileptic disorders have a genetic component which need not always run in families. 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.
The correct identification of the type of seizure and the epilepsy syndrome is of paramount importance and helps the physician to guide a patient’s treatment.
Dos & Don’ts 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 a 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 thatwhatever 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. Evidence is lacking whether the introduction of any material into the mouth to prevent tongue bite may be beneficial, in fact it may be counterproductive and can injure patient or the helper.
Investigations
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. At times for a better characterisation of the seizures, the doctor may ask for a video EEG, which includes admission and continuous video and EEG recording of the patient including his or her habitual seizures if need be. Vision assessment, speech and language assessment, psychological review all form necessary tools of investigations in select cases.
Treatment
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.Medication side effects can occur with any medicine and with any treatment system and are not restricted to antiepileptic medications. Just like any other drug class, this group of medicine have their own spectrum of side effects, no more, no less. The type of seizure and the epilepsy syndrome would guide the choice of antiepileptic drug and would vary from one patient to another and does not follow one-fit-for-all policy. The diagnosis of seizure do not warrant treatment at all times but when taken, decision is in conjunction with patient’s wishes after discussing all the pros and cons. Patients are encouraged to clarify all their doubts.
Conclusion
Epilepsy continues to evoke emotions of fear and misunderstandings regarding its treatment still exist in the community. It has to be borne in mind that majority of patients can have seizure freedom with the institution of correct medication at correct dose. In those unfortunates in whom medical treatment fails to control seizures adequately, surgical management is a treatment option.
Dr Deepak Menon
Consultant Epileptologist
KIMS Hospital, Thiruvananthapuram
(The views expressed by the author are his own)
