A Simple Guide to Epilepsy

A Simple Guide to Epilepsy
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What is epilepsy?
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Epilepsy is a neurological disorder which occurs when the brain malfunctions due to sudden abnormal electrical discharge of brain cells.
If all the brain cells discharge abnormal signals at once, the epileptic fit is called a generalised fit or grand mal.
If only part of the brain is involved in discharging abnormal signals, the fit is called a partial epileptic fit.
Epilepsy is diagnosed only when there are repeated episodes of epileptic fits.

What are the types of epilepsy?
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Epileptic Seizures may vary from the briefest lapses of attention(trance) or muscle jerks to severe and prolonged convulsions.
They may also vary from less than one a year to several per day.
Seizures are classified :

1.Partial or focal seizures
These seizures arise from an electric discharge of one or more localised areas of the brain regardless of whether the seizure is secondarily generalized.
They may or may not affect consciousness.
Partial seizures begin in a localized area of the brain, but then may spread to the whole brain causing a generalized seizure.

2.Generalized seizures
Generalised electrical discharge involves the whole brain.
It may cause loss of consciousness and/or muscle convulsions or stiffness.
They include what used to be known as grand mal convulsion and also the brief petit mal absence of consciousness.

3.Status epilepticus
This is a condition in which a person has very frequent seizures without recovery of consciousness between each episode.
This is a dangerous condition and if not treated may lead to brain damage or death.

What are the causes of Epilepsy?
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In 70% of cases the cause is unknown.
In such cases, the theory most commonly accepted is that this epilepsy is the result of an imbalance of certain chemicals in the brain (especially chemical messengers known as neurotransmitters) causing them to have a low convulsive threshold.
Epilepsy of unknown or genetic origin are present in children and adolescents.

In the remaining cases, the causes can be found and some may be treated.

1. Brain infection can cause epilepsy at any age. Neurocysticercosis cysts on the brain caused by tapeworm infection, malaria and meningitis are common causes.

2. Febrile illness of any kind can trigger seizures in young children.
Some 3% of children who have febrile convulsions go on to develop epilepsy in later life.

3. Stroke may damage brain cells resulting in seizures.

4. Trauma and head injury may also damage brain cells resulting in seizures.

Certain flashing lights (discos, television, video games etc.), over-breathing, over-hydration, loss of sleep, and/or emotional and physical stress, may stimulate seizures.
Although these are not causes of epilepsy, they may affect the timing and frequency of seizures.

Who are at risk of Epilepsy?
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It occurs in men and women and can begin at any age, but is most frequently diagnosed in infancy, childhood, adolescence and old age.

What are the Symptoms of Epilepsy?
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Symptoms varies depending on the part of the brain which is functioning abnormally.

Generalised Fits
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There are several types of generalised fits.
In the classical Grand mal fit:
1.there is a sudden loss of consciousness and the person fall to the ground.
2.The eyes may roll up.
3.There is body stiffening and convulsions.
4.The tongue may be bitten during the fit
5.The urine may passed out due to loss of bladder control.
6.After the fit the body relaxes and the patient may fall into a sleep for several hours.

In the generalised Petit Mal Fit:
1. There may be a sudden absence of movement or sudden interruption of speech for a few minutes
2. This is followed by the patient picking up the speech or movement where he last stopped.
3. It can be dangerous especially while driving or doing dangerous work which require continous movements.

Partial or focal Fit
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Just as in generalised fits, there are also many types of partial fits.
In a partial fit , there may be changes to the way the person looks at things, feels, smells or taste.
In other cases there may be staring and unusual movement like hand rubbing etc.

What are the investigation for Epilepsy?
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All suspected epileptic cases should undergo the following tests:

1. blood tests - for chemicals imbalance or poisoning
2. MRI of brain (or CAT Scan of the brain) to detect any any abnormal focal area of the brain
3. EEG of brain (which measures the brain electrical waves)

What is the Treatment of Epilepsy?
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It has been shown that 70% of newly diagnosed children and adults with epilepsy can be successfully treated (i.e, their seizures can be completely controlled for several years) with anti-epileptic drugs.
After 2-5 years of successful treatment, drugs can be withdrawn in about 70% of children and 60% of adults without relapses.

Modern drugs used for epilepsy are:
phenytoin
carbamazepine
sodium valproate

Some 30% of people may not respond to drug therapy.
A factor which leads to worse prognosis is the presence of an underlying brain disease.

Partial seizures, especially if associated with a brain disease, are more difficult to control than generalized seizures.
Surgery may be considered when the epilepsy or the brain disease poses a danger to life.

Secondary seizures- not epilepsy- such as those related to an acute, short-lasting brain disease, may run a self-limiting course.
A significant proportion of people may develop established epilepsy.

What are the complications of Epilepsy?
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Epilepsy can be associated with an increased risk of mortality.
Death may be related to:
1.An underlying brain disease, such as a tumour or infection;

2.Seizures in dangerous circumstances, leading to drowning, burns or head injury

3.Status epilepticus;

4.Sudden and unexplained causes, or a possible respiratory or cardio-respiratory arrest during a seizure;

5.Suicide.

How do you prevent another Epilepsy Fit?
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The patient must do the following:
1. take his anti-epileptic medicine exactly as prescribed, avoid stopping his medicine or altering the dosage of medicine.

2. strive for a healthy lifestyle with balanced diet, regular exercise and effective stress management.

3. limit the intake of alcohol

4. get adequate sleep and rest as lack of sleep can trigger a fit

5. avoid operation of heavy machinery

6. carry a card stating his condition and medicines.
This will be helpful in an emergency.

How to help a person having a Epilepsy Fit?
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As a person having an epileptic fit may be unconscious or drowsy, you should :
1.keep the person safe from injury - protect him from falling to the ground, remove any sharp objects near the drowsy epileptic person

2. do not place any object in his mouth - this may cause injury like chipped teeth or even a broken jaw

3. put him in a prone position with the mouth sideways to avoid any blockage of his airway - may sure that he is able to breathe properly

4. Call an ambulance if the fit lasts more than 5 minutes, or if there is repeated seizures, or if the person is pregnant or has diabetes