Patient Information on Epilepsy

Is there any difference between seizure, convulsion, fits & epilepsy?

“Seizure” is an alternative term for “epileptic attack”. It’s the manifestation one gets due to abnormal electrical discharge in the brain. The terms like convulsion or fits etc are used for the same only.

Epilepsy on the other hand is a disease where an individual has a tendency to get recurrent unprovoked seizures.

What are the common causes of epilepsy in India?

  • Hypoxic injury to brain at the time of child birth
  • Brain infections such as neurocysticercosis and tuberculosis,
  • Head injury secondary to road traffic accident, falls etc.
  • Other causes – Stroke, tumours

At what age epilepsy usually starts?

Epilepsy can start any age but is more common in children and in elderly people after 60 years of age. Even patients with birth defects can develop epilepsy at a later age.

Grossly we can divide epilepsy into two types.

  • Focal or partial epilepsy : In this condition the seizures start from a particular part of the brain and then can spread to involve whole of the brain.
  • Generalized epilepsy : Where there are no apparent single foci of for the origin of the seizures.
  • How epilepsy is diagnosed? Do I need to get EEG and MR imaging of brain?

    Epilepsy is a clinical diagnosis and detailed eye witness account is the key to diagnosis.

    The relevant investigations include MRI brain and EEG, other than simple blood investigations. Electroencephalograph (EEG) record helps to study the abnormal electrical activity of the brain which directly corresponds to the epilepstic condition of the brain. Ideally EEG should be of atleast half an hour. A sleep record with sleep deprivation in the previous night should be there in EEG as many abnormalities can be missed in an only awake record.

    MRI brain (1.5 or 3 Tesla) helps to identify affected areas of the brain which is causing these recurrent seizures. It should be good quality imaging done as per epilepsy protocol.

    What are the treatment options for eilepsy?

    Epilepsy is primary treated with medicines. The good news is that four out of five people with epilepsy can have their seizures controlled by proper medications. Type of medicine will depend on the type of epilepsy. Majority of the people with seizures have very good improvement with single drug though some may require addition of another drug. There are numerous newer antiepileptic drugs which are very safe to use for long term.

    What are the factors which can provoke seizure?

  • Missed medication
  • Lack of sleep
  • Inter current illness (both with and without fever)
  • Severe psychological stress
  • Heavy alcohol use
  • Use of cocaine and other recreational drugs such as ecstasy
  • Over-the-counter or prescription medications or supplements that decrease the effectiveness of seizure medicines, antibiotics
  • Nutritional deficiencies: vitamins and minerals
  • Hormonal changes in menstrual cycle
  • What to do if I have epilepsy? Can I stop medicine if I have fever or respiratory infections?

    You should consult a neurologist who is expert in epilepsy. Once the diagnosis and type of epilepsy is confirmed, take appropriate medicines prescribed by your doctor regularly and don’t miss them even for a single day. Even if you are not able to meet your doctor on the appointment date, do not stop your medicines and continue them as before.

    If you have intercurrent illness like fever, respiratory infections, don’t stop epilepsy medications. Always make it a point to inform your family physician that you are on these medications.

    What is the duration of treatment?

    Usual duration of treatment is 3-5 years. In some cases as acute head injury, alchol withdrwal related acute symptomatic seizures, antiepileptic medications can be discontinued after a month. Some patients may have to continue treatment for many years and even lifelong (like Juvenile myoclonic epilepsy).

    Most important precaution is that the medicines should be stopped only after proper consultation as sudden stopping of medicines can result in seizure relapse even after good control of seizures for 3-4 years.

    Will medicines produce any side-effects if I take them for long-term?

    Majority of the medicines are safe and do not produce any long-term side effects or damage to body organs. Most of the medicines produce short term side effects if doses are very high or medicines are too many. These can be managed by simplifying the treatment regimen by reducing the doses or number of medicines.

    Is epilepsy curable?

    Epilepsy is treatable in majority of the cases. Majority of the people with seizures have very good improvement with single drug though some may require addition of another drug.

    In few individuals (one in five) the seizures are not well controlled with medication. These “drug resistant epilepsy” cases can be attempted for cure by surgery. If the seizures are starting from a single point of the brain, then it can be treated by removing that point of the brain.

    When should I consider the option of epilepsy surgery?

    Epilepsy surgery is considered in those cases where seizures cannot be controlled by medicines. If your seizures are not controlled with proper doses of one or at the most two medicines, then you should consider the option of epilepsy surgery and discuss with it your treating neurologist. Please note that surgery is usually not considered if your seizures are well controlled with medicines.

    How effective and safe is epilepsy surgery?

    In properly selected patients, seizures may be completely stopped in 50-80% of patients with epilepsy surgery. After 2-3 years of surgery, medicines can also be stopped in 30-50% of patients. Epilepsy surgery is safe and complication rate is less than 1% which is similar to any brain or other organ surgery.

    I have epilepsy, Can I marry?

    In 1976, there was amendment in the existing laws prohibiting persons with epilepsy from getting married. With medical treatment and control it was realized that it was discriminatory and not required. After the efforts of Indian Epilepsy association, the central government passed a bill in 1999allowing individual with epilepsy to have a legal marriage. Today a person with epilepsy can have a legally valid marriage and epilepsy is no more an illness to claim for divorce.

    Should I disclose about my epilepsy before marriage to my fiancée and his/her family members?

    Although disclosing can have some problems, it is always better to disclose about epilepsy before marriage to avoid any future troubles. Be confident and honest while sharing information about your disease. Even better, fix an appointment with your treating doctor and allow him or her to explain your condition to your would-be-partner. In our country, it is also important for the women to be employed so that she is financially independent and can make independent decisions.

    Is epilepsy hereditary?

    In a majority of cases, epilepsy is not hereditary. Only certain types of epilepsies, usually less than 5% of cases, are hereditary.

    Will antiepileptic drugs affect my pregnancy and future child?

    In most of the people with epilepsy there is no problem with regard to kids. There are high chances of having a normal pregnancy. The chances of epilepsy or antiepileptic drugs affecting kids are very low.

    In normal population the chances of having major congenital anomaly is 2 to 3%. In patients on antiepileptics the risk goes from 3 to 9% highest risk being in those on multiple medications and high dose valproate. Many of the newer antiepileptics are quite safe.

    If you are on antiepileptic drugs it is very important to consult your doctor before planning for pregnancy as you may require medication adjustment and adding of multivitamin like folic acid.

    What to do if I witness someone has seizure (First aid during seizure)?

    Facts about a seizure episode

  • Don’t last long – Majority (>95%) of seizures are self limiting and stop within 1-2 minutes
  • You can’t stop a seizure by restraining, smelling onions, rubbing metallic objects – let’s wait for the seizure to run its course and try to protect the person from harm.
  • Only drugs can bring a seizure to stop in case it is not ending on its own.
  • Not dangerous to others-It is unlikely that during seizure the patient will harm to others.
  • During a fit, one should take following first-aid precautions:

  • Reassure every one, don’t panic.
  • Remove move things out of the way so the person won’t injure him or herself.
  • Loosen any tight clothing around the neck and remove spectacles.
  • Reposition – Put a pillow or something soft under the head or keep hand under the head.
  • Lay him or her on left side, let the saliva drain out.
  • .

  • Record – Time the seizure duration.
  • Reassure-others and stay with the person until recovery is complete.
  • Do not give anything to eat or drink till the patient regain full consciousness
  • Don’t Restrain

  • Do not attempt to force a hard object (spoon or metal) between the teeth. You can cause more damage than you can prevent.
  • Do not try to hold the person down during the seizure.
  • If the person having a seizure turns blue or stops breathing, try to position their head to prevent their tongue from blocking their airways. Breathing usually starts on its own once the seizure is over.
  • CPR or mouth-to-mouth breathing is rarely needed after seizures and cannot be performed during the seizure.
  • Call an ambulance if:

  • The seizure lasted longer than five minutes.
  • The person was injured during the seizure.
  • If it seems like one seizure is immediately following the previous one. And the person is not regaining consciousness in between.
  • What precautions should I take for effective seizure control and better quality of life?

  • Take your medication regularly as advised by your doctor
  • Identify your seizure triggers and try to avoid them
  • Follow regular sleep pattern and avoid sleep deprivation
  • Maintain regular food habits and avoid fasting.
  • Avoid undue stress, alcoholism, smoking and weight gain.
  • Develop a positive mental attitude, be active, and be happy as much possible.
  • I am feeling very depressed. What should I do?

    Depression and other psychiatric problems are common in people with epilepsy. Discuss the problems with your neurologist who will guide you about further treatment. Majority of these problems can be very well treated with counseling and medicines. Have positive attitude about life and consider epilepsy as only one aspect of your life.

    How can I help my child with epilepsy?

    One should try to be as normal as possible with the child without being overprotective. One should patiently explain the child about the nature of illness and the minor restrictions. Give medicines regularly to child, ensure regular and proper sleep, and take the child for safe outdoor activities. Talk to the teacher about the nature of illness and be patient with child while teaching.

    My child is hyperactive and poor in studies. What should I do?

    Attention deficits and hyperactivity are common in children with epilepsy. This can be managed by behavioral therapy and in some cases with medicines. It may require help from a child psychologist, speech therapist and an occupational therapist. You can also discuss the need for special schooling if your child is not able to cope with regular school.

    Can I lead a normal life with epilepsy?

    Because of the intermittent nature of seizures, epilepsy can restrict some activities like driving and active socializing. However, epilepsy can be very well controlled in more than 70% of patients with proper treatment. These people can lead completely normal life without any restrictions. Even people who have uncontrolled epilepsy can lead normal life with minor restrictions.

    What can one do to prevent epilepsy?

    One cannot prevent all types of epilepsy but can take precautions to prevent certain conditions which can cause epilepsy. One should ensure proper prenatal and perinatal care to prevent birth injuries, proper immunization to prevent infections like meningitis, use of helmet while driving, following traffic rules, and proper regular and healthy life style with avoidance of smoking and excess alcohol, treatment of hypertension and diabetes to prevent strokes.