Patient Information on 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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

Facts about a seizure episode

During a fit, one should take following first-aid precautions:

.

Don’t Restrain

Call an ambulance if:

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.

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.

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.

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.

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.