Epilepsy

A seizure is any abnormal involuntary movements caused by abnormal electrical discharge in the brain, while, “epilepsy” means a tendency to have recurrent seizures. In a normal brain there are multiple neuronal circuits which work together for synchronous activity of the brain. In epilepsy because of various reasons this circuit is disturbed or impaired thus causing hyper synchronous repetitive discharge involving large groups of nerve cells. This is manifested in the form of abnormal movements of parts of the body depending on the part of brain affected. In an epileptic, seizures may be generalized involving the whole body. This is technically known as tonic-clonic seizures. These are the best known ones and are known as epilepsy by lay people. The affected person may suddenly fall down while standing or doing some work followed by involuntary outward movement of limbs. There may be respiratory arrest in severe cases. Tongue may stick out and get bitten, accompanied by frothing from the mouth. The epileptic may become unconscious. Regaining consciousness, he may have no memory of the preceding horrifying event (called retrograde amnesia). Sometimes they sleep for hours due to exhaustion following the attack. There may be an aura preceding the attack, but mostly the attack is instant, giving no time for the person to avoid it or call somebody. Partial seizures involve only a part of the body maybe a limb or face depending on the part of brain affected. The patient may suddenly start staring blankly or making rhythmic smacking or grimacing movements of the lips. All this happens in a few minutes. Sometimes an attack of epilepsy may be followed by paralysis for a few minutes or hours (Todd’s palsy). There are many types of epileptic seizures depending on the part of brain affected with many fancy names. But overall it is a very scary situation for the sufferer as well as the observer. Due to ignorance about the disease, it is often thought that the concerned person is possessed by evil spirits and well wishers may go for witchcraft for cure. While watching a poor man having a seizure one would think him to be mad or intoxicated. If not attended urgently a person may sustain injury, develop permanent paralysis or even die due to aspiration of secretions. There are many causes for epilepsy. The tonic-clonic seizures are commonly genetic and run in families. In children injury to head during birth, diminished blood supply to brain are often the fore-runners of epilepsy. Seizures due to high fever in a child may be the beginning of epilepsy. In both children as well as adults metabolic disturbances such as diminished sugar or salt in blood may cause seizures which may become recurrent. Any trauma, infection or tumour of the brain can also cause epilepsy. Sudden withdrawal of alcohol can cause epilepsy in addicts. Strokes are the commonest cause of epileptic seizures in elderly. Degenerative diseases of the brain like Parkinsonism and Alzheimer’s disease can also cause epilepsy in elderly people. Diagnosis of epilepsy is based on a history of recurrent seizures and electroencephalogram (E.E.G which shows the electric activity of the brain). Clinically these people are mostly normal. There are malingerers or hysterical persons who may mimic epilepsy for any personal gain. The most important differentiating feature between a true epileptic and one faking it is that a malingerer would never injure himself during an, attack. There are certain factors which trigger the attacks in susceptible people or those suffering from epilepsy. These are bright flickering lights, loud music or sounds, high fever especially in children and looking down from heights. Unaccustomed exertion in any form, excess consumption of alcohol can also precipitate a seizure in an epileptic person. Pregnancy is a known risk factor for aggravating epilepsy. Once epilepsy is diagnosed treatment is by antiepileptic medication and treatment of cause if possible like surgery of a brain tumor. Antiepileptic drugs like phenytoin, carbamazepine, sodium valproate, gabba pentin e.t.c. have to be taken mostly for life. All these medications produce side-effects invariably on long term use and also interact with other drugs. Therefore a physician prescribing them needs to be very vigilant. The side effects should not become more troublesome than the disease itself. A person suffering from epilepsy should always consider him self a especial case and be very careful. Bright lights, loud sounds, alcohol or exertion should be avoided. Driving is not very safe. Careful driving is needed with permission from the doctor. Along with the patient his family and friends also have to be vigilant. In case of a child, the affected child should be immediately put in a quiet room. In case of youngsters their epileptic status should be disclosed to the school authorities and friends so that in case of emergency they can be helpful. After all there is nothing to be ashamed of epilepsy. It is a disease like any other disease and can affect anyone. If one happens to see a person having an attack of epilepsy he or she should be immediately put in a lateral position with head flexed so as to avoid aspiration of fluid in lungs in case of frothing. A gag should be placed in the mouth so that no injury occurs because of tongue bite. The person should be sent to the hospital at the earliest. Women who take anti-epileptic medication should be careful while taking contraceptive pills. Antiepileptic pills like carbamazepine and phenytoin reduce the effectiveness of contraceptive pills and they may become pregnant in spite of pill. When pregnancy starts they should be very careful as the attacks may be aggravated. To summarize we can say that epilepsy is a disease not a curse and no reason why an epileptic cannot lead a normal life as other people. All that is required is certain precautions and medication. The author is a specialist in Internal Medicine.E-mail – rachna212002@yahoo.co.uk