Consultancy Corner: 10 things to know about epilepsy

Seizures, fits, jerks, seizure disorder and convulsions are the other names for epilepsy.

Brain is like a complex electrical jack box with billions of inter-wined wires and as many junctions between them. Brain cells communicate between one another through electrical transmissions. Seizures are caused by sudden surge of excess electrical impulses in the brain circuitry. 

Many different causes can disturb the normal brain electrical function. It can be as simple as “low blood sugar” (hypoglycaemia) or traumatic brain injury during a motor vehicle accident. The tendency to have seizures in the above two examples abates once the underlying problem is corrected (normal blood sugar or healing of brain trauma) and these people have had “provoked” seizures but do not have epilepsy! But a proportion of patients who had brain injury develop repeated seizures months or years after the injury. 

This is due to the scarred brain producing abnormal local electrical impulses resulting in seizures. This later condition is called epilepsy when the patient has recurrent “unprovoked” seizures. Mostly epilepsy starts during childhood and continue to adulthood in some cases.

The physical manifestations of seizures can be in any form such as loss of consciousness, staring and unresponsiveness, up rolling of eyes or eye blinking repeatedly, sudden falling down, stiffening or jerking of limbs, etc. 

 Epilepsies can be divided in to two groups, focal epilepsy and generalised epilepsy depending on whether seizures start in one particular part of the brain or simultaneously from both hemispheres, respectively. Distinguishing between focal and generalized epilepsies is very critical for diagnostic tests and treatment approaches. 

Most important thing here is not all episodes of loss of consciousness, unresponsiveness and shaking are seizures. There are many other phenomena that can look similar to seizures (seizure mimics). Video recordings of the episodes in your smart phone help doctors distinguish between seizures and mimics in many cases. Rarely, video-EEG recording of seizures in hospital is required to make this distinction. Tests are usually performed to support the diagnosis (EEG), to know which type of epilepsy one is dealing with (EEG/video-EEG) and to detect the underlying cause of epilepsy (MRI of the brain, genetic tests, etc). 

Normal EEG and normal brain scan does not rule out the diagnosis of epilepsy! In fact most patients with epilepsy have normal brain MRI. MRI of the brain is similar to the hardware of the computer. Computer hardware can be perfectly normal but the same computer can have software problem(s). Likewise, epilepsy patients with electrical disturbances can have perfectly normal brain structure in the MRI scan. When the seizure focus is very deep down in the brain, EEG may not detect any abnormalities. 

Uncontrolled epilepsy needs evaluation by a specialist epilepsy centres with advanced treatment options. Epilepsy in 70-80 per cent of patients can be easily controlled with available modern anti-seizure medications. Taking appropriate medications regularly can keep epilepsy under control. 

 Patients with epilepsy can lead a normal life. Patients with epilepsy can get married and bear children without any problems. Patient with seizure episodes in the last six months should not drive either a two wheeler or a four wheeler. Swimming should only be allowed with close supervision by another person who knows swimming well. 

Suddenly stopping the anti-seizure medications knowingly or by accident is one of the most common mistake by patients with epilepsy. This can cause potentially life-endangering long seizures called status epilepticus. Most common cause of recurrence of seizures in patients with epilepsy is non-compliance with medications. Not taking good sleep can be problematic as sleep deprivation causes seizures. Taking alcoholic drinks can make the anti-seizure medications ineffective.