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Epilepsy

WHAT IS EPILEPSY

Epilepsy is a comparatively common condition in which the electrical and chemical activity of the brain loses its usual co-ordination for short periods of time. These times of uncoordinated brain activity are called seizures or ‘fits’ or ‘spasm’. Epilepsy is not the only reason that someone may have a seizure — fever, excess alcohol use and an infection of the brain may also cause a seizure.

DIFFERENT TYPES OF SEIZURE

There are several types of seizures in epilepsy. They can be roughly divided into generalized seizures and partial seizures.

Generalized seizures

Generalized seizures arise from abnormal electrochemical activity affecting the whole brain at the same time.

Tonic-colonic seizures involve the whole brain and cause a person to lose consciousness. Their body tends to go stiff and they fall to the ground; their body then starts repeated jerking movements; they may dribble saliva or vomit, and may lose control of their bowel and bladder. The seizure usually lasts a couple of minutes, and breathing may stop for part of this time, resulting in a bluish tinge to the skin. After the seizure the person may feel confused, have a headache or feel agitated. They may feel very tired for several hours and want to sleep.

Absence seizures most often begin in childhood and result in an altered state of consciousness, lasting several seconds, during which the person seems to ‘tune out’ and be unaware of their surroundings. When the seizure finishes the person usually resumes their current activity, although they will not have been aware of anything around them during the seizure.

Myoclonic seizures cause very brief jerky movements, usually of the upper body, without loss of consciousness. They can cause the person to spill a drink they are holding or fall off a chair.

Tonic seizures are a brief stiffening of the whole body causing the person to fall to the ground. Tonic seizures tend to occur in people with severe epilepsy.

Atonic seizures also cause a person to drop to the ground as all the muscles of the body suddenly and briefly lose their tone (become floppy). There is no loss of consciousness.

Partial seizures

Partial seizures arise from abnormal electrochemical activity affecting one part of the brain, but which may spread to other parts of the brain. Simple partial seizures affect only one part of the brain and usually last less than a minute. The symptoms will depend on which part of the brain is affected, but may only involve altered sensations such as an unpleasant taste or smell, stiffening of muscles, a sensation of fear, or an abnormal feeling, such as numbness, in one part of the body. The person does not lose consciousness in a simple partial seizure.

CAUSES OF EPILEPSY

Epilepsy affects about 3 people in every 100. It often starts in childhood, although it can begin at any age. For example, elderly people may develop epilepsy after a stroke.

Although the cause of the epilepsy cannot be established in about half of those people who have epilepsy, there are several known causes, such as the following:

• An inherited disposition towards epilepsy in the family;
• The brain being damaged at birth;
• A period of anoxia (an absence of oxygen) affecting the brain;
• An accident that results in a brain injury; or
• An infection, blood clot or other illness that affects the brain.

TREATMENT OF EPILEPSY

Epilepsy is treated with prescribed epilepsy medication that aims to prevent the occurrence of seizures. Many people who have epilepsy take this medication for a number of years. Some people may be able to have their dose gradually reduced to nothing under guidance from their doctor if several years have passed without them having a seizure. Also important in managing epilepsy is leading a healthy and balanced lifestyle. Surgery is a treatment option for some people who have epilepsy, although it is usually used where medications have failed to give control of seizures and it does not have a 100 per cent success rate. Surgical treatment must therefore be carefully considered. Generally for most of the people, their epilepsy can be well controlled, and they can lead a full and active life.

DIAGNOSING EPILEPSY

To diagnose epilepsy a doctor will first need a description of your symptoms, because it is unlikely that you will show any seizure symptoms when you are visiting your doctor. Often a friend or parent who has been with you when you are having a seizure can help in describing what happens during the seizure, for example, how long it lasts, and whether or not you appear to lose consciousness.

Your doctor may ask about any other health problems you have, any head injuries you have had in the past, any medications or recreational drugs you are taking, the age you were when the seizures started, and whether or not anyone else in your family has epilepsy. Your doctor will do a full physical examination and also a neurological examination, which aims to pick up any abnormal function of your nervous system.

Your doctor will usually want you to have some blood tests done, and be referred to have an EEG (electroencephalogram) — a test that tracks the electrical activity of your brain. This test takes about one hour and is painless. It involves you having small electrodes placed (glued) on your head and attached via leads to a machine that traces the electrical activity of your brain onto paper or a computer screen. Your hair does not need to be cut, but to help the electrodes stick it should be thoroughly washed the night before. You might also need to have a test called a brain scan that shows the structure and sometimes the function of your brain. There are several types of scans, including CT scans and MRI scans. Sometimes the results of these tests can be normal, despite the fact that you have had seizures.

However, they may be useful in detecting illnesses other than epilepsy that can also cause seizures. It may be that between seizures your test results are normal. To overcome this limitation, an EEG is sometimes performed over a longer period of time while you stay in a hospital room that is fitted with video recording equipment. The aim is to record an EEG while a seizure is occurring, and also to record a video of the seizure itself. This can be very helpful to your doctor in deciding the type of seizures that you have and the best type of treatment.

HOW TO COPE WITH EPILEPSY

With the right epilepsy medications most people with epilepsy can have their seizures well controlled and can live normal lives.

Important elements of treatment include the followings:

• Continuing to take the epilepsy medication that has been prescribed for you.
• Sleeping well and regularly.
• Striving for a balanced and healthy lifestyle.
• Managing stress.
• Eating well and regularly because fits are more likely if you're very hungry.
• Find out, if your seizures are triggered by flashing lights, video games or flickering sunlight, this can occur in a small percentage of people with epilepsy and taking preventative steps to avoid seizures arising from these triggers.
• Surgical treatment is a possibility in a small number of people who have epilepsy, but is usually a last resort.

FACTORS THAT MAKES EPILEPSY WORSE

• Not taking your drugs properly or stopping suddenly — this can trigger a severe seizure.
• Getting tired or over-stressed.
• Consuming a lot of caffeine, and missing meals.
• Not doing anything/being bored (remember to include regular exercise in your day).
• Drinking alcohol/taking illegal drugs.
• Having a fever or infection (treat these early).
• Hormonal and other changes during the menstrual cycle.

HOW TO HELP DURING A SEIZURE

• If a person is having a small fit — for example, where the person seems to ‘tune out’ but doesn’t fall to the ground or appear to lose consciousness — talk calmly and reassure the person, and repeat any information they have missed during the seizure. Lead them somewhere safe, if necessary.
  
• If they are having a big fit — for example, falling to the ground with loss of consciousness and jerking body movements — don't restrain them. Make sure there is nothing they can hurt themselves on, put something soft under their head and loosen their clothing if it’s constricting their breathing.
  
• If they have vomited, lay them on their side so that any fluid can easily flow out of their mouth and not obstruct breathing.
  
• Do NOT put anything in their mouth or force their mouth open: this may damage the area. They will not swallow their tongue.
  
• DO NOT move them unless they are in a dangerous position.
  
• When the fit is over, turn them on their side, reassure them, tell them where they are and that they have had a fit.
  
• If a person is having their first seizure, or the jerking doesn't stop within 5 minutes, or they have trouble breathing after the jerking stops, or they have diabetes, or you are in doubt for any reason — call an ambulance.
  
• Watching someone have an epileptic fit is very frightening — it can seem to go on forever; stay very calm and try not to panic.