Epilepsy is a neurological disorder characterized by sudden recurrent episodes of sensory disturbances, loss of consciousness, or seizures associated with abnormal electrical activity in the brain. It is one of the commonest neurological disorders. With a worldwide prevalence of 5-7/1000 population, India has more than 7 million persons with epilepsy. The greatest problem facing them is the lack of proper medical care. In a study in rural Karnataka, only22% of the epileptic population was found to receive any sort of medical treatment. Lack of access to medical treatment leads to misdiagnosis. It is often considered a psychiatric or “mental” problem. Delay in diagnosis and erroneous treatment makes the disease more resistant and can be fatal in some circumstances. In a study conducted in Kolkata recently, compared to the general population of Kolkata, the all-cause standardized mortality ratio (SMR) for persons with epilepsy was 2.58 overall (men 3.67; women 1.77).
Now what then are the types of seizures and how do you recognize them?
There are many ways to classify seizures. A simple way is to divide them into 2 types 1) Partial seizures (seizures beginning in a small location in the brain) and 2) Generalized seizures (seizures that are bilaterally symmetric and without any local onset). Partial seizures can be subdivided into simple, complex, and evolving to secondarily generalized seizures depending on the clinical phenomenology and propagation. Simple partial seizures may consist of motor, sensory, autonomic, or psychic symptoms and signs. Complex partial seizures on the other hand are accompanied by impaired consciousness. The generalized seizures again can be subdivided into absence, myoclonic, tonic, atonic, clonic, and tonic-clonic seizures depending on the ictal manifestations. There are also many unclassified seizures. While it is easy for an epileptologist to rattle off hundreds of exotic names and subtypes, the common man finds himself at a loss to understand the myriad manifestations that a seizure can have. The classical generalized tonic-clonic seizure with involuntary shaking of the arms or legs and loss of consciousness with foaming from the mouth and incontinence may be easy to identify. However focal motor seizures with brief attacks of shaking or trembling in one arm or leg or in the face may be underrecognized. Similarly, absence attacks in a child with eye blinking or staring during which he/she lost contact with the environment can be noticed only by an alert observer. The most troublesome are the complex partial attacks in which the epileptic briefly loses contact with the surroundings and experiences abnormal smells or just mutters something incomprehensible while continuing to fiddle with his hands.
What causes this epilepsy?
There is no single cause. According to the cause, some of these may have a genetic basis can be idiopathic, symptomatic, or familiar. Idiopathic, literally means no known cause. Symptomatic epilepsies arise as symptoms of a known brain abnormality. The symptomatic epilepsies include mesial temporal sclerosis which can be cured surgically. Other common causes include head injury, stroke, brain tumor, hypoxic damage, and brain infections (e.g., neurocysticercosis, tuberculosis, etc). Metabolic derangements, drugs, and substance abuse can also provoke seizures. Familial epilepsies arise usually from a known genetic defect.
How is epilepsy diagnosed?
The diagnosis is essentially clinical. The semiology of the seizures needs to be described by an epileptologist before one can be sure. There are other investigations like brain imaging (CT scan, MRI) and EEG (electroencephalogram) that helps in clarifying diagnosis and finding out the correct cause. Long-term video monitoring of the patient with the EEG can be done on an inpatient basis to record the actual seizures. Functional brain imaging with PET and SPECT scans can also help in identifying the seizure focus in some cases. Home video recordings using a smartphone can sometimes help in diagnosis.
What are the precautions that an epileptic should take?
Once a diagnosis is made, patient education is the most important. It needs to be made clear that nearly 70% of persons with epilepsycan lead a normal life with proper anticonvulsant medication. In some cases, the drugs can be stopped after2-3 years of seizure freedom. However, the chances of success are clearly dependent on proper drug compliance. The second factor is avoidance of the precipitants of the seizures. These include fasting, sleep deprivation, alcohol, and video games at frequencies. They should also avoid driving unless there is complete seizure freedom. Swimming and working with heavy instruments, fire, or at a height also needs to be carefully supervised. Women of childbearing age should consult their epileptologist before planning pregnancy.
–Dr. Amit Halder, Director, Neurology, Fortis Anandapur