DR. E.S. KRISHNAMOORTHY AND C. ARUN KUMAR

National Epilepsy Day on November 17 is observed to create an awareness and remove misconceptions about this disorder.

THE earliest medical writings mention epileptic seizures but the dramatic and intermittent nature of the affliction caused it to be masked in mysticism for many centuries.

Seizure or epilepsy

Seizure (often called fit, attack, turn or blackout) is an isolated episode, which could happen to anyone in certain circumstances. The affected person generally experiences alteration or loss of consciousness, has some abnormal involuntary movements of the face, arm, or leg, may fall to the ground, pass urine involuntarily, bite his tongue or suffer other injuries.Epilepsy is a tendency to experience repeated spontaneous seizures without an obvious cause. Epilepsy is not just one condition and it is not therefore easy to explain in many people why seizures begin at a certain time or why the illness follows a certain course. It is important to understand that epilepsy is neither a disease nor is it transmissible from one person to another.Seizures occur due to a sudden disruption (a short circuit) in the normal electrochemical activity of the brain. Recurrent seizures (Epilepsy) are a reflection of an increased liability to such short circuits. While all of us are liable for seizures in certain extreme circumstances (brain injury or infections for example), we generally have a high resistance or high seizure threshold, which makes such an event unlikely.

Diagnosis

People with epilepsy (PWE), due to a range of reasons like genetic factors, early brain injury, biochemical and hormonal abnormalities, antecedent neurological events, medical disorders generally have a low seizure threshold and go on to develop recurrent spontaneous seizures (epilepsy). While in about 10 per cent of people with epilepsy there is a straightforward genetic cause affecting several people in the family, in most PWE the cause is multi-factorial. Few people have peculiar forms of epilepsy that occur as a reflex to some stimuli (flashing lights, reading, eating, video games) the most important type in south India being Hot Water Epilepsy that follows the ritual hot water bath. Epilepsy is commonly a consequence of brain injury: road traffic accidents, infections, birth trauma, stroke or tumour.Unlike most neurological disorders, there may be no physical signs. The diagnosis is, therefore, made on the basis of a history of more than one epileptic seizure. An accurate eyewitness account is crucial to making a correct diagnosis, as the person experiencing the seizure usually has no recollection of what has happened.To help confirm the diagnosis, the doctor may arrange for a number of tests that may also help determine whether there is any identifiable cause. EEG (Electroencephalogram): This test records the brain's activity by picking up the tiny electrical signals given off by communicating nerve cells. The EEG only gives information about the electrical activity of the brain during the period of recording. Other state of art technology employed to diagnose epilepsy include: ambulatory EEG, Videotelemetry, brain scans such as MRI/CT/SPECT/PET and in specialist centres combinations of the above.Blood Tests: These check the general health and help exclude a metabolic cause for the attacks. People with new onset epilepsy or those under treatment in whom the course or manifestations of epilepsy have changed should have routine blood parameters such as sugar and electrolyte balance tested.

Treatment

People react to a diagnosis of epilepsy in different ways. Many people experience a range of different emotions and it is only natural. People often feel that they want to talk to others about their diagnosis and www.epi-life.org is an interactive portal offering support and information to people with epilepsy, their families and care givers.Anti-epileptic medication is used to prevent seizures from occurring rather than treat the cause of epilepsy. It is, therefore, necessary to take medications regularly and consistently. In some people it may be necessary to do so for long periods. As different anti-epileptic drugs are effective for different types of seizures, the doctor will have to choose the most effective drug for the individual. When a person starts taking anti-epileptic medication, the drugs are usually introduced gradually, and the dose increased slowly until it is at a level where it either controls the seizures or the person starts to experience side effects. It is therefore ideal to consult an expert for early diagnosis and initiation of treatment although treatment could thereafter continue under the supervision of a family physician. It is important not to keep taking medication without ever consulting a doctor; regular treatment reviews by a physician are necessary and desirable.

Surgery

In some people, epilepsy is caused by a specific structural problem in a part of the brain. This may have resulted from some form of head injury, occurring either at birth or in later life, or from a cerebral infection. It is also possible that the brain did not develop properly or there is some form of brain scarring which the person was born with. Good MRI scans today have the ability to detect subtle brain lesions and this may help in decisions about therapy. In particular some PWE may be helped by epilepsy surgery, which very simply means removing the abnormal or damaged part of the brain. While this is major brain surgery and not undertaken lightly, it is quite safe in expert settings with over 70 per cent of people (who are judged to be good candidates for such surgery in a detailed expert work-up) becoming completely free of seizures.Epilepsy has an impact on the mind, body and spirit. As a consequence, the best treatment centres are multi-disciplinary and involve: Comprehensive assessment by a multidisciplinary staff comprising epileptiologist, neurologist, neuro-surgeons, neuropsychiatrists, counselors and therapists, social workers, clinical psychologists and special educators; Appropriate anticonvulsant medication; Appropriate surgical procedures, if needed; Behavioural Therapies such as social skills, anger management, relaxation; Special / Remedial education in case of children. The Vinothan Comprehensive Epilepsy Care Centre at The Institute of Neurological Sciences, Voluntary Health Services is a non-profit centre in Chennai. For more information visit www. epi-life.orgThe authors are with the Institute of Neurological Sciences, Voluntary Health Services Hospital, Chennai

List of centres where epilepsy surgery is performed in India:

  • Sri Chitra Tirunal Institute of Medical Sciences, Thiruvananthapuram

  • All India Institute of Medical Sciences, New Delhi

  • National Institute for Mental Health and Neurosciences, Bangalore