What is Epilepsy?
Epilepsy is one of the most common neurological conditions with 50 million people affected globally. 80% of this population lives in low and middle-income countries. It causes frequent seizures due to abnormal electrical impulses that erupt in the brain that can last lifelong or slowly decrease over the years. The condition usually starts early in childhood or late in adults over the age of 60 years and causes various symptoms.
What are the triggers and causes of epilepsy?
There are several stimulants for seizure activity in the brain to happen randomly, such as substance abuse by alcohol and recreational drugs, stress, lack or disturbed sleep or waking up from sleep, use of medications, lights flashing from televisions and mobile phones, and menstrual cycles in women.
Additionally, there are possible causes for epilepsy such as brain tumours, brain damage caused by stroke, traumatic injury, or infections, genetic conditions like Dravet syndrome, anomalies in an infant’s brain structure, lack of oxygen to the brain during birth, and idiopathic causes in one-third of the people affected by epilepsy.
What are the symptoms of epilepsy?
As a health professional working among adults with epilepsy, there are various symptoms that I witnessed such as:
Muscles become stiff in tonic seizures
Patient loses awareness of their surroundings and stares emptily into space in absent seizures.
Collapse onto the floor or crash into nearby objects in atonic seizures.
Uncontrollable jerking and involuntary movements of the muscles in clonic seizures.
Getting an aura before a seizure such as tingling sensations along the arms and legs, uncomfortable feeling in the stomach, nauseous smells, and taste.
How can we diagnose epilepsy?
According to Dr. John M Stern, a professor at David Geffen School of Medicine, the University of California Los Angeles, good communication between the patient and his doctor is vital to diagnose, identify the triggers, identify the type of epilepsy, and discuss care plans. Additionally, the patient can identify their triggers for epilepsy by noting them down in a diary and discussing it with their physician so that it’s easier for the doctor to grasp the frequency and intensity of the episodes. Secondly, the patient can undergo an electroencephalogram (EEG) to detect any abnormal electrical impulses in the brain by attaching small sensors to the scalp. These are recorded by a machine to check for unusual activity in the brain. Finally, a brain scan such as MRI detects any brain tumours, stroke, or any other traumatic injury to the brain.
How can we treat epilepsy?
Treatment reduces the frequency and intensity of the seizure episodes, or they can permanently stop the condition. Some patients require the medication lifelong, and in some individuals, it can be stopped once the seizures disappear.
First-line treatment includes the use of antiepileptic drugs (AEDs) such as diazepam, midazolam, sodium valproate, and phenytoin. In my work experience, I have seen that individuals with epilepsy have an emergency protocol with a suitable emergency medicine such as buccal or nasal Midazolam. Parents or carers can administer if the patient exceeds the usual time of the seizure episode. This is very convenient and efficient instead of travelling to an emergency centre. Other treatments include surgery that involves removing a small portion of the brain that causes the seizure and the use of a Vagal nerve stimulator, a device placed inside the body to control seizures. Finally, a ketogenic diet helps in controlling seizures to an extent.
How can a patient with a seizure be supported?
Home: Individuals with epilepsy can be safe at home by not locking the door while using the bathroom, installing smoke alarms, and covering the sharp edges of furniture to avoid any injuries.
Schooling: Children with epilepsy can attend a mainstream school and take part in all activities. However, make sure the school staff and supervisors are made aware of the child’s condition so that necessary precautions can be taken such as knowing the administration of antiepileptic medications, watching out for a seizure, and being aware of how it affects the child’s overall performance in behaviour and academics.
Employment: The employer should be informed about the individual’s condition so that certain adjustments at the workplace can be arranged such as adjusting work hours, providing extra recess time, not including driving in job duty, and permitting giving reports in written form instead of verbal reports.
Pregnancy: The patient should discuss with their doctor their plans for planning a healthy pregnancy so that medications can be altered if needed like the use of sodium valproate as these can cause anomalies in the fetus. If the pregnancy was unplanned, it is best to contact the doctor for more information before stopping or making any adjustments to medications on their own. However, if the patient wants to avoid possible pregnancies, they can use different contraception methods not affected by AEDs such as condoms, IUDs, intrauterine systems, and progestogen-only injections.
Driving: The patient must stop driving if he/she experiences recurrent seizures as it is unsafe for them and for others on the road with them as they can lose control of their vehicle.
Sports and extracurricular activities: Most patients can take part in activities as long as necessary precautions are taken such as wearing a helmet during cycling, avoiding swimming, or working out in the gym with certain equipment, and letting the gym staff be aware of their condition.
When to call for help?
Finally, if a person seizes, it is best to call the ambulance especially if the person is having:
Seizure for the first time
Seizure lasting more than 5 minutes
Having lots of seizure episodes without recovery time in between episodes.
Suffered any fatal injuries during the episodes.
References:
NHS (2020). Epilepsy. Available at: https://www.nhs.uk/conditions/epilepsy/ (Accessed on 16/01/2023).
Epilepsy Action (2022). What is epilepsy? Available at: https://www.epilepsy.org.uk/info/what-is-epilepsy (Accessed on 16/01/2023).
