Epilepsy all you need to Know

Table of Content

• What is Epilepsy?

• Causes of Epilepsy

• Seizure v/s Epilepsy

• Types of Epilepsy

• Symptoms of Epilepsy 

• Triggers of Epilepsy

• Diagnosis of Epilepsy

• Is Epilepsy a Disability?

• Is Epilepsy Contagious?

• Is Epilepsy Fatal?

• Treatment of Epilepsy

• Take-Home Points

• FAQ on Epilepsy

Introduction

You must have heard, or maybe even seen, perfectly healthy people suddenly acting weird or going into spasm, fumbling uninterpretable words, and maybe even falling to the ground. Superstitions and stigma around such conditions would cause some people to deduce that the reason behind these sudden acts is possession by some evil spirit or a curse. Often, people would surround the person, start chanting the name of God, try to make them smell or eat things and maybe consult an occultist. Some people, on the other hand, would label such a person as mentally sick and break ties, if any, with them. Only a few, however, would know that what that person is suffering from is an Epileptic attack or Epilepsy and not any act of God or Evil.

Epilepsy is a very common neurological condition that can be treated. The history of epilepsy dates back to prehistoric times. The word epilepsy is derived from the Greek verb “epilambanein”, which means “to be seized” or “to be overwhelmed by surprise”. Epilepsy is one of the most common serious brain disorders which is surrounded by myth and prejudice. It is one of the most common neurological conditions, with an incidence of approximately 50 new cases per year per 100,000 population. This blog will tell you all you need to know about epilepsy.

What is Epilepsy?

Epilepsy - a very common disorder of unprovoked seizures, is a multifaceted disease, affecting individuals of all ages with a particular predilection for the very young and the elderly. Rather than a single disease, Epilepsy refers to an entire clinical phenomenon, because it occurs in many forms and can happen due to many causes. Epilepsy describes a condition in which a person has a risk of recurrent seizures due to a chronic underlying process. In addition to seizures, many patients often report cognitive and psychiatric problems. About 75% of all epileptic cases begin in childhood. The World Health Organization (WHO) estimates that approx 50 million people worldwide suffer from epilepsy.

Causes of Epilepsy

To understand the cause behind epilepsy one must understand the basic workings of the human brain. Roughly speaking, the human brain is a group of neurons closely knit together working synchronously by the help of electrical charges. These neurons fire electrical impulses at each other, which are perceived by the target neurons and thus transfer of information takes place from one neuron to another. Sometimes, with some people, there are some neurons that produce extra electrical impulses i.e. there is excessive electrical firing which causes the target neurons to act weird, causing a chain reaction of electrical impulses in the neurons which can be seen as a Seizure or an Epileptic attack. The cause behind this asynchronous abnormal firing could be anything, ranging from genetic cause to anatomical abnormality. 

In many cases, the exact cause behind the condition might not be known, but the major factors that can cause epilepsy are : 

1. Genetics: According to a 2015 research review, 70-80% of epilepsy cases are due to genetics. There are approx 900 genes related to transmission of epilepsy. Certain gene mutations can cause epilepsy in people without family history of the condition.

2. Head injury 

3. Stroke or brain tumor

4. Encephalitis 

5. Drugs and medication 

6. Cysticercosis 

7. Developmental conditions like autism

8. Brain injury before birth.

Seizure v/s Epilepsy

According to the International League Against Epilepsy (ILAE) - the main governing body for terminology and nomenclature for seizures and epilepsy, a seizure is defined as an abnormal electrical perturbation resulting from a network of neurons. In the year 2014, an ILAE task force revised the definition of epilepsy according to which, a person is considered to have epilepsy if they meet any of the following conditions:

• At least two unprovoked or reflex seizures occurring less than 24 hours apart.

• One unprovoked or reflex seizure and a probability of further seizures similar to the general recurrence risk of at least 60% after two unprovoked seizures occurring over the next 10 years.

• A diagnosis of epilepsy syndrome.

Types of Epilepsy

The ILAE Commission on Classification and Terminology classified epilepsy into three broad classes, based on the clinical features of seizures and associated electroencephalographic findings. 

1. Focal onset / Partial

2. Generalized onset 

3. Motor - 

   • Tonic- clonic

   • Other motor (atonic , myoclonic)

4. Non motor ( absence)

• Unknown onset - Motor, Non motor or unclassified.

A person's experience during seizure will depend upon the area of the brain involved during seizure. 

Symptoms of Epilepsy

The main symptom of epilepsy is recurrent episodes of seizures. However many people experience symptoms other than seizure as well like:

• Convulsion without fever

• Short blackouts 

• Confused memory

• Intermittent fainting spells, during which the person loses bowel or bladder control, frequently followed by extreme tiredness

• Temporary unresponsiveness to instructions 

• Sudden stiffness for no apparent reason

• Sudden falling for no apparent reason

• Sudden bouts of blinking without apparent stimuli

• Sudden bouts of chewing without any clear reason

• Repetitive movements that seem involuntary

• Panic or anger

• Peculiar changes in senses, such as smell, touch, and sound

• Jerking arms, legs, or body, which will appear as a cluster of rapid jerking movements in babies

 If you experience one or more of the following please consult a physician today.

Triggers of Epilepsy

Unfortunately, little is known about the specific factors that determine precisely when a seizure will occur in a patient with epilepsy. According to various studies, a universal precipitating factor for seizures is sleep deprivation. Hence epileptic patients should focus on optimizing their sleep quality. Other triggers for Epileptic attacks include stress, fatigue, flickering lights, consumption of high levels of alcohol and certain medications.

Diagnosis of Epilepsy

The diagnosis for epilepsy is made by a doctor with the help of patient history, symptoms and certain investigations. Investigations used to diagnose epilepsy are :

1. EEG, to detect abnormal wave patterns

2. Routine blood investigations, to determine underlying infections

3. CT scan, to detect underlying pathology 

4. MRI scan

5. Magnetoencephalogram

6. Body electrolyte studies

Is Epilepsy a Disability?

The prejudiced attitude of people towards epileptic patients is driven by their knowledge about the condition. Since ancient times there has been a dogma around epilepsy. People who couldn’t explain the cause of epilepsy, ended up considering it to be a disability. Even in modern times, epileptic patients are suffering from prejudice due to the stigma around the condition. They are facing trouble in securing jobs as epilepsy is considered to be a disability by people. The truth on the other hand is way different from what the masses believe. A person suffering from epilepsy due to any cause is absolutely fit to perform any kind of work. Infact, people with epilepsy have certain employment  related protections under the American with Disability Act (ADA). One can know that epilepsy is not a disability by seeing many examples of people with epilepsy who accomplished significant achievements in their lives: Alexander the Great, Peter the Great, Julius Caesar,  Joan of Arc, van Gogh, etc.

Is Epilepsy Contagious?

The popular belief that epilepsy is contagious dates back to ancient times when people suffering from the condition were looked down upon, used to get spit on and sometimes even shunned from family and society. Even till the late 19th century, it was reported that many people with epilepsy were prone to violence and religious ecstasy. All this was because people weren't educated about the condition back then. The truth is that Epilepsy is a non communicable disease. One can't contact the disease merely by sharing meals or sleeping beside someone suffering with the condition. Society should stop looking down at people suffering with the condition and understand that even they can have a normal life after getting proper treatment and eradicating the cause of epilepsy. 

Is Epilepsy Fatal?

Epilepsy can impair one's life in numerous ways. Sudden seizures during activities like driving, swimming etc. can lead to drowning, falling, accidents, or other injuries that could be fatal. An emergency condition due to epilepsy, known as status epilepticus can also cause death. Thus people suffering with epilepsy should always diligently take their medication and be extra careful about their surroundings.

Treatment of Epilepsy

There is no permanent treatment for epilepsy but the condition can be put under check. There are many treatment modalities that can be opted for to treat epilepsy. Consult your doctor today to know the most appropriate treatment for you. The type of seizure and intensity decides the best treatment modality. The various ways to treat epilepsy are : 

Treatment of underlying condition:

Treating the cause of epilepsy is the most important step. If the cause behind the seizures is an infection, treating the infection should be the primary step. If drugs are the cause behind the epilepsy then those drugs must be stopped. 

Anti Epileptic Drugs:

There are many drugs that are available which can control epilepsy in about 60-70% cases. These drugs are : 

1. Valproic acid

2. Lamotrigine

3. Levetiracetam

4. Phenytoin

5. Clonazepam

6. Carbamazepine

Most of these drugs have serious side effects and shouldn't be taken without consulting a doctor. So if you are suffering with epilepsy, consult your doctor today to know which would be the best suited treatment option for you.

Surgery:

Surgery is the choice of treatment when drugs fail to serve the purpose. The most common surgical procedure for patients with temporal lobe epilepsy involves resection of the anteromedial temporal lobe - temporal lobectomy. Other surgical procedures that can be opted are- Multiple subpial transection, Corpus callosotomy and Hemispherectomy.

Lifestyle changes:

Less stress, proper sleep, avoidance of alcohol and diet rich in egg, bacon, nuts, avocados and certain fruits and vegetables are found to be beneficial to check Epileptic attacks under check.

Myths and Facts about Epilepsy

Myth 1: Epilepsy is a mentally debilitating disease and it prevents the person from leading a healthy and meaningful life.

Fact: Epilepsy is a chronic neurological condition which can be kept under control by opting for right treatment. Any person suffering with the condition who is on medication can lead a healthy and meaningful life.

Myth 2: Epilepsy can't be treated.

Fact: Epilepsy can be treated. The treatment modality depends on various factors which have to be decided by your physician.

Myth 3: Patients suffering with epilepsy should not marry or have kids.

Fact: Anyone suffering with epilepsy can have a healthy and normal life. Patients suffering with epilepsy can plan pregnancy under the right medical supervision. 

Myth 4: Epilepsy can spread from one person to another.

Fact: Epilepsy is not an infectious disease.

Myth 5: During a seizure the patient must be made to smell certain items or maybe fed some things.

Fact: During a seizure, avoid putting anything in patients mouth as he/she may aspirate it and land in a medical emergency. Neither should the patient be made to smell anything. Rather shift the patient to a safe spot and call for medical aid immediately.

Take-Home Points

Hope this blog cleared the stigma around epilepsy and gave you a clearer picture about the cause and treatment related to the condition. Now if you see someone getting an Epileptic attack, you know it's not an act of God but rather, that person needs immediate medical attention.

• Epilepsy is a common, non communicable,  chronic neurological condition in which a person suffers with recurrent episodes of seizures. There can be other symptoms like jerky movement or loss of memory.

• Epilepsy has multiple causes. One can inherit epilepsy in their genes or can acquire it due to infections or brain injury.

• Epilepsy can be diagnosed using scans like EEG scan, CT scan, MRI scan etc.

• Epilepsy can be treated via multiple modalities. There are Anti Epileptic Drugs that can be used to control the condition or one can even opt for surgery or lifestyle changes to treat the condition.

References

• NCBI - Seizure and Epilepsy : an overview for neuroscientist 

• NCBI - Epilepsy: a spectrum disorder