Dr. Ira Shah
Epilepsy - Patient Education
What is epilepsy?
Epilepsy is defined as seizure disorder. A seizure (fit or convulsion) is an excessive electrical discharge of the nerve cells leading to abnormal posturing of limbs, clenching of teeth or just drop attacks and even unconsciousness.
Seizures are of various types. Some patients may just have blank spells and some may have abnormal postures with or without loss of consciousness.

What are the types of seizures?
There are 2 main types of seizures:

(a) Partial seizures: The electrical discharge begins in one part of the brain leading to involvement of only one side of body. They are also called focal seizures. If the patient remains conscious during the episode it is known as simple partial seizure and if becomes unconscious, it is known as complex partial seizure. A fit that starts in one part of the body and then involves entire body due to spread of electrical discharge to other parts of brain is called as partial seizure becoming secondarily generalized.

(b) Generalized seizures: Here, the electrical discharge involves almost the entire brain and patient has fits of entire body associated with loss of unconsciousness. Absence seizures are a form of seizure in which a patient has a brief spell of staring blankly and becoming unresponsive for a few seconds to minutes.

Are seizures life-threatening?
Prolonged seizures can be life threatening as it may lead to decreased oxygen supply to the brain. However that is very rare.

Why does epilepsy occur?
Seizures may be seen in various conditions such low blood sugar, high blood pressure, meningitis (infection of the brain), brain tumor etc apart from epilepsy. Epilepsy is a seizure disorder due to low threshold for a nerve cell to throw an electrical discharge. The cause of most kinds of epilepsy is not known.

Is epilepsy infectious?
No, epilepsy is not contagious. However, some types of epilepsy are inherited and have a strong familial pattern.

What happens if a child has seizure?
Prolonged refractory seizures can lead to brain damage. Seizures can lead to a social handicap in terms of mobility and jobs that need to be avoided are driving, working near electricity, working at heights or working underwater. Some patients may develop poor memory due to epilepsy or it treatment.

What are the factors that can trigger a seizure?
Alcohol in large amounts as well as alcohol withdrawal can trigger a seizure. Excessive stress, worry and anxiety can also precipitate seizure. Sometimes epilepsy may be associated with a metabolic disorder in which case certain food items may have to be omitted. Lack of sleep may also precipitate seizures.Video games due to its flickering light and changing patterns of images can precipitate seizures. Certain drugs such as antidepressants, antibiotics, Theophylline may provoke a seizure.

Does epilepsy affect schooling?
Most children with well-controlled seizures and no additional handicap can attend a normal school. Extra curricular activity such as swimming, climbing and cycling on road should be avoided. Informing the schoolteacher about the child's disorder will aid in helping them to know what to expect when a child has a seizure and decide what to do.

What is the treatment for epilepsy?
Treatment for epilepsy consists of anti-convulsant drugs. Prior to starting therapy, your doctor may advise certain tests such as EEG, CT SCAN of brain or MRI to classify the seizure type and decide on best treatment option.

Does a normal EEG rule out a seizure disorder?
EEG may be abnormal in only about 60% of patients with epilepsy. Also, a small proportion of general population may have epileptiform abnormalities in EEG.

EEG is useful in identifying type of epilepsy, detecting a structural brain abnormality, differentiate between true seizures and pseudoseizures.

Is epilepsy curable?
Majority of children with epilepsy stop having seizures once they are put on treatment. If seizure free, treatment is continued for 2-3 years and then gradually tapered off. In most patients, the chance of having another seizure is minimum but still exists.

Why do some patients continue to have seizures despite treatment?
There could be several reasons:

- Inappropriate drug for a particular kind of seizure
- Incorrect dose of drug
- Irregular treatment
- Underlying condition is getting worse
- Patient does not have epilepsy at all
- Patient has true drug resistant seizure.

My child missed one dose of his anticonvulsant. What should I do?
If only one dose has been forgotten, the next dose can be doubled except for carbamazepine where there should be a gap of a few hours between regular dose and extra dose.

What are the side effects of anticonvulsant drugs?
Certain drugs such as Phenobarbitone or Phenytoin can cause memory disturbance. Some drugs may cause cosmetic side effects such as increase in gums or weight gain.

My child continues to have seizures inspite of taking multiple drugs. What should be done?
20% of patients have refractory seizures inspite of being on appropriate anti-seizure medication. These patients can be considered for epilepsy surgery. Some patients may respond to diet modification. Ketogenic diet (high fat diet) is used in small group of children with resistant seizures.

What factors affect the outcome of epilepsy?
The following factors have a poor outcome:

- Epilepsy difficult to control
- More than one anti-seizure drug is required to control seizures
- Epilepsy is associated with structural brain damage
- Repeated episodes of prolonged seizures
- Associated mental retardation or cerebral palsy
- Seizures that start early (before 2 years of age).

Following factors are associated with a good outcome:

- Epilepsy that starts between 5 and 13 years of age
- Epilepsy which is inherited
- Seizures that are easily controlled and require only drug to control it.

What are the chances that seizures will recur once treatment is stopped?
Most of the patients with good seizure free period on anticonvulsants have less chances of recurrence once treatment is stopped. Following factors may increase the recurrence risk:

- Age greater than 16 years at onset of seizures
- Break through seizures on treatment
- An abnormal EEG.

What is the first aid measure at the time of seizure?
Once a patient has seizures, clear the mouth to prevent difficulty in breathing. Put nothing in the mouth as it will not prevent biting but may obstruct breathing. Turn the patient on the side so that tongue does not fall back & obstruct the airway. Do not try to hold the tongue. Call for a doctor and ambulance if seizures last more than 10 minutes.

Epilepsy Epilepsy 08/01/2015
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