All About Epilepsy
Epilepsy effects one percent or more of the population. It is one of the commonest neurological disorder, but is eminently treatable.
We need to educate ourselves about epilepsy and its therapy, as well as the do's and don'ts.
It is treatable with almost all medications being available in India. While 70% of patients respond to medicines, 30% do not to even two or more medicines and these may have to be investigated for the possibility of a surgical cure.
What is epilepsy?
Epilepsy is a neurological disorder (and NOT a mental illness). It occurs due to sudden burst of abnormal electrical discharges from the brain. It can happen to any one of the 1% of the population, at any time and any place. So everyone must know about it.
Why does it occur?
In a great majority of patients one does not know the exact cause for this condition. The medical science is yet to find the cause of many common diseases like high blood pressure, diabetes and so also epilepsy. Many causes in our country are preventable, like perinatal / peri-birth insult, infections in the brain - like tape worm or tuberculosis, head injury, etc.
How common is epilepsy?
Epilepsy is a fairly common condition affecting nearly 1-3% of the population which means in our country with one billion population, there are at least 10 million patients. One of the problems is that no one wants to talk about their illness with the result every one thinks that he is the only unfortunate victim. A situation like heart attack and diabetes is discussed freely even in social gatherings while epilepsy is always concealed.
Is epilepsy preventable?
Yes, to some extent, though in a great majority the cause for epilepsy is not known, certain conditions like head injury, stroke, brain infection (meningitis / encephalitis) which contribute to epilepsy are preventable.
Are all epilepsies the same?
No, all epilepsies are not the same and no two people with epilepsy would have the same course or type of disorder. There can be minor or focal types or generalized types. It is important that the bystander and caregiver give a detailed account of what happens before the seizure during it and after so that the doctor can decide which is the best medication for the patient, as different types respond differently to medication.
What should be done during the fit?
- Keep calm.
- Loosen tight clothes around the patient's neck - tie, tight collar, etc and remove the spectacles.
- Prevent the patient from injuring himself. Put him/her in a safe place away from glass, machinery, staircase, stones etc.
- Turn the patient to a side and wipe the froth from mouth.
- Try to find out if the patient is carrying an ID card with name, telephone and doctors contact details. Contact them only when above are done.
- Some medicines can be used in emergency - they should be given if clear instructions for there use are given.
- Rush the person to hospital if the fit does not stop in 5 minutes. This may be status epilepticus.
- Do not insert spoon, cloth or any such articles into the mouth.
- Do not restrict convulsive movements as it could cause a fracture.
- Do not crowd around the patient.
- Do not give water / tablets or any other liquid orally till the patient is fully conscious.
There are certain special situations in epilepsy and these are:
Education and employment
Patients with epilepsy should not be denied employment or access to any educational, recreational, or other activity because of their seizures. However, about 60 percent of people with epilepsy finish high school and about 15 percent finish college - rates much lower than those for the general population. The same survey found that more than 50 percent of working-age people with epilepsy are unemployed. These numbers indicate that significant barriers still exist for people with epilepsy in educational institutions and work. Restrictions on driving limit the employment opportunities for many people with epilepsy, and many find it difficult to face the misunderstandings and social pressures they encounter in public situations. Antiepileptic drugs also may cause side effects that interfere with concentration and memory. Children with epilepsy may need extra time to complete schoolwork, and they sometimes may need to have instructions or other information repeated for them. Teachers should be told what to do if a child in their classroom has a seizure, and parents should work with the school system to find reasonable ways to accommodate any special needs their child may have.
Pregnancy and motherhood
Women with epilepsy are often concerned about whether they can become pregnant and have a healthy child. This is usually possible in 95% of pregnancies. While some seizure medications and some types of epilepsy may reduce a person's interest in sexual activity, most people with epilepsy can become pregnant. Moreover, women with epilepsy have a 95 percent or better chance of having a normal, healthy baby, and the risk of birth defects is only about 4-6 percent. The risk that children of parents with epilepsy will develop epilepsy themselves is only about 5 percent unless the parent has a clearly hereditary form of the disorder. Parents who are worried that their epilepsy may be hereditary may wish to consult a genetic counsellor to determine what the risk might be. Amniocentesis and high-level ultrasound can be performed during pregnancy to ensure that the baby is developing normally, and a procedure called a maternal serum alpha-fetoprotein test can be used for prenatal diagnosis of many conditions if a problem is suspected.
There are several precautions women can take before and during pregnancy to reduce the risks associated with pregnancy and delivery. Women who are thinking about becoming pregnant should plan their pregnancy, should talk with their doctors to learn any special risks associated with their epilepsy and the medications they may be taking. Some seizure medications, particularly valproate, and phenytoin, are known to increase the risk of having a child with birth defects such as cleft palate, heart problems, or finger and toe defects. For this reason, a woman's doctor may advise switching to other medications during pregnancy. Whenever possible, a woman should allow her doctor enough time to properly change medications, including phasing in the new medications and checking to determine when blood levels are stabilised, before she tries to become pregnant. Women should also begin vitamin supplements - especially folic acid, which may reduce the risk of some birth defects - well before pregnancy. Women who discover that they are pregnant but have not already spoken with their doctor about ways to reduce the risks should do so as soon as possible. However, they should continue taking seizure medication as prescribed until that time to avoid preventable seizures. Seizures during pregnancy can harm the developing baby or lead to miscarriage, particularly if the seizures are severe. Nevertheless, many women who have seizures during pregnancy have normal, healthy babies.