Epilepsy is treatable

On the eve of national epilepsy day which is celebrated every year on 17^th November to raise awareness about this disease. I want to answer some questions which cross the minds of epilepsy patients and public at large. Such questions are sometimes left unanswered because of many social barriers which surround this disease and paucity of time in our OPDs, clinics and other interactions with patients.

What Is Epilepsy and seizure?

Epilepsy is one of the world’s oldest recognized conditions, with written records dating back to 4000 BCE. Epilepsy has been surrounded by fear, misunderstanding, discrimination and social stigma for centuries. This stigma continues in our country and societies today and does impact on the quality of life for people with the disease and their families.

 Epilepsy is a brain disorder that causes recurring, unprovoked seizures. This begets the need to understand what is a seizure? In simple terms, seizures are electrical bursts that cause involuntary body movement or other changes in function like sensation, behavior and awareness. Every human being’s brain has the potential to seize. A person with epilepsy is more likely to have seizures than people without epilepsy. Here we have to make distinction between seizures and epilepsy. A seizure is an event and can be a symptom of other medical problems. “Not everyone who has a seizure has epilepsy."

What is incidence of epilepsy?

Epilepsy is a noncommunicable disease of the brain that affects people of all ages. Around 50 million people worldwide have epilepsy, making it the fourth most common neurological diseases worldwide. Three fourth of people with epilepsy living in low-income countries do not get the appropriate treatment.

What are the causes of epilepsy?

There are numerous causes of epilepsy and they may vary according to age. In children genetic causes, infections, malformations in brain and any perinatal insults are important causes. In adults, epilepsy following traumatic injury to brain, brain infections, drug abuse are some important causes. In the elderly strokes, brain tumors are some well known causes. It is important to have an idea about the cause of epilepsy in order to treat it efficiently.

What are the triggers of epilepsy?

Many triggers are known to provoke seizures. They don’t cause the epilepsy disease as such, but in an epilepsy patient they can trigger a seizure and hence are known as seizure triggers. Skipping doses of antiseizure medicines are commonly involved in precipitating seizures. Alcohol and other illicit drugs can cause seizures both by intake as well as withdrawal. Lack of sleep which is seen in our society around marriages and sleep deficits by various other reasons are common triggers.

Other triggers include flashing lights seen in parties, while seeing video games on mobile or electronic device which give out alternating colors and contrasting patterns. Hormone changes during the menstrual cycle and stressful episodes can also elicit seizures. Dehydration and Skipping meals are other important causes. Intercurrent illnesses like fever, cold, cough etc., also can trigger seizures in person with epilepsy.

What are symptoms of epilepsy?

Symptoms of seizures vary and depend on the site of electrical disturbance in the brain, and how far it spreads in the brain. Symptoms such as loss of awareness or consciousness, involuntary movements, sensation (including vision, hearing and taste), mood, or other cognitive functions occur in it.

How is it diagnosed?

Epilepsy is diagnosed by getting a good account of a patient's problem. In other words, epilepsy can be diagnosed without doing any test and just by a good description of patient’s symptoms usually by attendants of the person with epilepsy. A video recording of the event is very helpful in the diagnosis of this disease, therefore videography of the event by a smart phone should be done whenever possible to facilitate early diagnosis.

Many a times some tests like electroencephalogram (EEG) are done for helping in making the diagnosis and to find out what type of epilepsy a patient has, thereby helping in the treatment as there are different medicines for different types of epilepsies. Tests like MRI or CT scan of brain are done to look for any structural cause of epilepsy.

How is it treated?

Epilepsy is treated by prescribing medicines which are usually taken orally. There are around two dozen antiseizure medications (ASM) which are now available. Around 60% patients are treated by a single appropriately chosen ASM. Still another sizeable fraction is treated by two or more ASMs. The dose of some antiseizure medications is many a times increased slowly so that they are tolerated well. Further ASMs need a strict compliance by the patient in order to maintain a steady level in the blood.

But there are some patients who don’t respond to medicine and surgery might be beneficial to a good fraction of such patients.

How long have the medicines to be taken? Usually, ASMs need to be taken for minimum of 2 to 3 years. But in many cases, they are to be taken lifelong or extended period of time depending upon the age and type of epilepsy.

What should be done and not done in case of seizure?

In case a person with epilepsy (PWE) has a seizure despite medication, he or she should not be restrained during a seizure episode. Patient should be positioned in a lateral position if possible so that any secretions in his mouth flow out. No attempt should be made to put anything in the mouth as it leads to injury of teeth and jaw. Usually, seizure stops on its own in couple of minutes. Further nothing should be given orally ( including water)  until the patient regains consciousness fully . In case seizure does not stop or patient does not regain consciousness or gets repeated seizure he or she needs to be taken to hospital for medical care.

Can a person with epilepsy live a normal life?

Yes, a vast majority of patients can live a normal life provided they take medications regularly. We as a society need to give such patients confidence and more so epilepsy support groups can also have a role in helping such patients making best of their life

Can a person with epilepsy marry?

Marriage is an important step in our lives and epilepsy in most cases is not and should not be a barrier in this. We usually come across with parents of girls with epilepsy   saying “ ye cham nah’az kooree mohnew” and deep inside is the worry about social discrimination and stigma attached to this condition and worry about a successful marriage .Much of this worry is cultural as up to 94 % pregnancies are uneventful if properly treated and looked after during pregnancy.

Can children with epilepsy go to school?

Most of the children with epilepsy can continue their schooling unabated. As for a small fraction of children who still are getting breakthrough seizure a very frank and transparent communication is helpful with school teachers and other relevant persons in school and this includes  school bus drivers and conductors. Any rescue medication can be kept available at the school for ready use. Such children should be encouraged to participate in all extracurricular activities available at school including camping etc. Care should be however taken to share triggers of their epilepsy with teachers and need to avoid them. Swimming may be avoided till seizures are fully under control. It is important to keep help available around swimming pool if decision is made to allow swimming after consultation with the neurologist.

Can a person with epilepsy drive?

As for medical advice and opinion is concerned, a person with epilepsy should only drive once his seizures are under control and certified by the neurologist. Worldwide there are set guidelines for permission regarding driving and they differ from country to country. Most states in the USA permit a person to drive if she/he has been free of seizures for varying periods, between 3 and 18 months. In the UK, a driving license can be granted if the person has been free from seizures for one year. Usually, such driving licenses are with certain conditions.

As of today, the Government of India has no provision to issue special driving licenses to People with Epilepsy (PWE), no matter how long they have been seizure free. But it is also true that PWE drive merrily without disclosing their epilepsy condition and whether their epilepsy is controlled, thus they put considerable risk to their own safety and those of others. This is partly because they know that even a slight reference to their medical history could cost them their driving license. A revised law which is sensitive to the actual condition and history of those with epilepsy can address the situation scientifically and justly.

What a person with epilepsy can and cannot eat?

Patients and their caregivers often have a worry if any particular food is to be avoided and there are some cultural taboos also involved. Non vegetarian food has not been shown to worsen epilepsy and persons with epilepsy can take any food without any restriction. Prolonged fasting has however been shown to trigger a seizure and should be avoided.

Is it contagious or hereditary?

No, epilepsy is not contagious and any amount of contact with person with epilepsy doesn’t increase chances of epilepsy. As for, whether epilepsy is hereditary? Yes, epileptic patients do have family history of epilepsy and there is a genetic transmission in these families though it is not always necessary.

Can epilepsy be prevented?

Approximately 25% of epilepsy cases are potentially preventable. Preventing head injury, for example by reducing falls, ensuring proper regulations to decrease road traffic accidents and avoiding sports injuries by taking proper protection, is the most effective way to prevent post-traumatic epilepsy.

Adequate care at the time of birth of a neonate can reduce new cases of epilepsy caused by birth injury. The use of drugs and other methods to lower the body temperature of a child with fever can reduce the chance of febrile seizures.

The prevention of epilepsy associated with stroke is focused on cardiovascular risk factor reduction, e.g. measures to prevent or control high blood pressure, diabetes and obesity, and the avoidance of tobacco and excessive alcohol use. By preventing substance abuse especially of illicit drugs, and preventing alcoholism we can again prevent epilepsy in young adults.

Brain infections are common causes of epilepsy in tropical areas, where many low- and middle-income countries are concentrated, and prompt and effective treatment of such infections prevents epilepsy in such patients.

In the end we at an individual level and a society as a whole need to spread awareness and take right steps in managing epilepsy and stopping false and wrong perceptions about epilepsy in our society.

Prof (Dr) Bashir Ahmad Sanaie is  HOD and Dr Sheikh Hilal Ahmad is Assistant Professor Neurology, Superspeciality Hospital GMC Srinagar.