Epilepsy is one of the most common neurological conditions occurring at all ages. In simple terms, it can be explained as abnormal electrical activity in the brain causing seizures or fits. It is estimated that nearly 5 lakh people, approximately 6 to 10 per 1000 population, in both the Telugu states combined suffer from epilepsy.
Epilepsy is a chronic neurological disease characterised by recurrent spontaneous seizures. A seizure is a sudden onset of symptoms and clinical manifestations caused by sudden abnormal bursts of electrical brain activity that disrupt brain functions. Epileptic seizures may arise from different brain regions and can cause abnormal motor activity, sensory changes, mood changes and unconsciousness.
Depending upon which treatment plan is for you, our doctors are there to guide you and help manage your epilepsy. Dr. Dinesh Nayak and Dr. B. Ravi Mohan Rao have over 20 years of experience in the field and have performed over 700 surgeries. We are equipped with an Epilepsy Monitoring Unit and the most qualified neurologists, epileptologists, and neurosurgeons to provide our patients with around the clock treatment.
A person may experience one or many seizures. While the exact cause of the seizure may not be known, the more common seizures are caused by the following:
– In newborns and infants:
> Congenital problems
> Birth trauma
> Metabolic or chemical imbalances in the body
– In children, adolescents, and adults:
> Alcohol or drugs
> Head trauma
> Congenital conditions
> Genetic factors
> Progressive brain disease
> Alzheimer’s disease
Other possible causes of seizures may include the following:
– Brain tumor
– Neurological problems
– Drug withdrawal
The person may have varying degrees of symptoms depending upon the type of seizure. The following are general symptoms of a seizure or warning signs of seizures
– Jerking movements of the body
– Stiffening of the body
– Periods of rapid eye blinking and staring
– Loss of consciousness
– Falling suddenly for no apparent reason
– Breathing problems or breathing stops
– Loss of bowel or bladder control
– Not responding to noise or words for brief periods
– Appearing confused or in a haze
– Sleepiness and irritability upon waking in the morning
– Lips may become bluish and breathing may not be normal
The evaluation of patients with epilepsy is aimed at determining the type of seizures (epileptic versus non-epileptic) and their cause, since various seizure types respond best to specific treatments. The diagnosis is based on:
The patient’s medical history, including any family history of seizures, associated medical conditions, and current medicines. A detailed and accurate history of a patient’s episodes is the most helpful tool for making the diagnosis of epilepsy. The doctor will want to know:
How did the episode begin and what happened?
Was there a lack of sleep or unusual stress preceding the episode?
Was there any recent illness?
Had the person taken any medications or drugs, including over-the-counter drugs, alcohol, or illegal drugs?
What was the person doing immediately before the attack: lying, sitting, standing, getting up from a lying position, exercising?
Was consciousness lost or impaired?
Were there jerking movements, automatic chewing or hand movements, eye deviation or blinking, head turning to one side, loss of bladder control, or a tongue bite?
Afterward, did the person go to sleep? Or appear confused?
How long did the episode last?
– Others who have often seen you before, during, and after seizures, such as family and close friends, should be present to provide details of your seizures if they involve loss of consciousness.
General Medical Examination
Because seizures may be caused by medical disorders, a general medical examination is an important part of the first consultation. The examination and certain laboratory studies can tell the doctor whether the liver, kidneys, and other organ systems are functioning properly.
Both the neurologist and the primary doctor should know if a person has both seizures and a medical disorder such as thyroid or kidney disease. The primary doctor may have insights into the cause of the seizures. Also, if an antiepileptic drug is recommended, the doctors need to discuss the possibility that it will interact with medication taken for the medical disorder.
– Identifying whether there is an area of abnormal brain function is the essence of the neurological examination. A complete neurological exam of muscle strength, reflexes, eyesight, hearing, and ability to detect various sensations is used so that your doctors can better understand the cause of your seizures. A detailed examination is performed to evaluate patterns of weakness or sensory loss, and to detect subtle signs or asymmetries not apparent to an untrained observer. Additional testing often includes:
An electroencephalogram (EEG), which measures electrical activity in the brain
Imaging studies of the brain, such as magnetic resonance imaging (MRI)
Blood tests to measure red and white blood cell counts, blood sugar, blood electrolyte levels, and to evaluate liver and kidney function (Blood tests help rule out other illnesses.)
Other tests are used as needed, including magnetic resonance spectroscopy (MRS), positron emission tomography (PET), and single photon emission computed tomography (SPECT).
If epilepsy is suspected, there are many neurological tests available to help with the diagnosis. Electroencephalography, or EEG, is the most specific test for diagnosing epilepsy because it records the electrical activity of the brain. It is the only test that directly detects electrical activity in the brain (seizures are defined by abnormal electrical activity in the brain). During an EEG, electrodes (small metal disks) are attached to specific locations on your head. The electrodes are also attached to a monitor to record the brain’s electrical activity. The EEG is useful to confirm a diagnosis of epilepsy and to determine the type of epilepsy.
The routine EEG is the most common test for epilepsy, but a routine EEG records only about 20 minutes of brain waves. Because this is such a short amount of time, prolonged EEG monitoring might be necessary. Prolonged EEG-video monitoring is an even better diagnostic method. During this type of monitoring, an EEG monitors the brain’s activity and cameras videotape body movements and behavior during a seizure. Prolonged monitoring often requires the patient to spend time in a special hospital facility for several days. Prolonged EEG-video monitoring is sometimes required to definitively diagnose epilepsy.
Antiepileptic drugs (AEDs) can prevent seizure activity by altering neurotransmitter activity in nerve cells, but cannot correct the underlying condition. Approximately 70% of patients successfully control seizures with medication. Nearly 50% of those require two drugs to be seizure free. Because medications interact, the drug regimen must be carefully designed to maximize the effectiveness and to avoid serious complications and side effects. The type of treatment prescribed will depend on several factors, including the type of epilepsy (focal/partial versus generalized), the frequency and severity of the seizures, the person’s age, overall health, and medical history.
The goals of treatment are no seizures and no side effects. If possible, treatment should consist of one drug (called monotherapy). Seizure management is complicated when patients are given more than one drug. The patient may experience drug interactions, increased side effects, and other adverse reactions.
Compliance is essential. To control seizures, a constant level of medication must be maintained in the body. Antiepileptic drugs should not be discontinued abruptly because of the risk for triggering life-threatening status epilepticus.
When seizures cannot be controlled by medications or control can be achieved only at the cost of severe and unacceptable adverse effects, surgery is an alternative. Epilepsy surgery has an excellent chance of completely controlling seizures and its absolute risk is less than that of uncontrolled epilepsy. Modern brain imaging and non-invasive neurophysiologic analysis of normal and abnormal brain function have allowed an understanding of a person’s epilepsy never before possible. Neurosurgery has evolved and benefited from advanced technology and a growing understanding of complex brain function, making surgery of the brain safer than ever before. By considering and comparing the risks of recurrent seizures and the usual progression of epilepsy over the patient’s lifetime to the risks of epilepsy surgery, epilepsy surgery, which can completely control seizures, is in the long run less risky than uncontrolled seizures.
Vagal nerve stimulation (VNS) is another surgical option for the treatment of epilepsy. It involves implantation of an electrode that stimulates the vagus nerve, a nerve that travels through the neck and is connected to various areas of the brain. With this new treatment, approximately 40 percent to 60 percent of patients are helped, in that seizures might become less frequent or less severe. VNS is typically reserved for those epilepsy patients who are not candidates for respective surgery.
People with epilepsy whose seizures are not fully controlled by antiepileptic drugs or who experience troublesome adverse effects may consider looking into the emerging field of complementary and alternative therapies (CAM). Options in the alternative health care arena include treatments such as herbal medicine, relaxation and biofeedback, acupuncture and even chiropractic therapy.