Know about Epilepsy (Seizures)

Epilepsy is a neurological disorder in which a nerve cell activity is disturbed leading to a seizure or periods of unusual behaviour and sometimes loss of awareness. Epilepsy is the fourth common neurological disorder in the world.

Both males or females can suffer from epilepsy irrespective of ethnicity or age. Anyone including children can develop epilepsy.

A person who has two unprovoked seizures (or one unprovoked seizure with a probability of another) is said to be suffering from epilepsy.

During a seizure, the brain experiences burst of electrical activity which causes different movements like shaking, teeth chattering, etc. Each one experiences seizure in a different way. Seizures typically have three stages. But not everyone experiences all three stages.

The first stage is called as prodrome is when a person experiences signs of a seizure. A person may go through mood changes, negative thoughts, racing thoughts, déjà vu. Physical changes like sweating, nausea, dizziness, changes in heartbeat, headache, blurry vision, unusual tastes, loss of hearing or hearing noises may be the signs of a forthcoming seizure. In some cases, the first stage of ‘aura’ or warning is not experienced.

The second stage, ictal is the actual stage of seizure. During this stage, there is a frenzy of electrical signals in the brain. One loses awareness or hallucinates. One may experience memory lapse, trouble in speaking, drooling, loss in muscle control, palpitations, body convulsions and twitching.

The final stage is called as postictal. Here the brain tries to regain control of nerve cell activity. One may take some time to get back to their usual self. The recovery period may differ from person to person. Physical effects like fatigue, headache, fear and anxiety, stomach ache, weakness or soreness in muscles are experienced post-seizure.

In 50% of the cases, an exact reason for epilepsy cannot be determined. In the other 50% of the cases following can be the causes:

• Hereditary: Epilepsy can be transferred through genetics if any brain abnormality runs in the family.
• Head injury: Epilepsy can be experienced post a serious accident or a traumatic head injury.
• Developmental disorders: Certain developmental disorders like autism and neurofibromatosis can be associated with epilepsy.
• Prenatal injury: An infection to mother during pregnancy, or lack of oxygen may lead to brain injury during pregnancy which may later manifest as epilepsy or cerebral palsy.
• Brain tumour: Brain tumours or brain strokes can cause epilepsy. The cause of epilepsy in older people is brain tumours or strokes.

Symptoms of epilepsy

A seizure is a major symptom. Some people may experience an ‘aura’ before the seizure. The symptoms of a seizure are:

• Jerky movements
• Sense of vomiting
• Dizziness
• Uneasiness in stomach
• Faster heart rate (palpitations)
• Occasional loss of memory
• Confusion
• Losing consciousness
• Vigorous body movements/tongue bites
• Uncontrolled bladder
• Purposeless gaze
• Disorientation
• Abnormal smell

The symptoms experienced varies from person to person.

Diagnosis of epilepsy

To diagnose epilepsy the doctor will study the medical history and the symptoms. Further, neurological and blood tests are performed to understand the causes. Tests suggested for diagnosis of epilepsy are:
1. Electroencephalogram (EEG)
2. Video EEG
3. Computerised tomography (CT)
4. Magnetic resonance imaging (MRI) epilepsy protocol
5. Functional MRI (fMRI)
6. Positron emission tomography (PET)
7. Single-photon emission computerised tomography (SPECT)
8. Neuropsychological tests

Treatment Procedures

The first step of treatment is medication. Most people get cured of seizures after a dose of antiepileptics or anti-seizure drugs. The other people are prescribed with a combination of medications. The patients are prescribed antiepileptics like levetiracetam, oxetol and gabapentin. After a certain duration, with reduced or no seizures, patients can discontinue medications with doctor’s consent.

When adequate response is not obtained from epilepsy medication, the doctors choose surgery as a mode of treatment. The surgery is suggested only when:

• The exact region of a person’s brain is identified as the cause of epilepsy
• The region of surgery does not interfere with other vital functions of the body

Epilepsy can be treated through therapies like vagus nerve stimulation, ketogenic diet and deep brain stimulation.

Dr Vara Prasad B Gillela
MBBS, MD, DNB (NEUROSURGERY)
Consultant – Spine & Neurosurgery,
Paediatric Neurosurgery & Epilepsy Surgeon
OMNI Hospitals, Kukatpally