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Epilepsy





Epilepsy or tendency to have “fits” observes no cultural, geographical, racial or economical boundaries. It can occur to anybody at any age. 70-75% have their first attack in childhood. Approximately one person in every hundred has epilepsy, so we have more than 10 million people with epilepsy in India.



Definition

The brain has a normal electrical rhythm and when that is upset it manifests in a convulsion/ seizure/ fit. Recurrent seizures are termed as Epilepsy. It is like having a storm in the brain.

Characteristics

The behaviour changes occur only during the attack and the person is normal in between them. He may experience an “Aura”, a warning such as change in taste, fear for no apparent reason etc. Confusion, disorientation, headache & drowsiness are the after effects of an attack

Causes of Epilepsy

Birth injuries, brain infections, head injuries, vascular insufficiency and deficiency of sodium, sugar or calcium in the body are some of the causes of Epilepsy.

Types of Seizures

Epileptic seizures can take a wide variety of forms but are broadly divided into Generalised and Focal (partial seizures).

Generalised seizures

affect the whole body and consciousness is lost. However, most common are Generalised Seizures (involving the whole of brain) commonly known as "Grand Mal" or "Tonic-Clonic" seizures.

Partial or Focal seizures

affect part or a whole limb and may and may not become generalised. If there is no alteration in consciousness, it is known as simple partial or Jacksonian seizures and if consciousness is altered or lost it is known as complex partial seizures, commonly known as psychomotor or temporal lobe epilepsy.



Factors Provoking Seizures


They are:
  • Irregular eating and sleeping habits particularly when associated with severe mental stress and anxiety.
  • Physical exhaustion
  • Emotional upsets
  • Fever, particularly in children
  • Premenstrual tension
  • Pregnancy
  • Alcohol over intake / withdrawal state



Management First Aid during the Seizure


  • Make the person lie on one side so the saliva drips down.
  • Loosen the clothing e.g. tie. Remove spectacles, tie, etc.
  • Place a towel or cloth under his head.
  • Clear the area and remove objects that may cause danger.
  • Do not restrict convulsing movements.
  • Do not offer anything to eat or drink during the attack.
  • Do not crowd around.

Usually, the attack lasts for less than two minutes. If the duration is too long or the person has recurrent attacks, call a doctor.



Medical Management


  • Treatment is determined based on case history, an EEG and MRI. These tests are to be repeated as and when necessary.
  • Anti Epileptic Drugs (AEDs) prescribed by the neurologist are to be taken regularly and for specified time.
  • Regular follow ups and feedback about medication is a must.
  • Regular daily routine of adequate sleep & timely meals to be followed.


Treatment Options



Epilepsy Surgery

Some people have refractory (difficult to control) epilepsy whose seizures remain resistant to treatment with anticonvulsant medications. They may have symptomatic localization-related epilepsy; a focal abnormality that can be located and therefore removed. For them epilepsy surgery is an option.



Ketogenic Diet


The Ketogenic Diet is a high-fat, adequate-protein, low-carbohydrate diet used primarily to treat difficult-to-control (refractory) epilepsy in children.
When there is little carbohydrate in the diet, the liver converts fat into fatty acids and ketone bodies. The ketone bodies pass into the brain and replace glucose as an energy source. An elevated level of ketone bodies in the blood, a state known as ketosis, leads to a reduction in the frequency of epileptic seizures.

Psycho – Social Management

  • Avoidance of known provoking factors like watching excessive T.V. or gettingin to arguments.
  • Avoidance of overprotection by parents and caregivers.
  • Acceptance - personal and societal.



Misconceptions

Unfortunately, many a time, a person with epilepsy is thought to be possessed by an evil spirit. As a result, the person is taken to a mantrik (witch doctor) or a quack or a godman and the condition deteriorates. Epilepsy is equated with mental illness and as a result, it is hidden.Epilepsy has social repercussions like stigma and discrimination. Awareness, Early Intervention and Psychosocial Support can produce significant results and attitudinal change.




What does the law say about Epilepsy?


The Rights of Persons with Disabilities Act, 2016 recognises Chronic Neurological Conditions as a disability.It defines “chronic neurological conditions” as a condition that has its origin in some part of person's nervous system lasting for a long period or marked by frequent recurrence.Though refractory epilepsy is a chronic neurological condition;the law is ambiguous about the certification procedure of such conditions & it does not mention either the duration of illness or frequency of recurrence.

Many people with refractory epilepsy also have ID/CP/ Autism/ SLD, thus they are covered by the law. But stand alone cases of refractory epilepsy without any co-occurring condition need high support and legal backing.

Epilepsy Organisations are working towards making medical, educational, travel concessions available to persons with epilepsy & their caregivers considering many key areas of their life like education, employment, marriage, childbearing & social interaction are severely affected