Epilepsy





Epilepsy has been known throughout history. It observes no cultural, geographical, racial or economical boundaries. It can occur to anybody at any age. Approximately 1 in every 100 suffer from it, so we have about 10 million sufferers in India. 70-75% have their first attack in childhood. If not treated properly at the right time, epileptic attacks recur and hamper the growth and development of these children. Epilepsy thus poses a widespread major problem.





Genesis of Epilepsy

The brain is the control center for the body like a computer of the highest generation. It is made up of millions of tiny nerve cells or neurons and supporting glial cells. Each neuron is connected to thousands of other neurons and in turn to the different parts of the body via nerves. Each neuron has electrical voltage difference across its cell membrane. (This inherent electrical activity can actually be detected, measured and recorded by electroencephalogram-EEG). A seizure occurs when there is sudden "surge" or "excess" or "chaos" in the normal electrical activity in groups of neurons (epileptic focus) possibly due to change in metabolism. This abnormal electrical discharge spreads to other areas of the brain. This chaotic state of excessive excitability is ultimately brought under control by inherent inhibitory influences.

The abnormal discharges may involve a small part of the brain only manifesting as partial or focal seizure or a much more extensive area in both cerebral hemispheres manifesting as generalised seizures. The presence or absence of warning or n Aura and a typical sequence of the events during an attack reflect the point in the brain from where the attack begins.




Types of Seizures


Epileptic seizures can take a wide variety of forms but are broadly divided into generalised, and focal or partial seizures. Partial or Focal seizures affect part or a whole limb and may and may not become generalised, and focal or partial seizures. Partial or Focal seizures affect part or a whole limb and may not become generalised. If there is no alteration in consciousness it is known as simple partial ore Jacksonian seizures and if consciousness is altered or lost it is known as complex partial seizures, commonly known as psychomotor or temporal lobe epilepsy. Generalised seizures affect the whole body and consciousness is lost. However, by far the most common are Generalised Seizures (involving the whole of brain) commonly known as "Grand Mal" or "Tonic-Clonic" seizures are major seizures




Factors Provoking Seizures


They are:
  • Irregular eating and sleeping habits particularly when associated with sever mental stress and anxiety.
  • Physical exhaustion
  • Emotional upsets, more so for persons emotionally very sensitive.
  • Fever, particularly in children
  • Premenstrual tension
  • Pregnancy
  • Alcohol over intake and alcohol withdrawal state



Causes of Epilepsy

According to the causes, epilepsy is divided into primary or idiopathic and secondary. Primary means no cause is demonstrate with all available investigations including latest Neuroimaging studies like Computerised Axial Tomography (CT scans), and Magnetic Resonance Imaging (MRI Scans).

Secondary are those where seizures are manifestation of demonstrate structural diseases of the brain or they could definitely be attributed to causes like birth injuries, deficiency of sodium, sugar or calcium in the body, brain infections, head injuries and vascular insufficiency.

About 40-50% of the cases are Primary or Idiopathic.




Diagnosis of Epilepsy


Epilepsy is essentially a clinical diagnosis, e.g. form history and physical examination. Detailed account of the attack from patient and the eye witness is more important than the results of all the investigations as regards confirmation of the diagnosis. It often gives clues to the basic cause also. Thus every effort must be made to obtain this.
Investigations are done to confirm the diagnosis and determine the cause. Depending on the age of the onset of the first seizure and associated symptoms and signs, the doctor decides the number and priority of the investigations. They include

  • Plain X-rays of skull and the chest
  • Blood count and Hemoglobin concentration
  • Electroencephalogram (EEG)
  • Cerebral Fluid Examinations obtained through lumber puncture
  • CT Scans and MRI Scans of the brain
  • Angiographies
  • IQ Test and personality tests





EEG

EEG is done to increase the certainty of the diagnosis and to ascertain the type of the seizure. It helps to determine proper medication and prognosis. However, EEG is not required in all cases and management of epilepsy in a given case can be done without the help of EEG if not available. Normal EEG does not rile out epilepsy.




Management


It consists of following steps :
  • Treatment of the cause if detected by investigations.
  • To avoid known provoking factors.
  • Drug therapy.
  • Balanced adjustment of daily routine and social acceptance.
  • The general practitioner or family doctor and family members play a key role to help the patient achieve this.

    Commonly used anti-epileptic drugs:
    • Phenobarbitone
    • Phenytoin
    • Carbamazepine
    • Sodium Valproate
    • Ethosuximide

    These drugs suppress he neuronal hyperexcitability responsible for seizures and gradually may cool down the potentially hyperexcitable epileptic focus so that over the years after the last attack, they could be withdrawn gradually. In few cases recurrence of seizures is still a possibility, so a plan for withdrawal of drugs should be done strictly under medical supervision. 

    Many great men in history like Julius Caesar, Napoleon Bonaparte, Van Gogh and Alfred Nobel had Epilepsy.
    Epilepsy is no bar to achieve greatness in any sphere. 

    Resonance to the single drug or combination of the drugs is variable and depends on.

    • The gap between the first seizure and initiation of the proper treatment
    • Proper drugs in proper compliance of all the instructions
    • Regularly and proper compliance of all the instructions.
    • Type of seizures.

    The treatment of every patient is highly individualised and strictly under medical supervision. The choice of the drug, the dosage of the drug, total duration of the treatment after the last attack and mode of withdrawal of the drugs are highly individualised. As the cost of the drugs like Carbamazepine and Sodium valproate is high and since the duration of the treatment is in years, economic constraints become an important factor for the choice of the drug.
    A record of attacks and drug therapy must be maintained. It is important to follow the doctor's instructions on periodic follow up examinations. This helps the physicians to monitor the patient's progress and detect any side effects of the drugs that may develop. Common side effects are nausea, drowsiness, weight loss or weight gain. These must be reported to the doctor. There is a general belief that these antiepileptic drugs dull the intelligence due to long term use and often this is the major reason to discontinue treatment. The drugs do have mild effect on cognitive function but the advantages outweigh the side effects.
    The selected cases it may be necessary to estimate the concentration of the drug in serum so that the optimal efficiency of the drug is combined with minimum side effects. This is known as serum level estimation or therapeutic drug monitoring.
    In chronic patients total seizure control may not be possible and in such cases one may have to strike balance between seizures and side effects of the drugs. This should be accepted by the patient and the relatives.



    Restrictions


    A person with epilepsy can do every thing except

    • Drive a vehicle.
    • Work with machines or fire.
    • Swim alone (once fits are properly controlled, swimming can be done under supervision).





    What is a Support Group & Self Help Group


    Support Groups have very strongly emerged on the therapeutic scene. In support group meetings, people with disabilities, family friends and well-wishers come together and lend support to each other in overcoming the disability. Here, members share their experiences, feelings, interests and aspirations. Members encourage and motivate each other. The general atmosphere is of warmth. support and acceptance. This facilitating scene foster positive change in the member. They discover that they are not alone and their problems are not unique.
    Empowerment of the person with disability being the ultimate goal.
    Most important message is "Their problems can be overcome!" and "Self help is the best help"

     

    The Epilepsy Support / Self Help Groups(SG) in India are as follows:

    SAMMAN Association - Mumbai
    (Formerly Indian Epilepsy Association, Bombay Chapter) ,

    c/o ADAPT( Formerly Spastics Society of India,1st Floor, K.C. Marg, In front of Hotel Rang Sharda,
    Near Lilavati Hospital, Bandra Reclamation, Bandra, Mumbai- 400050
    Office Timing- Mon-Fri 9 to 1pm, SG meetings every 2nd and 4th Saturday 2.30- 4.30 p.m.
    Contact- +91 9820902143, Carol D'Souza (+91 9819029338 )
    Email- mumbaiiea@gmail.com,
    Website - www.epilepsymumbai.org, Blog - ecellin.wordpress.com


    UTTEJAN  ( उत्तेजन )- Thane Institute for psychological Health(IPH),
    Shree Ganesh Darshan, LBS Marg,
    Between Hari Niwas and 3 Petrol Pumps,Naupada, Thane West.
    SG meetings 1st Sunday of the month at 4 p.m.
    Mrunalini Palshikar (+91 9820451916 )
    E-maildrmrunalini.palshikar@gmail.com ,
      Alpa Chande  (+91 9820969210 )

     

    PROTSAHAN - Dombivli
    Contact   Dr. Adwait Padhye +91 9820235518 , 
    Dr.Mansi A. Kulkarni +91 9820609535,Dr. Geeta Mondkar +91 9821351588 


    SANVEDANA - Pune
    Epilepsy Counseling Centre
    Niwara Old-Age Home, Near S.M. Joshi Hall, Navi Peth,Pune - 411030
    Every Tuesday 4.30 pm to 7.30 pm by appointment 
    Yashoda Wakankar +91 9822008035,  Radhika Deshpande +91 9850887644 
    EmailYashoda.wakankar@gmail.com
    Sanvedana also runs a Marriage Bureau. Pl.contact Mr. Mohan Phatak- +91 8983632893

    SAMVAAD - Nagpur
    Contact - Dr. Poornima Karandikar +91 9372512142 
    https://www.facebook.com/epilepsy.samvaad

    SAMMAN - Indore <
     Mangesh Neuro Centre, 1, Kanchan Baugh, Indore 452001, M.P.
    Contact - Dr. Mrs. Vrushali Nadkarni ( +91 9826020232 )
    Email vrushalinadkarni@yahoon.com


    Epilepsy Support Group - Aurangabad
    Contact - Dr. Vijay Pathade + 91 9049070365 


    Epilepsy Support Group - Sholapur
    Contact  - Dr. Valsangkar +91 9823900112 / +91 9823296871 


    Ekatwam, Delhi 
    contact@ekatwam.org   http://ekatwam.org


    Dr. Bindu Menon Foundation, Andhra Pradesh 
    Axon Neuro & Rehab Care D No.16-7-129, 2nd street, Ramamurthi Nagar,
    Nellore, Andhra Pradesh. Ph- 08612350350, 9676037037
    Email- bindu.epilepsycare @gmail.com 
    http://www.drbindumenon.com


    Epilepsy Surgery 

    Epilepsy Surgery  Support Group - Thiruvananthpuram R. Madhavan Nayar Centre for Comprehensive Epilepsy Care,
    Sree Chitra Tirunal Institute for Medical Sciences & technology (SCTIMST), Tiruvananthapuram 695011.
    Contact- Dr.D. Jayachandran - 0471-2524282 Emailcec@sctimst.ac.in  www.sctimst.ac.in

    KEM Hospital, Seth GS Medical College, Mumbai 
    Acharya Donde Marge, Parel, Mumbai 40012 India. 
    Tel:  
    91-22-2410 7000

    For Ketogenic Diet 
    Dr. Janak Nathan-Sanjiv Clinic - 91-22-24459414
    janak.nathan@gmail.comwww.ketogenicdietindia.org

     




    A Call From our Hearts



    Dear sisters and brothers, Listen!
    Epilepsy is neither a crime nor a sin,
    It is wrong to hide and not declare,
    To yourselves it would be most unfair.

    For centuries we have been hearing;
    For years we have been repeating
    That Epilepsy is a blemish, Epilepsy is a weakness.
    Let us banish this myth
    And let them know the truth.
    Our sons and daughters need to understand,
    We ought to let them know.
    Dear sisters and brothers, Listen.....

    With Epilepsy we shall have to live,
    Bear it with a smile and shed no tear;
    Together we shall walk and march ahead without fear.
    Why curse our fate and lament?
    Why can't we become self-reliant?
    Let us adopt Epilepsy as our silent companion
    And give our future a new dimension.

    (This is a translation. Original song in 'HINDI', Indian National Language)
    Kavita Shanbhag



    Useful links


    http://www.epilepsyindia.org
    http://www.epilepsymumbai.org/
    http://www.efa.org
    http://www.ilae.org
    http://www.ibe-epilepsy.org
    http://indianepilepsycentre.com
    http://www.ketogenicdietindia.org
    http://www.aarogya.com
    http://www.healthymind.org