Epilepsy Isn’t the End – You Can Keep Your Seizures in Check

Did you know that epilepsy is one of the oldest recorded health challenges, dating back to around 4000 BCE? Even legendary figures like Hippocrates, Julius Caesar, and Napoleon faced this condition. To effectively confront epilepsy, it’s crucial to understand its causes, triggers, and precautionary measures. Let’s face this challenge head-on and empower ourselves with knowledge. 

Epilepsy is a long-term neurological disorder that affects the brain and leads to recurrent seizures. In a healthy brain, neurons — cells that send messages using electrical and chemical signals — work together in a well-coordinated manner, much like a perfectly synchronised orchestra creating beautiful music. Each neuron plays a specific role, and together, they produce a harmonious symphony of signals that allows the brain to function properly.

However, in epilepsy, this harmony is disrupted. The neurons begin to fire signals abnormally and uncontrollably, resembling an orchestra suddenly playing out of sync. This chaotic electrical activity can result in sudden, short-lasting seizures, interrupting the brain's normal rhythms and causing various symptoms.

Epilepsy also has physical implications, as seizures impact the body's condition. Epilepsy can only be diagnosed when there are multiple episodes of seizures, not just one. 

There are many myths surrounding epilepsy:

• Epilepsy is not contagious. 
• Genetic alterations could be significant factors in the onset of specific types of epilepsy. Various forms of the condition often impact several family members, suggesting the presence of an inherited gene(s). 
• Epilepsy is unrelated to decreased intelligence, learning abilities or poor cognition. It is purely a neurological disorder and not a mental issue.  However, it may cause memory loss, especially during seizure episodes. 

Studies show that there are about 50 million people worldwide with diagnosed epilepsy; 10-12 million of those are in India.  That contributes to nearly one-sixth of the global epilepsy population. There are ongoing efforts to establish preventive, promotive, curative, and rehabilitative services for epilepsy in the country. 

Dr George Abraham Ninan, Assistant Professor of Neurology at Christian Medical College Hospital Vellore, says, “The causes of epilepsy range from genetic factors to brain injury, infections, or structural abnormalities. Diagnosis requires a clinical evaluation that measures electrical activity in the brain and imaging studies.”

Based on the causative factors, epilepsy can be acquired, idiopathic, genetic or developmental. Here are the epilepsy causes:

• Congenital defects or genetic diseases that lead to brain malformations
• Brain damage caused by low birth weight, trauma during delivery, or low oxygen levels
• Severe damage to the head or trauma and or after a major head surgery
• Stroke, which cuts oxygen supply to the brain.
• Meningitis, encephalitis, and neurocysticercosis are examples of brain infections which may cause epilepsy
• Specific hereditary disorders
• Brain growths or tumours

Epilepsy can have acute causes that initiate seizures immediately or remote causes that impact later in life. According to research, 40 out of every 100 cases of epilepsy have a known cause, which includes intracerebral haemorrhage, ischemic stroke, brain injury, infections in the central nervous system, and neurodegenerative illnesses.

Seizures can be either focal or generalised:

• Focal seizures: They impact only a portion of the brain. Focal seizures can generate unusual sensations. A person may have delusions or see and smell things that aren't there.
• Generalised seizures: Generalised seizures have an impact on the entire brain. They often result in the complete loss of consciousness.

Here are some of the triggers of epileptic episodes:

• Flashy, bright lights: Around five per cent of individuals with epilepsy are prone to seizures triggered by flashing lights, a condition known as photosensitive epilepsy. 
• Consistent lack of sleep and rest
• Extreme stress and anxiety
• Physical and mental exhaustion with sleep deprivation
• Alcoholism
• Extreme emotional changes and mental trauma
• Missing doses of prescribed medications

The symptoms of epileptic seizures vary from person to person. Dr Ninan adds, “While seizures are often associated with intense convulsive movements, such as jerking of the arms and legs or frothing at the mouth, they can take many other forms. These include brief lapses in awareness, sudden falls, blank stares accompanied by chewing or lip-smacking, and unintentional hand movements.”

Common symptoms include:

• Seizures can cause temporary loss of awareness or consciousness, as well as changes in movement, sensations (such as vision, hearing, and taste), mood, confusion or cognitive ability.
• Post-seizure symptoms include anxiety, depression, irritability, excessive salivation, excitement, hypomania, sleep, coma, lethargy, exhaustion, vomiting, anorexia, laughter, sighs, headaches, and even migraines.
• Delirium, or the disoriented and disturbed state of mind, after an epileptic seizure usually lasts a few hours but might last for one to two days.

Epilepsy can become complicated if not managed correctly. These complications are:

• Early death or Sudden Unexpected Death in Epilepsy (SUDEP): SUDEP is a rare condition where a person dies without a convulsive seizure, with over a third of cases showing evidence of a seizure shortly before death. The cause is unclear and may vary between cases, with some researchers suggesting irregular heart rhythms and others suggesting breathing problems after a seizure.
• Seizure emergencies: This may include fractures, biting on the tongue/lips/cheeks, head injury, road accidents, kitchen accidents, etc. 
• Compromised bone health: Epilepsy patients are at higher risk for osteoporosis and fractures, with antiseizure medications, especially older ones, being linked to osteoporosis.
• Decline in cognitive abilities: Seizures can interfere with specific brain regions responsible for functions like language, making it difficult to name objects or form coherent thoughts. They also disrupt communication between different parts of the brain, leading to fragmented conversations and may cause individuals to lose track of their thoughts mid-sentence.

Two primary indicators for predicting seizure recurrence are documented causes and abnormal electrical activity patterns in the brain, which are diagnosed through tests. This forms the basis for management and prevention.

World Health Organization (WHO) pilot projects have demonstrated that training primary healthcare providers in epilepsy diagnosis and treatment can significantly reduce treatment gaps. This approach shows that basic healthcare can play a crucial role in managing epilepsy in various regions.

Preventing epilepsy is often linked to avoiding specific risk factors:

• Preventing head injuries by reducing falls, road accidents, and sports injuries is a key strategy to prevent the development of epilepsy. 
• Proper prenatal and perinatal care can lower the risk of epilepsy due to birth injuries.
• Controlling fever in children with medications or other methods can help reduce the likelihood of febrile seizures.
• Preventing stroke-associated epilepsy is related to managing high blood pressure, diabetes, and obesity, as well as quitting smoking and drinking alcohol. 

Dr Ninan advises, “Treatment for epilepsy usually focuses on medications to manage episodes rather than providing a complete cure. This approach requires long-term follow-up, strict adherence to prescribed medications, and lifestyle adjustments, including ensuring adequate sleep. Breaking the stigma around epilepsy and fostering support from society, family, friends, and colleagues can greatly improve the quality of life for countless individuals living with this condition.”

Extensive research and tools are available for epilepsy today. However, epilepsy cases in developing nations often get misdiagnosed, leading to complications. Living with epilepsy can be challenging, but with the right know-how, precautions and management techniques, it can be tackled well. 

Some epilepsy episodes that occur in childhood completely resolve in adulthood — remission. However, others may need lifelong management.

Common triggers for seizures in epilepsy include anxiety, stress, alcohol, sleep deprivation, and mental trauma. 

Epilepsy can be genetic. About one-third of the cases can be due to hereditary causes. 

Precautionary measures such as stress management, good rest, quitting alcohol, sleeping better, staying away from fire, avoiding solo travel, etc. can help manage epilepsy.

Epilepsy can affect children, adolescents and adults.