What is epilepsy?
Epilepsy is a disease of the brain. Brain cells create abnormal electricity that causes seizures. A seizure may cause “jerking” movements. In some cases, seizures cause only a loss of consciousness, a period of confusion, a staring spell or muscle spasms. A single seizure is not considered epilepsy. People with epilepsy have repeated episodes of seizures, at least more than 2 episodes at intervals of more than 24 hours.
How common is epilepsy?
It is very common with incidence of 10/1000 populations. In India-10 million people are affected.
What causes Epilepsy?
There is fine balance in the brain between factors that begin electrical activity and factors that restrict it, and there are also systems that limit the spread of electrical activity. During a seizure, these limits break down, and abnormal electrical discharges can occur and spread to whole groups of neighbouring cells at once. This linkage of electrical discharges creates a “storm” ofelectrical activity in the brain. This is called epileptic seizure.
What are the causes forepilepsy?
Some important causes in India are
1. Fever-Febrile seizures
2. Birth Trauma-lack of oxygen, glucose during the time of delivery.
3. Head injury-road traffic accidents, falls.
4. Brain Fever-bacteria, virus etc
5. Brain tumors
6.Hereditary- if somebody in the family having fits, chances are more, however it will not spread from one person to other person by contact.
What are the different types of Epilepsy?
There are different types of fits in children. Many times difficult to recognize by parents and even by neurologist.
Generalized- involves whole body with loss of consciousness
1. Tonic – stiffness of limbs and body
2. Clonic – shaking movements
3. Absence - staring and eye blinking and dreaming like episodes
4. Atonic – sudden falls
5. Myoclonic – sudden jerks
Partial – involves only one part of the body
1. Simple- shaking of one part of the body without loss of consciousness
2. Complex- shaking of one part of the body with loss of consciousness
Special types in children
Infantile spasms - West syndrome
In this type of fits, sudden movement of neck, trunk and limbs in clusters after awakening from sleep. Usually occurs multiple times per day. During these episodes baby can cry or smile without apparent reason. Usual age of onset is around 4-8 months. These are difficult to recognize by parents. Neurologist should be consulted if any doubt. These are very common when child brain has already damaged during the time of birth. These fits are dangerous to brain if not recognised and treated because it causes further damage to brain. Child will forget already leaned activities.
What happens during aseizure?
Some seizures are hardly noticed perhaps only a feeling of “pins and needles” in one thumb for a few seconds. During other seizures, the person may become unconscious; fall to the floor and jerk violently for several minutes. Between these extremes is an astonishing range of feelings and actions.
Many people think that the only real seizures are ones with strong, uncontrolled movements. They think that having a strange feeling in the stomach, blanking out for a few seconds, or jerking one arm a few times is nothing important, at most a minor “spell”. But in fact, any change in feeling or behavior that results from an uncontrolled discharge of electricity in the brain is a seizure.
Do seizures cause braindamage?
Ina Tonic-Clinic seizure, the person loses consciousness, the body stiffens and then they fall to the ground. This is followed by jerking movements. After a minute or two, the jerking movements usually stops and consciousness slowly returns. Tonic –Clonic seizures lasting less than 5-10 minutes are not known to cause brain damage or injury. However, there is evidence that more frequent and more prolonged tonic-clonic seizures may in some patients injure the brain. Prolonged or repetitive complex partial seizures (a type of seizure that occurs in clusters without an intervening return of consciousness) also can potentially cause long-lasting impairment of brain function.
Some children have difficulty with memory and other intellectual functions after seizures. These problems may be caused by the after-effects of the seizure on the brain, by the effects of seizure medicines, or both. Usually, however, these problems do not mean that the brain has damaged by the seizures on brain function, but this effect appears to be rare.
What should be donewhen child has a seizure?
If someone near you has a seizure, use the following general guidelines:
Is epilepsy inherited?
Most cases of epilepsy are not inherited, although some types are genetically transmitted (that is, passed on through the family). Most of these types are easily controlled with seizure medicines.
What tests should be done?
How to Treat?
Before starting treatment
1. Need for definite diagnosis whether fits or fits like conditions
2. Following first episode of fits treatment usually not indicated unless if associated with some other problems.
3. Treatment usually requires after second episode of fits except in some cases like febrile first.
4. Attempt single drug if requires
5. Start with low dose and increase gradually
6. Should be taken regularly
DURATIONOF TREATMENT
Minimumseizure – 2 year’s free period
Longduration
Side-effects
— Sedation
— Hyperactivity
— Calcium/vitamin D/ folic acid deficiency
— Liver problems
— Blood problems
— Allergy
Newtreatments
— Ketogenic diet
— Vagal nerve stimulation
— IVIG
— Surgery
Howfrequently one should visit Doctor?
As prescribed by doctor. In general, once in 3 months. Doctor will assess for any side effects of medicines. In each visit, all drugs, seizure diary, and reports should bring to the hospital.
Is epilepsy a curse?
No. Epilepsy has nothing to do with curses, possession, or other supernatural processes, such as punishment for past sins. Epilepsy is not a mental illness, and it is not a sign of low intelligence. It is also not contagious. Between seizures, a child with epilepsy is not different from anyone else. Like asthma, diabetes, and high blood pressure, epilepsy is a medical problem.
Should epilepsy be a barrier to success?
No. Epilepsy is perfectly compatible with a normal, happy, and full life. The child’s quality of life, however, may be affected by the frequency and severity of the seizures, the effects of medications, and reactions of onlookers to seizures, and other disorders that are often associated with or caused by epilepsy. However with proper treatment and care, the patient’s quality of life can be improved.
If I have epilepsy, does my child have to take medicines every day?
Yes. Child must take medicine every day, even when child not having seizures or when you think you won’t have a seizure till the time your physician asks to change or stop. To prevent seizures, child has to take the medicine regularly, just asyour doctor tells you.
What Should I do if Iforget to take my medicine?
Usually you should give medicine as soon as you know you forgot a dose.
Should I give extra medicine if I think I’m about to have a seizure?
No. The amount of medicine you take is carefully set for child needs. No extra medicine should be taken without your doctor’s approval.
Will I have to give the medicine forever?
No.It may be possible for some children with epilepsy to stop taking medicine. However, this decision must be made by your doctor. Before you and your doctor can decide to stop the medicine, several questions should be considered. These include how quickly your seizures were controlled, how long child have been free of seizure, and if you have other illnesses that may affect child problem.
Can I give other drugswhile taking anti-epilepsy drugs?
Yes, only on the basis of the doctor guidance only you can take other drugs. Because many drugs affect the ability of your epilepsy medicine to control child’s seizures, ask your doctor or pharmacist before taking other drugs, even drugs you can buy without prescription. Can be taken with other drugs, however should be informed to treating doctor regarding drugs because they can cause precipitation of seizures.
Can I take for a holiday?
Travel is much easier if Child's epilepsy is well controlled! Means of transport (plane, train, or car) are not factors that aggravate epilepsy but may cause stress and or lack of sleep that could trigger a seizure.
Do’s
1. First aid
2. Don’t put anything in mouth
3. Put in lateral position
4. Take child to nearest hospital
5. Take all drugs and reports when you are visiting a doctor
Don'ts
1. Driving
2. Swimming
3. Climbing
4. Electricity and machinery works
Wrong beliefs
— Fits are Rare
— Fits spreads from one person to other person (Communicable disease)
— Restrain during attack
— It occurs from birth
— Low IQ
— Family isolation
Lifestyle
Education -They can go to normal school as normal children
Playing –They can play as normal children
Uncontrolled fits - causes are
— Fits like conditions mistaking for fits
— Type of fits and selection of drug may not work
— Pseudo fits due to stress
— Drug selection: improper selection
— Dose: incorrect dosage
— Compliance: not taking drugs regularly
— Cause: if underlying cause not treated
Prevention: fits can be prevented by preventing
— Birth trauma
— Accidents
— Vaccines are available to prevent occurrence of brainfever
— Good hygiene to decrease worm infestation
— Maintenance of good Environment to prevent fever associated fits and infections