International Epilepsy Day 2023: Causes, Risks And How To Manage Epilepsy

Epilepsy, a neurological condition that is characterized by a range of symptoms from mild episodes of "getting stuck" to severe ones that include shaking of the whole body, almost 60 lakh people in India suffer from epilepsy. Along with being a neurological disorder, epilepsy has significant social and mental consequences as well. The disease and the seizure medications can have adverse effects on pregnant women. So, prescriptions have to be changed to safer alternatives in women who are pregnant or planning pregnancy as some seizure medications can cause women to give birth to children with developmental defects and learning disability. Another major concern is the SUDEP (Sudden Unexpected Death of Epilepsy).About 1 in 1000 people with epilepsy who are otherwise healthy die annually because of SUDEP, which is about 24 times that happens in general population.

The majority of the time, the cause for epilepsy may not be identified. Still, one of the major known causes of epilepsy is an injury to the brain. People at risk for epilepsy include head trauma, trauma at birth, developmental malformation of the brain, brain tumour, stroke, multiple family members having epilepsy, meningitis or encephalitis infection.

The type of epilepsy is determined by where in the brain the abnormal electrical activity occurs. A focal seizure is one where the seizure is generated from one part of the brain region. In a generalized seizure the abnormal electrical activity involves the whole of the brain. A focal seizure may present with altered feelings or sensations transiently, body jerking, dizziness, or flashing lights. Another type of focal seizures characterized by impaired awareness is where the affected person stares blankly into space, does not respond normally, or performs repetitive movements, such as rubbing their hands, chewing, swallowing, or walking in circles.

In almost all epilepsy patients treated with antiepileptic medications, they live a normal life. Only about 30% of epilepsy patients experience drug-resistant epilepsy where the seizures continue to occur in spite of appropriate medications. A significant proportion of this group become seizure free with surgical removal of the seizure focus. Recently, significant progress has been made in the field of drug-resistant epilepsy. Advances in the MRI technique like 3T MRI and PET MRI have increased the detection of subtle lesions which were not identified previously. Surgical advances have also revolutionized the treatment of difficult epilepsy cases with minimally invasive surgical techniques like Stereo EEG and radiofrequency ablation.

Epilepsy remains a significant cause of morbidity and a social stigma in our country, but with recent advances in epilepsy treatment options, increased awareness, and state-of-the-art epilepsy centers available, the majority of patients hope to achieve seizure freedom. 

Management of epilepsy is very important and here are few things to keep in mind: 

• If you witness an attack, take careful notes because an accurate description prevents incorrect diagnosis. Now with the availability of smart phones one could video the event which would be a very important tool for diagnosis and treatment. 
• Early treatment is critical
• The prescribed medications must be taken on a regular basis. Do not skip any doses
• The duration of treatment varies with each individual
• There are only few restrictions for someone suffering from epilepsy. Make sure you get enough sleep. Patients can study, work, and live their lives l
• Epileptic women can marry and have children
• Folate supplementation should be encouraged in all women of childbearing age who are taking any seizure medications.
• Treat epilepsy the same way you would treat other diseases like diabetes or hypertension. Do not overprotect or isolate.

International Epilepsy Day was established with the goal of promoting the right laws to ensure that the human rights of people suffering from epilepsy are protected and to empower such people to have the best quality of life possible.

(Dr. Siby Gopinath, Professor, Department of Neurology, Amrita Hospitals, Kochi)

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