A Family Doctor's Tale - EPILEPSY

DOC I HAVE EPILEPSY

In a family practice, high fever in children sometimes give rise to febrile fits.

I would normally give an injection of valium and put a cooler pad on the forehead.

In most cases the fits will stop.

Adult fits or epilepsy are less common .

I still have a patient who has been on epilepsy medicines for at least 30 years.

He is fairly under control with the medications

Epilepsy is a neurological disorder which occurs when the brain malfunctions due to sudden abnormal electrical discharge of brain cells.

If all the brain cells discharge abnormal signals at once, the epileptic fit is called a generalized fit or grand mal.

If only part of the brain is involved in discharging abnormal signals, the fit is called a partial epileptic fit.

Epilepsy is diagnosed only when there are repeated episodes of epileptic fits.

Epileptic Seizures may vary from the briefest lapses of attention(trance) or muscle jerks to severe and prolonged convulsions. They may also vary  from less than one a year to several per day.


Seizures are classified :

1.Partial or focal seizures
These seizures arise from an electric discharge of one or more localised areas of the brain regardless of whether the seizure is secondarily generalized.

They may or may not impair consciousness. Whether seizures are partial or focal, they begin in a localized area of the brain, but then may spread to the whole brain causing a generalized seizure.

2.Generalized seizures
Generalized electrical discharge involves the whole brain and may cause loss of consciousness and/or muscle contractions or stiffness. They include what used to be known as "grand mal" convulsion and also the brief "petit mal" absence of consciousness.

3.Status epilepticus
This is a state in which a person has frequent seizures without recovery of consciousness between each episode. It is a dangerous state and if not treated may lead to brain damage or death.

In 70% of cases the cause is unknown.


In such cases, the theory most commonly accepted is that this epilepsy is the result of an imbalance of certain chemicals in the brain (especially chemical messengers known as neurotransmitters) causing them to have a low convulsive threshold.


Epilepsy of unknown or genetic origin are present in children and adolescents.

In the remaining cases, the causes can be found and some may be treated.

1. Brain infection can cause epilepsy at any age.

Neurocysticercosis cysts on the brain caused by tapeworm infection, malaria and meningitis are common causes.


2. Febrile illness of any kind can trigger seizures in young children. About 3% of children who have febrile convulsions go on to develop epilepsy in later life.


3. Stroke may damage brain cells resulting in seizures.


4. Trauma and head injury may damage brain cells resulting in seizures.


5. Certain flashing lights (discos, television, video games etc.), over-breathing, over-hydration, loss of sleep, and/or emotional and physical stress, may stimulate seizures.


Although these are not causes of epilepsy, they may influence the timing and frequency of seizures.

Epilepsy occurs in men and women and can begin at any age, but is most frequently diagnosed in infancy, childhood, adolescence and old age.
Anyone can be affected by seizures.



Symptoms varies depending on the part of the brain which is functioning abnormally.

Generalized Fits
There are several types of generalized fits.
In the classical Grand mal fit,
there is a sudden loss of consciousness and the person fall to the ground.
The eyes may roll up.
There is body stiffening and shaking movements.
The tongue may be bitten and
the urine passed out due to loss of bladder control.
After the fit the body relaxes and the patient may fall into a sleep for several hours.

Partial or focal Fit
There are also many types of partial fits.
In a partial fit , There may be changes to the way the person looks at things,feels, smells or taste. In other cases there may be staring and unusual movement like hand rubbing etc.

Investigations for Epilepsy are
1. blood tests


2. MRI of brain


3.EEG of brain which measures the brain electrical waves

Treatment of Epilepsy is by:
Recent studies in both developed and developing countries have shown that up to 70% of newly diagnosed children and adults with epilepsy can be successfully treated (i.e, their seizures can be completely controlled for several years) with anti-epileptic drugs.

After 2-5 years of successful treatment, drugs can be withdrawn in about 70% of children and 60% of adults without relapses.

Drugs used are:
phenytoin
carbamazepine
sodium valproate

Surgery may be considered if medicines does not work.


Up to 30% of people may not respond to drug therapy.

A factor which leads to worse prognosis is the presence of an underlying brain disease.


Partial seizures, especially if associated with a brain disease, are more difficult to control than generalized seizures.


Secondary seizures- not epilepsy- such as those related to an acute, short-lasting brain disease, may run a self-limiting course.

However, a significant proportion of people will develop established epilepsy.


For economic and social reasons, 3 out of 4 people with epilepsy do not receive treatment at all.

Most of these people live in developing countries.

Epilepsy is associated with an increased risk of mortality.

Death may be related to:
1.An underlying brain disease, such as a tumor or infection;


2.Seizures in dangerous circumstances, leading to drowning, burns or head injury, for example;


3.Status epilepticus;


4.Sudden and unexplained causes, or a possible respiratory or cardio-respiratory arrest during a seizure;


5.Suicide.