Epilepsy Related Questions and Answers

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This is a common serious but treatable neurological disorder of the brain. It is characterised by recurrent unprovoked epileptic siezure which are due to an abnormal synchronised electrical discharge by neurons (or brain cells) in the brain. Epilepsy is not contagious.

Any abnormal electrical discharge in the brain can cause disruption to the processes in the brain and cause abnormal functioning. This is what happens during an epileptic seizure which can be likened to an electrical brainstorm. When it occurs, it can prevent the brain from interpreting and processing incoming sensory signals and controlling muscle movement. The intensity of a seizure varies from person to person and if severe or prolonged, can damage the brain.

Who are at risk?

Epilepsy may affect 4 to 12 out of every 1,000 people. It can affect anyone, at any time and at any age. It has no geographical, racial or social class boundaries. Although a specific cause can be identified in 30 per cent to 40 per cent of patients with epilepsy, most patients with epilepsy have no definite cause.

Some of the known causes of epilepsy include:

severe head injury
infections that affect the brain
hereditary diseases affecting the brain
tumours, scars or strokes in the brain
perinatal or intrauterine infections or strokes
abnormal brain malformations

What are the symptoms?

Signs and symptoms may vary depending on the type of seizures. A seizure may present itself in many forms. It may sometimes manifest itself stare, an unusual movement of the body, alteration in awareness, muscle spasms or convulsions.

Most people with epilepsy experience the same type of seizure, with similar symptoms, each time they have a seizure, but others may experience a wide range of types and symptoms. However, a single seizure does not constitute epilepsy. Only when seizures occur unprovoked and recurrently, the patient is said to be suffering from epilepsy.

The duration of a seizure may range from a few seconds to a few minutes. The number of seizures may also vary from person to person, from a rare few per year to several a day.

Seizures may be divided into five types:

tonic-clonic seizures - these seizures involve the entire body and are usually characterised by violent and rhythmic movements
myoclonic seizures - these seizures are fast movements and short contractions of bodily muscles, which usually happen at the same time on both sides of the body
absence seizures - these seizures cause loss of awareness, usually with staring episodes that start and end quickly, lasting only a few seconds
simple partial seizures - these seizures cause no loss of consciousness
complex partial seizures - during these seizures, patients do not know what's happening and cannot recollect afterwards what happened during the seizure

How is it diagnosed?

Your doctor will review your personal and family medical history, description of seizure activity and conduct various physical and neurological examinations to rule out conditions that cause symptoms that may resemble epilepsy or may provoke seizures. These other conditions include transient ischemic attacks (TIA), fainting (syncope) and sleep attacks (narcolepsy) among others.

Neurological testing would include an electroencephalogram (EEG) to record the electrical activity in the brain. Brain imaging utilising Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) may be performed to detect structural abnormalities in the brain if indicated.

How is it treated?

Medications

There are many types of medications available to treat epileptic seizures. When the diagnosis of epilepsy and the epilepsy syndrome are established, anti-epileptic medication is prescribed according to the particular syndrome. Between 60-70 per cent of epileptic patients respond to medication and have their seizures controlled. Some may require only one type of medication while others may require more.

Procedures

Where epileptic seizures cannot be controlled by medication alone, surgery may be considered. Patients first have to undergo pre-surgical evaluation to assess if their condition would benefit from surgery.

This often includes a video-electrographic (video-EEG) evaluation where patients are admitted to a specialised tertiary setting and have their seizures recorded real-time on video with electrographic correlation. This aids in the determination of surgical suitability and helps in the planning of the surgery itself.

Other evaluative procedures, including those aimed at determining eloquent brain regions, neuropsychological and psychiatric assessments, are also essential pre-surgical considerations.

Surgery in properly selected patients with epilepsy will yield a higher chance of controlling seizures and even of curing epilepsy.

Vagus nerve stimulation is another available treatment for patients whose seizures are not optimally controlled by or who have intolerable side effects from medications. This is a device, implanted beneath the skin just under the collarbone, with electrodes (electrical wires with contacts) leading to a nerve in the neck.

The device emits a small amount of electrical signals intermittently through this nerve to modulate impulses from the brain.

Patients with epilepsy do have varied treatment options and even opportunity for cure. Proper assessment and management by trained professionals may help patients improve their quality of life.n

The author is the Head, Neurosurgery, National Healthcare Group's Alexandra Hospital and National University Hospital.

Submitted By:
DR CHOU NING

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