First Glance

Ans. Food

No. In very rare cases there may be some substance in the diet which provokes seizures and this may be looked for by dietary manipulation.

A ketogenic diet (a high-fat diet) is used as a form of treatment for a small group of children with resistant seizures.

Very rarely, the epilepsy may be associated with an inborn error of metabolism, in which case certain substances may have to be omitted or added ( e.g. pyridoxine-dependent seizures in infants).

In rare cases, eating or drinking may precipitate a seizure- this is called reflex epilepsy.

Drink

Non-alcoholic - No.

Alcoholic - Alcohol in large amounts can trigger a seizure, as can its withdrawal. The maximum safe daily amounts is two small measures of spirits. Alcohol is known to interfere with antiepileptic drugs to reduce their effectiveness. Thus the alcohol should be omitted, not the antiepileptic drug. An occasional modest drink can be taken. Lack of sleep plus alcohol can also interact to produce a seizure. Stress, worry and anxiety, if excessive, may precipitate seizures.

2. What are the factors which make it less likely that seizures will stop?

Ans. For both adults and children

• Epilepsy initially difficult to control
• More than one drug needed.
• Structural brain damage and abnormal neurological signs.
• Bouts of status epilepticus.
• Myoclonic (jerks) or atonic (drop) seizures

Additional factors for poor outlook in children :

• Associated cerebral palsy or mental retardation.
• Seizures start early -before age 2.

Factors carrying a good outlook

• Epilepsy starts between the ages of 5 and 13 years.
• Particular epilepsy syndromes that have a good outlook -petit mal epilepsy - benign partial epilepsy with centrotemporal spikes on EEG.
• No identified cause.
• Strong family history.
• No neurological signs on examination.
• Seizures easily controlled.
• Only one drug necessary.

3. What factors make it more likely that seizures will recur after treatment has been stopped?

Ans..

• Age greater than 16 years at the onset of seizures
• H/O seizures after treatment started
• Tonic-clonic seizures
• Myoclonic seizures
• An abnormal EEG, but only in children. Particularly the presence of spike and wave discharges.

Note : Decision to start treatment after a single seizure and to stop treatment in partnership with the patient. Situations in which a decision whether to continue treatment needs to be carefully considered are occupations where another seizure may be hazardous, such as driving, and proposed pregnancy when the future mother may wish to discontinue treatment.

4. Is it possible to stop a seizure after it begins? Can I stop my own seizure?

Ans. After the aura, some people can stop a seizure by biofeedback, mental relaxation or concentrating on something else.

5. Can I have a seizure while making love?

Ans. Yes. However, seizure are less likely to occur during pleasurable activity. There is no danger to the other person. If the other partner is unaware of epilepsy it will be a surprise.

6. Can epilepsy affect my sexual life?

Ans. Generally, it should not. Anxiety about having a seizure when with someone of the opposite sex may result in a decline in sexuality. Patients with temporal lobe seizures may have reduced libido and potency. Antiepileptic drugs, particularly primidone and phenobarbitone may result in a loss of libido, but this is uncommon, and is more likely to happen because of psychological factors. Antiepileptic drugs, except sodium valproate, reduce the effectiveness of oral contraceptive drugs and may result in an unwanted pregnancy.

7. Can lack of sleep bring on seizures?

Ans. Yes. Lack of sleep alters cerebral electrical activity and may precipitate seizures. This could particularly affect students who stay up late to study before an important examination and who omit to take their tablets because they think the tables make them drowsy.

8. Can I harm anyone during a seizure?

Ans. Unusual. Rarely, in complex partial seizures with postical automatism.

9. Can menstruation produce seizures?

Ans. Yes. In some women seizures occur mainly in the premenstrual period. They may be due to fluid retention and are possibly helped by diuretics. e.g. Diamox (acetazolamide) 250 mg b.d. commencing a few days before the menstrual period.

10. Can epilepsy pass from me to my children?

Ans. If the patient has partial seizures, transmissions is highly unlikely. If the prospective parent has primary generalized epilepsy, one child in six will have definite seizures. The chances of this being a significant problem are no more than 5% .

11. I want to have a baby. How will my epilepsy affect the pregnancy?

Ans. Having epilepsy is no bar to pregnancy. 7-10% of women who have epilepsy and are taking antiepileptic drugs will have a baby with some congenital abnormality. This figure is3-5% greater than the risk in the general population. This also means 90-93% of women with epilepsy will have normal babies, compared with 95-97% of women without epilepsy having a normal baby. The abnormalities that occur are usually minor, such as cleft lip or palate, small fingernails and toenails. Phenytoin and phenobarbitone have usually been thought to be responsible for these. Sometimes antiepileptic drugs cause more serious abnormalities, such as congenital heart disease and spina bifida. Patients taking sodium valproate have a 1-2% risk of having a baby with spina bifida. Those taking carbamazepine have a smaller risk. Withdrawal of antiepileptic drugs from a woman needing them to control her seizures is more dangerous to the mother and baby than taking the drugs, as a generalized seizure can result in severe hypoxia to the baby with possible death or permanent damage. The mother may go into status epilepticus. Antiepileptic drugs should never be withdrawn from a woman who is already pregnant.

To minimize risks, the following steps should be taken :

• Assess first whether the woman needs antiepileptic treatment, well before conception is planned.
• Use monotherapy of the lowest effective dose.
• Give 5 mg folic acid daily to any woman who is likely to become pregnant. It is thought to reduce the risk of neural tube defects.
• Early monitoring of pregnancy with serum µ-feto protein estimation and detailed ultrasound of the foetus. Look particularly for neural tube defects and cardiac abnormalities.
• Vitamin K should be given to the baby as antiepileptic drugs can cause bleeding disorders. The effect of pregnancy on epilepsy is to worsen seizures in one-third of women with epilepsy. This is largely because pregnancy alters body fluid balance and serum protein levels which in turn affect the pharmacokinetics of the antiepileptic drugs. To overcome this problem there should be more frequent clinical follow-ups and drug level monitoring.

12. Can I breast feed my baby?

Ans. Yes. Antiepileptic drugs are secreted in breast milk, but to a very small extent only and it is quite safe to breast feed. If the mother takes phenobarbitone, after delivery, the baby's level of serum phenobarbitone will drop and the baby can become jittery and irritable for a few days. If breast feedings is started early, the small amount of phenobarbitone in the breast milk reduce these effects.

13. Can I drive my car to work? It is only a short distance, the roads are empty and there is no public transport.
      I have no other skills. My wife and our three children depend upon me for support. Can I drive?

Ans. The inability to drive is a great handicap in terms of social mobility and earning capacity for those whose occupation involves driving. The law does not take hardship into account. If a seizure occurs while someone is driving, he places himself and others at risk of injury or death. In one study, 55% of seizures that occurred while driving led to an accident. In India, someone who has epilepsy is banned from driving for life. In the UK, seizure free patients are allowed to drive only a light motor vehicle after one year from the date of the last seizure, irrespective of whether they continue to take treatment or not. However, it seems sensible for people who are free of seizures to continue to take treatment if they wish to drive. In UK, another category of patients permitted to drive, is those who have had seizure only during sleep. All types of seizures during the day, are included in the one-year rule i.e. absence seizures, complex partial seizures, seizures with a prolonged warning, even Myoclonic jerks.

14. Should I tell a present/future employer that I have epilepsy?

Ans. It is better and desirable to be frank and tell the employer. The reality is that employer probably will not take someone with epilepsy and the chance of dismissal if already employed is quite high. Patients with well-controlled seizures do not inform their employers. Only education can improve the situation.

15. We wish to get our daughter, who has epilepsy, married. Should we tell her future husband?

Ans. If you do not tell her future husband about your daughter's epilepsy when he or his family discover it later, under the Hindu Marriage Act, the marriage can be annulled. Even if it is not annulled, the relationship can be spoiled. You must consider these harsh facts before you decide to conceal her epilepsy. N.B. The petition to delete epilepsy from the Hindu Marriage Act was presented by the IEA to the Supreme Court. However, the Government of India said, they did not wish to defend it. We are hoping for more good news soon.