Guide

A diagnosis is often made during an emergency visit (because of a seizure) to the doctor. Sometimes the person may be seeking help for a previous episode of a seizure or a suspected seizure. The doctor generally takes a complete history of the patient, including a history of the seizures (either from the patient or the parent). Even a simple thing like how the patient wipes his/her nose can help a trained professional to make an accurate judgement as to where the origin of the seizure is located in the brain.

While diagnosing a patient for epilepsy, a doctor first and foremost tries to rule out any short-term causes like alcohol withdrawal, infections, head-injuries, drug abuse etc.

Next, a very widely used (though not the most sensitive) diagnostic tool - the electroencephalogram (EEG) is employed. Routine EEG may sometimes not be adequate to reliably prove or disprove the diagnosis of epilepsy. In which case the doctor may require confirmations with brain scans (CT Scan) or other advanced imaging techniques like the Magnetic Resonance Imaging (MRI) or Positron Emission Tomography (PET). These images are used to determine the nature of the disorder, or scarred locations in the brain where from partial seizures are triggered.

Future course of treatment may depend on these findings.

TREATMENT

Treatment and managing epilepsy is the job of a highly trained professional. Treatment of epilepsy is 'person specific'. Which means, treatment of epilepsy will differ from person to person.

Good news is that all kinds of seizures are treatable and 90% of people respond well to medication.

The group of medicines that are used to treat epilepsy are called anticonvulsants. Some of the more frequently used (or front-line) drugs are carbamazepine, phenytoin, valproate, phenobarbital, ethosuximide and clonezepam. Most treatments start with a single medicine.

The doctor needs to monitor the drug and the dosage depending on its efficacy and side-effects. The doctor aims to achieve the best balance. That is, maximum seizure control with minimal side-effects.

In case the seizures are not effectively controlled then the doctor may prescribe a combination of drugs. But in cases where even the combination does not produce the desired result, the doctor may move to what are called the second-line drugs like gabapentin, lamotrigine, topiramate, vigbatrin. Finally even some hormonal treatment may have to be administered.

(ALL VISITORS TO THIS SITE ARE CAUTIONED, NOT TO ATTEMPT ANYSELF-MEDICATION OR CHANGE OF MEDICINE/DOSAGE WITHOUT CONSULTING THEIR DOCTOR)

Beside proper medication, regular food habits and sleep habits also help in reducing the seizures.

LIVING WITH EPILEPSY

Childhood And Epilepsy

To diagnose a epilepsy syndrome, a doctor usually proceeds along the following lines :

• Thorough history of age of onset
• Developmental milestones
• Congenital malformations
• Abnormal movements etc
  

This list is merely indicative and far from exhaustive. However, once a child is found to have epilepsy, with proper medications :

• It is critical to encourage a child with epilepsy to learn to live with it like an essential nuisance.
• The child should be told that having epilepsy is neither shameful nor something extraordinary.
• Other children would not be harmed in any way.
• If a child is having problems at school (academic or social) the teacher must be requested to help.
• It is essential for the self-esteem of the child to be involved in most of the normal activities in the school. Including sports.

The child should participate without restrictions in most of the activities, in the same manner as a child without epilepsy. However, it is advisable for children with epilepsy, not to go for unaccompanied swims or ride bicycles in traffic conditions. Not for any other reason but to prevent the child from being exposed to unnecessary and potentially dangerous situations.

Adult & Elderly

Epilepsy in adults is not very different from the one in childhood. In fact about 70% of adult epilesies have their onset in the paediatric (children) age group.

Therefore while most of the signs & symptoms would be the same as mentioned elsewhere, some new causes may get added for example, brain tuberculosis, head injuries, brain tumours, lack of sugar in blood, use of intoxicants, insomnia (sleeplessness), glaring lights, watching TV for long hours etc.

Marriage And Motherhood

Contrary to popular belief, myth, practice, epilepsy is not a deterrent to a happy married life.
However 'motherhood' needs to be properly planned and discussed with the doctor. The doctor will want to either change the medication or alter the dosage during the days of conception and during the different stages of pregnancy so as to minimise the effect of the medicine of the developing foetus.

In fact most women have no change either in the frequency of seizures nor in their intensity during pregnancy. 90% of women who are on anti-convulsant medicines during their pregnancy deliver perfectly healthy babies.

Like a planned pregnancy, a nursing mother on anti-convulsant medicines should consult with the doctor. These drugs are known to be secreted to the baby during breast feeding and may cause drowsiness in the infant. Cases are rare when the doctor may advise an epileptic women not to have a child.

Life - Style Adjustment

Coming To Terms : While epilepsy is a medical problem, the first challenge is the acceptance of its diagnosis. Often, people refuse to accept and admit the same. They may even hold the doctor responsible for wrong diagnosis. But with information and support, most develop a positive attitude towards their condition. Some of these problems become simpler to handle when the newly diagnosed epileptic discusses the condition with friends and relatives.

Activities best avoided : It is a commonly accepted fact that medicines are very useful in seizure control and epileptics lead a normal life. However certain activities are best avoided. For example, not to drive a motor car till the completion of at least one year from the last epileptic episode. Or avoid swimming alone or ride a cycle in traffic.

Even in terms of their job, a little caution would help. Avoid jobs where dangerous machines are involved and the job also requires intense concentration over long periods of time. Or again places where machines tend to heat the surrounding atmosphere.