Epilepsy is one of the oldest conditions known to mankind and affects people in every country of the world including Anguilla. It is one of the most common neurological disorders affecting any defined population and it is estimated that up to 5% of people in the world may have at least one seizure in their lives. Epilepsy can have profound social, physical and psychological consequences.

What is epilepsy?
Epilepsy is a neurological disorder that is characterized by a tendency to have recurrent seizures and is defined by two or more unprovoked seizures.

Seizures are the result of sudden, usually brief, excessive electrical discharges in a group of brain cells (neurons). Different parts of the brain can be the site of such discharges.

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

It is unclear why particular seizures occur at a particular age or time and not at other ages or times. Various factors might influence the timing and frequency of seizures although these do not cause seizures. Such factors include the following: certain flashing lights (discos, TV, video games), over-breathing, over-hydration, loss of sleep, and or emotional and physical stress.
Types of seizures
Seizures are classified according to where in the brain they arise.

Partial or focal seizures arise from an electrical discharge in one or more localised areas of the brain.

Generalized seizures - The discharge which leads to these seizures involves the whole brain and may cause loss of consciousness and /or muscle contractions or stiffness. To the observer, the person experiencing such a generalized seizure may cry out or make some sound, stiffen for some seconds, then have rhythmic movements of the arms and legs. Often the rhythmic movements slow before stopping. Eyes are generally open.The person may not appear to be breathing. The person is often breathing deeply after an episode.The return to consciousness is gradual and should occur within a few moments. Loss of urine is common.Often people will be confused briefly after a generalized seizure.

Status epilepticus - This is defined as 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.

What causes epilepsy?
Approximately 65% of people newly diagnosed with epilepsy have no obvious cause.

Epilepsy is often, but not always, the result of an underlying brain disease. Any type of brain disease can cause epilepsy. But not all people with the same brain disease will have epilepsy. In the many people for whom the cause cannot be identified, the theory most commonly accepted is that this epilepsy is the result of an imbalance of certain chemicals in the brain.

Children and adolescents are more likely to have epilepsy of unknown or genetic origin. The older the patient, the more likely it is that the cause is an underlying brain disease such as a brain tumour or cerebrovascular disease (for instance a stroke), or is the result of head injury.

Trauma and brain infection can cause epilepsy at any age.

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.

How is epilepsy treated?
It is estimated 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.

The type of treatment prescribed will depend on several factors including the type of epilepsy, the frequency and severity of the seizures, age, overall health and medical history. An accurate diagnosis of the type of epilepsy (not just the type of seizure, since most seizure types occur in different types of epilepsy) is critical to choosing the best treatment.

After 2-5 years of successful treatment, drugs can be withdrawn in about 70% of children and 60% of adults without relapses. Up to 30% of people may not respond to drug therapy.

What are the side effects of epilepsy medications?
As is true of all drugs, the drugs used to treat epilepsy have side effects. The occurrence of side effects depends on the dose, type of medication, and length of treatment. The side effects worsen with higher doses but tend to be less severe with time as the body adjusts to the medication. Anti-epileptic drugs are usually started at lower doses and increased gradually to make this adjustment easier.Side effects of epilepsy drugs can include blurry or double vision, fatigue, sleepiness, unsteadiness, stomach upset, skin rashes, low blood cell counts, liver problems, swelling of the gums, hair loss, weight gain and tremor.

What precautions should pregnant women take?
Women who have seizures can have healthy children, provided they receive good prenatal care. It is very important that women who have epilepsy discuss pregnancy with their doctors before getting pregnant.

Many seizure medications can prevent birth control pills from working effectively, which may lead to unplanned pregnancy. If pregnancy occurs unexpectedly, women should not discontinue their seizure medication without first consulting with their doctors. Abruptly discontinuing seizure medication commonly leads to more frequent seizures which can harm the baby.

Epilepsy and driving
Individuals with uncontrolled seizures have a higher risk of an accident if they drive. That is why doctors advise patients with seizures that they should not drive until their seizures are under reasonable control. If a well-controlled patient has a seizure after the doctor changes the medication, the patient may or may not be able to continue driving.

Helpful tips if you have epilepsy
Always carry medical identification. If an emergency occurs, knowledge of your seizure disorder can help the people around you maintain your safety and provide the appropriate treatment.

Make sure your family, friends and co-workers know what to do if you have a seizure.
Avoid potential dangers of high places or moving machinery at home, school or work if you have active seizures. Though there is less risk if your seizures are under control, your attention should focus on the specific risks of certain activities (such as mowing, working around farm machinery, hot appliances, etc.).

It is important for you to remain active, but participate in sports and other activities with caution. Avoid potentially dangerous activities such as bathing and swimming. Have another person with you who knows your seizure risk and is trained in life-saving techniques. Activities such as bike riding can be made safer by wearing helmets.

If you are prescribed anticonvulsant medication, do not suddenly stop taking it or change the dosage without consulting your doctor. The type of anticonvulsant medication you are prescribed depends on the type of epilepsy you have, and the dose that is prescribed especially for you according to your weight, age, gender and other factors.

Be alert to the risks of possible drug interactions between your anticonvulsant medications and other medications you may take, including over-the-counter drugs. Always call your doctor if you are not sure what interactions could occur before taking any medication.

Avoid alcohol, as it can interfere with the effectiveness of your medication.

What Should I Do for a Person Who Has a Seizure?
If someone is having a seizure:
Loosen clothing around the person’s neck.
Do not try to hold the person down or restrain him or her. This can result in injury.
Do not insert any objects in the person’s mouth. This can also cause injury.
Reassure bystanders who may be panicking and ask them to give the person room.

Remove sharp objects (glasses, furniture and other objects) from around the person to prevent injury.

After the seizure, it is helpful to lay the person on his or her side to maintain an open airway and prevent him or her from inhaling any secretions.

After many seizures, there may be confusion for a period of time and the person should not be left alone.

If the seizure lasts longer than 5 minutes, or if another seizure begins soon after the first, or if the person cannot be awakened after the movements have stopped, an ambulance should be called. If you are concerned that something else may be wrong, or the person has another medical condition such as heart disease or diabetes, you should contact a doctor immediately.

Conclusion
Epilepsy is a common neurogical disorder that has been described many centuries ago. A few misinformed indidivduals still feel that a person with a seizure is seized by a supernatural force or power. The vast majority of individuals with epilepsy can have their seizures controlled with medictions, but many persons fail to seek medical attention and thus do not benefit from medication. Once the seizures are controlled indivduals with epilepsy can live productive lives.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. Dr. Brett Hodge is an obstetrician/gynaecologist and family doctor who has over twenty years in clinical practice. Dr. Hodge has a medical practice in the Johnson Building in The Valley.

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