Epilepsy

About Epilepsy

Mission and Vision

What is epilepsy?
Epilepsy is a neurological disorder (and NOT a mental illness) due to a sudden burst of abnormal electrical discharges from the brain.

How common is epilepsy? Why am I so unfortunate?
Epilepsy is a fairly common condition affecting nearly 1% of the population which means in our country with one billion population there are at least 10 million patients. As no one wants to speak about their illness with the result, everyone thinks that he is the only unfortunate victim. The history of epilepsy is always concealed as compared to situations like heart attacks which is discussed freely even at cocktail parties.

Is it hereditary?
In a large majority of patients, it is NOT hereditary. Only in certain types of epilepsies, the ability to develop epilepsy is inherited to an extent of 2-4%, which, means a great majority do not have hereditary factors. This is one of the greatest myths in epilepsy.

Is epilepsy common in certain groups only?
Epilepsy is universal if affects all ages both sexes, developed and developing countries, rich or poor literate or illiterate

What is the difference between convulsions, fits, and epilepsy?
Convulsions/fits are involuntary to and fro movements (tonic-clonic) movements of limbs associated with loss of consciousness. Several situations can cause convulsions e.g. patients with kidney failure, liver failure, alcohol intoxication, brain hemorrhage - all these are not epilepsy. These are the manifestation of an underlying disorder. In epilepsy, there is no such obvious illness and the person is active and normal in-between the attacks of epilepsy

Is epilepsy preventable?
Yes some extent, though in a great majority the cause for epilepsy is not known certain conditions like head injury, stroke, brain infection/meningitis encephalitis which contribute to epilepsy are preventable.

What is the difference between seizure and epilepsy?
All seizures are not epilepsy for eg. Seizures can be seen in a variety of disorders like low blood glucose, high fever, liver-kidney failure, alcoholic withdrawal, etc. These are not epilepsy.

Does seizures cause brain damage?
Certainly not, it is the other way round that brain damage ( e.g. Head injury, brain fever, or cerebral palsy ) can cause epilepsy.

How do you diagnose epilepsy?
Epilepsy is diagnosed by obtaining a careful and detailed medical history from the person who has witnessed the attack. It is important to note that none of the investigations by themselves diagnose epilepsy. Scalp EEG and Video EEG aid in the diagnosis.

Is there a cure for epilepsy?
Epilepsy is certainly an eminently treatable condition. Nearly 80% can be easily controlled by the use of standard antiepileptic drugs and in the great majority can go off the drugs after a variable seizure-free period of 2 to 5 yrs.

What are the different type’s treatments available for managing epilepsy?
Epilepsy can be treated by

• Medical: Antiepileptic drugs
  Surgery
  Others: Vagal nerve stimulation

What are the trigger Factors in Epilepsy?
Triggering factors in epilepsy are:

• Lack of sleep
  Missed dosage of tablets
  Alcohol intoxication
  Absolute fasting

Are there any drugs in other systems of medicines - Ayurveda / Homeopathy / Unani etc?
Specialists from other systems of medicine claim that their system has safer medicines to treat epilepsy. Since we do not have knowledge about these systems of medicine and there are no convincing clinical trials to validate the effectiveness.

Is there a surgical treatment for epilepsy?
Surgery is another method of treatment for certain types of epilepsy. Patients, who continue to get epileptic seizure despite regular use of two AEDs, need to be evaluated for surgical method of treatment. Surgical treatment requires elaborate evaluation by a trained team of experts in this area.

Is there a surgical treatment for epilepsy?
Surgery is another method of treatment for certain types of epilepsy. Patients, who continue to get epileptic seizure despite regular use of two AEDs, need to be evaluated for surgical method of treatment.

Array of modalities in pre-surgical evaluation

• Scalp, video & intracranial EEG
• Structural volumetric MRI
  DTI, perfusion and functional MRI
  PET; SPECT
  MEG
• What is Video EEG?
• The Video EEG Monitoring Test is a more specialized form of an EEG test in which the patient is constantly monitored over a video screen. This allows doctors to observe brainwave activity during the time, a seizure or spell is occurring.
• How does it help in the management?
• It helps to diagnose episodic events (those which happen from time to time) like epileptic seizures, fainting or black-out spells. It helps in identification of origin of seizure in case of presurgical evaluation.
• Will the medications be reduced or stopped altogether?
• The treating doctor will decide about reducing your medication, if medication is to be reduced , it will be done slowly and not altogether.
• Is there a risk of seizure?
• VEEG will be done for the purpose of recording a few of your habitual seizures in order to characterize of events and to ascertain the origin of seizure.
• What are the benefits of VEEG
• It allows the doctor to determine whether events with unusual features are epileptic seizures, the type of epileptic seizure, and the region of the brain from which the seizures arise
• What is likely duration of the procedure?
• The duration may  be a day or prolonged (up to seven days) depending upon the amount of information required.  
• What to Expect during the VEEG monitoring?
• The patient should also bring reading materials and other things (laptop, videogames ) to keep themselves busy, as a prolonged hospital stay for monitoring can be boring. Patients are expected to be fairly confined to the room (either in the bed or a chair), as they should be on camera at all possible times and will only have a limited extension of cord that allows them to use the restroom in private.

What are indicators of surgery?

• Medically intractable seizures
  Inability to tolerate an effective antiepileptic drug
  Impairment of quality of life due to ongoing seizures

Surgically remediable lesional epilepsy syndromes
Mesial temporal sclerosis

• Benign neoplasms - Ganglioglioma , DNET, Low grade astrocytoma, Oligodendroglioma , Developmental Lesions
  Vascular malformations, Cortical scars
  Miscellaneous- Rasmussen’s encephalitis, Cortical Dysplasias

Types of epilepsy surgeries
Curative

• Anterior temporal lobectomy
  Selective Amygdalo Hippocampectomy
  Lesionectomy
  Focal corticectomy

Major resections- Hemispherectomy, Multilobar resection
Palliative- Callosotomy, Multiple subpial transactions (MST), Vagal nerve stimulation (VNS)

Can surgery cure epilepsy?
Some forms of epilepsy can be completely cured by surgery eg. If there is a known abnormality in the brain responsible for epilepsy, removal of such lesion can completely cure epilepsy. In certain other types of surgery frequency of seizures could be significantly reduced if not completely stopped.
Comprehensive epilepsy care is a Team work

Epilepsy and Marriage
Should I conceal the fact that I have epilepsy from my fiancée and his/her family members?
Honest perspective communication about epilepsy is important for nurturing a fruitful married life. It is evident from our experience that concealing epilepsy would, in all probability, have long-term disastrous consequences on married life. Though disclosure is not entirely without its problems (because it often results in breakup of marriage negotiations), It may be especially important to tell your fiancée about your epilepsy so that there won't be any unexpected surprises or disappointments in future life. Keep a positive attitude about yourself and epilepsy, and he/she probably will, too. If you desire, we can provide realistic information to the prospective spouse and his/her family about the medical and social aspects of epilepsy. Being employed is important for a woman with epilepsy as it makes her less dependent on the spouse and family on money matters, and more confident in making independent decisions. . One's belief in one's capabilities is highly essential. The more the woman and her parents view her disease as a stigma, the more they anticipate negative consequences of disclosure, and concealment becomes their coping strategy

Epilepsy and Pregnancy
AS I am on anti-epileptic drugs, is there a risk of my child developing any problems? Can I reduce the dose of medicines? Do I need to undergo an abortion? Will my seizures worsen in pregnancy?
Most women with epilepsy would have safe pregnancies and healthy children. The risk of birth defects in the baby is around 2 to 3 per hundred births, in the general population (ie. mostly women without epilepsy). In the case of women with epilepsy, the risk is around 7 - 8 per 100 births. In other words, in more than 90 percent of cases the babies are healthy and the pregnancy is without any complications Whatever be the cause of the malformations, they do not occur often enough to support avoiding or terminating a pregnancy. However, if a 4-8% risk of having a child with a malformation is unacceptable to you, it is important that you make the decision that's best for you. Do remember that there are prenatal diagnostic tests that can detect these malformations within the first twelve weeks of pregnancy. The decision to do these tests should be made in consultation with your doctor. The physician can also decide what minimum dose of drugs you need to be on.
Stillbirths or miscarriages are also slightly more common for women who have epilepsy, occurring in 1.7 percent of pregnancies. The blood levels of the drugs you take can be altered in relation to the normal changes that happen to the body during pregnancy. Do not attempt to alter the doses of the medicines without consulting your doctor as the recurrence of seizures can harm the baby as well as yourself