Epilepsy

Symptoms: Loss of awareness or consciousness, stiff muscles, state of temporary confusion, involuntary jerking movements in the arms and legs, loss of bladder control, respiratory problems, uncontrollable staring

Causes: Chemical or metabolic imbalances, birth trauma, infection, substance abuse, genetics, drug withdrawals, brain tumour, certain medications

Risk factors: Dementia, ageing, head injuries, vascular diseases, meningitis and other brain infections, family history of epilepsy.

Severity: Mild to high (depending on the type of epilepsy)

Which doctor to consult: Neurologist

Overview

Epilepsy is a neurological disorder that is responsible for causing recurrent seizures. These unprovoked seizures can occur at any time and place. In epilepsy, the patient’s brain activity fluctuates, causing extended periods of loss of awareness, sensations and unusual behaviour.

The seizures occur due to abnormal electrical discharges in a particular group of brain cells and this showcases different symptoms in each individual. For instance, some patients stare blankly at one specific spot during a seizure. Others may have involuntary and severe jerking of arms and legs while the episode lasts.

However, the presence of seizures does not indicate epilepsy. Seizures can be caused due to a variety of reasons like irregular sodium levels in the blood, brain injury during childbirth or electric shocks. For an epilepsy diagnosis, patients must have at least two unprovoked seizures in a span of 24 hours.

Although epilepsy is life-threatening in some instances, it can be combated with medication and surgery. These can help moderate seizures and reduce their frequency. Some patients might also require lifelong medication to control the condition. For others, epilepsy can go away with age.

When to Consult a Doctor?

If left untreated, epilepsy can result in bodily injuries, social disability and psychiatric impairment. It can also lead to irreversible brain damage. Hence, it is vital to consult a neurologist in the following cases:

• On the onset of physical symptoms:  Symptoms like abnormal body movements, slurred speech, restlessness, or sudden allergic reactions can point to epilepsy. If already diagnosed, patients must visit the doctor if the number of seizures increases or there is a noticeable loss in controlling the seizures.
• Psychological conditions: If patients are suddenly experiencing increased fear, anxiety or déjà vu, it could be a sign of epilepsy. During epilepsy, the area of the brain controlling emotions may not work as intended, resulting in these issues.
• Sudden memory problems: The condition of epilepsy impacts a patient’s ability to recollect events from declarative memory. Patients cannot process events consciously due to specific groups of brain cells getting affected.

Diagnosis

• Blood test: Doctors can diagnose the initial stage of epilepsy through a blood test to detect infections and genetic abnormalities. The blood test also aims to check for iron deficiency anaemia and diabetes.
• Neurological examination: It is a physical examination where the doctor assesses the patient’s mannerisms and other factors like language, eye and facial movements, and thinking capability.

Diagnostic Tests

• Electroencephalogram (EEG): The primary purpose of an EEG is to record brain activity through electrical signals. It achieves this by attaching electrodes to the scalp. If the readings showcase a change in routine brain activity, the doctor may confirm an epilepsy diagnosis and rule out other reasons for seizures.
• High-density EEG: While doctors usually employ traditional EEG to detect epilepsy, high-density EEG is a more accurate process. The electrodes are attached closer to each other on the scalp during this test. As a result, they provide more precise readings about the parts of the brain causing epileptic seizures.
• Magnetic Resource Imaging (MRI): Using an MRI, doctors can view and study a detailed structure of the brain. MRI uses strong magnets and radio waves to showcase a clear structure of the brain. It allows the doctors to weed out the abnormalities in the brain causing the seizures.
• Computerised Tomography (CT) scan: CT scans use x-ray imaging to acquire a cross-sectional view of the brain. These are easier-to-inspect images, allowing doctors to check for anomalies in the brain and classify the nature of epilepsy.
• Positron Emission Tomography (PET) scan: The PET scan focuses on understanding the metabolic activity of the brain to learn the cause of seizures. It utilises a low-dose radioactive material and injects it into the vein to check for brain areas witnessing low metabolism activity.
• Single-photon Emission Computerized Tomography (SPECT): In the rare case of MRI and EEG not providing a precise diagnosis, doctors rely on SPECT to detect the cause of seizures. SPECT is similar to PET as it involves inserting low-dosage radioactive material in the vein. However, the test relies on a 3D map of the blood flow activity to track the brain areas receiving a higher blood flow. Abnormal blood flow indicates that the area is the site for seizures.
• Transcranial Magnetic Stimulation (TMS): TMS is an upcoming procedure that banks on the application of magnetic fields on the areas of the brain, causing seizures to treat them. It is a non-invasive method most ideal for patients whose attacks occur in the area close to the brain surface.

Treatment

The following treatments have proved to be effective in controlling epileptic seizures.

• Homecare: Doctors may recommend diet for patients to control seizures. The diet may be having a high-fat and low-carbohydrate content and is constantly monitored by the patient’s dietitian and physician. It is usually recommended when medications are not much effective, especially in young adults.
• Medication: Doctors prescribe particular ‘anti-epileptic drugs’ once the diagnosis of epilepsy is confirmed. These are a group of drugs that target the inhibition or excitation of electrical activity in the brain responsible for causing epileptic seizures.
• Resective surgery: Epileptic surgery, also known as resective surgery, is performed to remove the part of the brain causing seizures. Doctors suggest surgery when medication fails to control the seizures. In this process, the operating surgeon separates the brain tissues in the area causing seizures.
• Alternative Management: Although resective surgery is most commonly used, doctors can also recommend other procedures like laser interstitial thermal therapy (LITT) and deep brain stimulation to address epileptic episodes. LITT uses MRI to pinpoint the exact location of the disruptive portion of the brain and correct it using a laser. On the other hand, deep brain stimulation involves permanent device implantation in the patient’s brain. The device sends periodic electrical signals to interrupt the activity of seizure-causing brain cells.

Risks and Complications if Left Untreated

The risks and complications of untreated epilepsy are provided below.

• Permanent brain damage: The patient is at risk of permanent brain damage if he/she encounters two epileptic seizures within five minutes or a single stroke that lasts longer than five minutes. This state is called status epilepticus, which can cause permanent brain damage or death without immediate medical intervention.
• Sudden unexpected death (SUDEP): SUDEP is a rare condition in which an epileptic patient can pass away without evidence of a convulsion. It occurs in one out of a thousand patients every year. Uncontrolled seizures are more likely to develop into SUDEP, so it is vital to seek timely medical assistance.

• Aspiration pneumonia: Epileptic seizures can sometimes lead to inhaling food and liquid through the windpipe. This results in aspiration pneumonia, which leads to excessive chest pain, breath odour, excessive sweating and coughing up phlegm filled with blood. Left unchecked, it can cause respiratory failure and widespread infection in the body, resulting in death.

• Constant injuries: Depending on the type of seizures and frequency, patients can sustain various injuries in their immediate environment. However, most of these are non-fatal injuries like burns, soft-tissue injuries and minor fractures.

• Birth defects: For pregnant women, epilepsy is a significant cause of concern since it can contribute to congenital problems in the child. Hence, doctors can chart out a plan for expecting mothers and advise them against taking certain anti-epileptic medicines that can cause complications for the child.

Additional Information

Different forms of epilepsy

The common symptoms of all forms of epilepsy are the onset of seizures. However, the intensity of attacks can help doctors determine the type of epilepsy. There are two primary types of seizures that occur in epilepsy.

Motor seizures impact the entire body leading to episodes that cannot be manually controlled. Usually, patients lose consciousness, and their muscles stiffen during these seizures. Non-motor seizures do not cause any noticeable physical symptoms. In fact, patients may perform a single activity for a long time, like staring blankly into space.

Epileptic seizures can be divided into two types based on the origin of the stroke.

1. Generalised: The most common type of epilepsy, generalised, begins on both sides of the brain. As it progresses, it impacts the brain networks on both sides. Generalised epilepsy is further divided into specific types based on affected body parts. These are:

• Absence seizures: These are commonly found in children and lead to involuntary bodily movements like eye blinking and lip-smacking. Although they last for 4 to 5 seconds, they can occur at a high frequency.
• Clonic seizures: These are synonymous with repeated muscle-jerking movements. Clonic attacks primarily impact the neck, arms and face.
• Myoclonic seizures: These occur spontaneously as brief jerks and usually result in the involuntary movement of the arms, legs and upper body.
• Tonic-clonic seizures: Known as the most severe form of epileptic seizures, tonic-clonic attacks can cause unconsciousness, loss of bladder control and body stiffening in the patient.

2. Partial seizures: These are also called focal seizures and begin from a single part of the brain. However, these can transform into generalised seizures and spread over multiple groups of brain cells

Partial epilepsy is further divided into:

• Seizures with impaired awareness: These seizures impact the awareness of a patient’s surroundings and result in a change of consciousness. For instance, patients may continuously stare into space without responding to their names being called out.
• Seizures without loss of consciousness: These seizures cause a change in sensory perception or emotions without the loss of consciousness. Patients may notice a difference in how they feel or sound. Additionally, this focal epilepsy may cause involuntary movement like leg jerking.