About Epilepsy

What is Epilepsy ?; Bangkok Post: Dr. Yotin’s interview

Epilepsy – a common neurological disorder characterised by recurrent seizures that generally last from a few second to a few minutes – is not a new illness. in fact, it may be one of mankind’s oldest diseases, said Dr Yotin Chinvarun, an epileptologist.

Yet, it can make those having it feel discriminated against, he added.

However, Dr Yotin insisted if given proper medical treatment, people with epilepsy can lead a normal life.

According to the expert, the seizures involve abnormal electrical function in the brain, normally caused by damages to certain area of the brain.

“Not everyone with a seizure has epilepsy,” he said. Seizures that are not related to epilepsy may result in different conditions such as facial twitching, hemifacial spasms and periodic limb movement. some people just have a muscle tic that may look or feel like a kind of seizure. but epileptic seizure is a chronic disorder that occurs repeatedly over weeks, months or years.

A 2007 file photo shows Mike Seman console his 2 1/2-year-old son, Alex, as doctors sedated him prior to brain surgery at the Children’s Hospital in Pittsburgh. Alex suffered from seizures since he was four months old. the bandages cover previously implanted sensors that guide surgeons as they remove the piece of abnormal brain tissue causing the seizures.

It is mostly found in young children and old people, Dr Yotin said, but seizures can start at any age.

There is a wide variety of epilepsy which can be categorised many ways. the most common classification of the epilepsies is determined by the syndromes related to the location where the seizure originates. the seizures may occur either in particular or general parts of body.

Seizures affect patients in many different ways – some may fall to the ground, others may experience body stiffness, muscle contraction or clonic spasm.

Other seizures may be more difficult to notice because they don’t develop reactions. Patients may have visual disturbance or experience deja vu or a certain illusion known as jami vu. some may have temporary speech problems. there are also difficult-to-notice symptoms like mild muscle twitches, unresponsive staring, lip movements like smiling or chewing and eye blinking.

“Patients with epilepsy may be conscious or unconscious during a seizure. It occurs without warning.

“My patient was caught stealing in a convenience store. in fact, he had seizure and couldn’t remember what had happened during the seizure and didn’t recall he was stuck with seizure.”

People with epilepsy need to avoid water sports, sleep deprivation and stay away from high places. Driving can be possible, should they be free of seizure for one year, he said, adding epilepsy is not a kind of mental illness. while symptoms may look scary, but they don’t make a patient violent or dangerous.

Children with epilepsy may have movement disorders, sleep disturbance, problems with growth and development.

Epileptic seizures are especially prevalent in autistic people – among 40% of them, said the doctor, adding that a number of people with Down’s syndrome experience myoclonic seizure – abnormal movements on both sides of the body at the same time – that can be fatal.

Children who suffer from autism and Down’s syndrome usually have abnormal cortical development, which is a common cause of epilepsy. Uncontrolled seizures will cause damage to the brain. they can often develop complications such as infections.

The type of seizures a patient has depends on many factors such as the part of the brain affected and the underlying cause of the seizure. Symptoms can be mild to severe.

WHAT TRIGGERS THE SYNDROME?

People with history of head injuries or brain infections have a high risk of developing epileptic seizures. Brain tumours or brain lesions where there is a scar tissue or abnormal mass of tissue damaged in a specific area of the brain can cause seizures. Genetic disorders may also be a cause for concern. in addition, stroke victims are susceptible to the development of epileptic seizures.

“People don’t have to have a family history to develop epilepsy. and the condition may develop although they don’t have any risk factors,” Dr Yotin said.

What’s more, complications during pregnancy through a difficult delivery are attributable to the syndrome. An infant who had premature birth complications and was born with head and brain injuries face a higher risk of developing epilepsy.

“Children may develop seizures after having vaccinations but there is no evidence for this claim. It may have a connection between seizures and the lymphatic system,” the doctor said.

Most common causes of epilepsy among older adults and the elderly may be dementia, strokes, metabolic disorders, underlying chronic kidney diseases, liver failure and degenerative diseases.

Numerous studies indicate high mortality in old people who have prolonged epilepsy, said Dr Yotin.

TACKLING THE SYNDROME

After physical and neurological examinations, if epilepsy is suspected, a doctor may do some tests. A routine EEG or electroencephalogram is normal for diagnosis. Dr Yotin said EEG is a test that measures and records the electrical activity of the brain. It is used to diagnose epilepsy and detect what types of seizures are happening.

“Special sensors will be attached to a patient’s head and hooked by wires to a computer, which is used to record the brain’s electrical activity on screen. So, seizures can be seen by the changes in the normal pattern of the brain’s electrical activity,” the doctor explained.

Also, additional tests may be performed to investigate and evaluate the condition. they are 24-hour video EEG monitoring and neuro-imaging MRI. Neuropsychological assessment and WADA testing may also be used to figure out brain function such as memory, language and attention.

Non-invasive tests including single photon emission computed tomography (SPECT) scanning, positron emission tomography (PET) scanning may be implemented to identify the epileptogenic zone if the initial evaluations are not conclusive. Brain functional mapping may be used in some cases.

KEEPING CONTROL

Medications may be common to treat epileptic seizures. they are used to prevent seizures and may reduce the number of seizures. according to Dr Yotin, patients may need to take seizure medicines for about 2-5 years.

“About 60% of those receiving medication achieve zero seizures. some may be able to reduce or completely stop their seizure medicine after having no seizures for several years. Seizures may persist in many cases so that medication treatment may be lifelong,” the doctor said.

Gamma Knife is radiosurgery, a non-invasive neurosurgical procedure that uses powerful doses of radiation to target and treat diseased brain tissue while leaving surrounding tissue intact.

Some patients with certain types of epilepsy may require brain surgery to remove the abnormal brain cells that cause the seizures.

“Surgery can be palliative, decreasing the frequency or severity of seizures in patients who are unresponsive to medicine . in some cases, it can be curative,” he said.

Meanwhile, others may be treated by vagal nerve stimulation that can help reduce the number of seizures.

A special ketogenic diet featuring high-fat, low-carb food is another treatment option. This non-drug treatment is ideal for difficult-to-control epilepsy in children. but it’s not recommended in the elderly.

WHAT TO DO IF A PERSON CLOSE TO YOU HAS A SEIZURE?

Be calm, Dr Yotin said. and remove things that could cause injury if the person falls down or bumps into them. Gently roll the person on his or her left side.

“Don’t move the person to another place. and never try to force the person’ mouth open or put anything in it because it can be dangerous for both patient and helper. the action may cause injuries to the patient such as chipped teeth or a fractured jaw, meanwhile the helper may get bitten.

“If a seizure lasts longer than 10 minutes, call for emergency medical service,” he said.

HOW TO WARD OFF THE CONDITION

In addition to a regimen of healthy diet and regular exercise, avoid sleep deprivation, alcohol and narcotics, the doctor advised. Also skip using sleeping pills for a long period. Avoiding head injuries may reduce the chance of developing epilepsy.

“If a person has such signs as slow response, cognitive impairment, chronic depression and clumsiness, consult a doctor. Epilepsy may be possible,” the doctor said.

He added several studies have found that there was misperception about epilepsy among the public and those suffering from it are deprived of medical benefits or compensation.

“As a result, patients don’t receive sufficient care, leading to poor living and premature death.

“It’s a formidable disease. Treatment usually works to control and reduce seizures. Without treatment, seizures may continue and even become worse and more frequent. One of the most dangerous complications of the condition is a prolonged seizure condition that can result in brain damage or death. People should learn about it as it can be useful to yourself and people near you.”

Thailand Epilepsy, โรงพยาบาลพระมงกุฏเกล้า Phramongkutklao Hospital