Understanding Seizures And Epilepsy
By PROFESSOR SHUBHI AGRAWAL
Special to India-West
Epilepsy is one of the most common diseases affecting the nervous system and implies a predisposition to seizures. Per best estimates from CDC and WHO, there are 3.4 million people living with epilepsy in the US and about 50 million worldwide. A person who has had two or more seizures without a clear triggering cause is diagnosed with epilepsy. Someone with a single seizure can also be diagnosed with epilepsy if the diagnostic tests suggest a high risk of seizure recurrence. Most commonly epilepsy starts in childhood or after 60 years of age, though it can begin at any age. Even though epilepsy is defined by recurrent seizures, most patients have additional associated problems like mood disorders, anxiety, memory problems, and slowed thinking.
What is a seizure?
A seizure is the collection of symptoms caused by sudden abnormal electrical activity in the brain. The symptoms depend on where in the brain seizure begins and how far it spreads. Some seizures cause subtle symptoms like unusual smell or taste, a rising sensation in the chest, inability to talk or respond for a few minutes, and confused behavior like repeatedly picking at clothes or lip smacking. Other seizures can cause stiffening or jerking in a part of the body or the whole body. Most often seizures stop on their own within a couple of minutes. While seizures can present with a variety of different symptoms in different people, one person’s seizures usually have very similar symptoms every time.
What are the causes of seizures?
For centuries, seizures have been associated with social stigma. In many cultures around the world, they have been associated with possession by evil spirits or the result of prior sins. However, seizures and epilepsy are a disease caused by an abnormality in the brain. There can be structural problems in the brain like tumors, bleeding, congenital malformations, strokes, traumatic brain injury, infection around the brain, scarring in an area of the brain, and neurodegeneration. Some people can have problems with brain function that affect metabolism or the flow of chemicals in the brain. These can be due to genetic diseases, diseases of the immune system, exposure to some toxins or drugs, sleep deprivation, etc. For many people, the exact cause of seizures and epilepsy cannot be determined.
What to do if someone is having a seizure?
If we notice someone around us having a seizure, we should stay calm. We should try to get the person into a safe position to minimize any accidental injury- like helping them to the ground, removing any sharp or hot objects nearby. If the is body is tense and shaking, we should turn them on their side if possible. We should stay with them until the seizure is over and they have recovered to their usual self. 911 should be called if it’s the first seizure the person has ever had, the seizure goes on longer than 5 minutes, there are back-to-back seizures, any obvious injury, or difficulty breathing after the seizure.
How is epilepsy treated?
There are many medications available that can reduce a person’s risk of seizures. Most of these are well tolerated with minor side effects that tend to improve within a few weeks or months of use. It may take some time to figure out the best medicine & dose for a particular person. About 60-70% of people with epilepsy can have complete seizure control with the first one or two medications they try and are able to tolerate well. Two tests are commonly performed for the evaluation of epilepsy- EEG and brain MRI. EEG can be thought of as EKG of the brain. Small metal electrodes are placed over the scalp to record electrical activity of the brain and look for signs suggesting an increased risk of seizures. Brain MRI takes very detailed images of the brain to assess for abnormalities that can be associated with epilepsy.
For the 30-40% of patients who do not achieve good seizure control from medicines, non-medication treatments are considered. Options include epilepsy surgery, neuromodulation devices, dietary therapies, and immunotherapies. These treatments are not appropriate for every person with epilepsy. A combination of specialized tests is needed to determine which treatments are options for a particular patient and their risks and benefits in that individual situation. Such evaluation is performed at a Comprehensive Epilepsy Center by a team of specialists that includes neurologists with specialized training in epilepsy, radiologists with specialized training in brain disorders, neuropsychologists, and neurosurgeons among others.
It is important to also address the other associated symptoms like mental health disorders. Depending on the symptoms and their severity, this may need coordinated treatment with a psychiatrist and psychologist, in addition to the person’s neurologist.
(Agrawal is an epilepsy specialist, currently an Assistant Professor at UC Davis School of Medicine. Her Neurology training is from the University of Nebraska Medical Center followed by an epilepsy fellowship NIH.)