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Epilepsy is a neurological disorder characterised by recurrent seizures. It is essential to differentiate between seizures and epilepsy as they are different. Seizures occur due to sudden abnormal electrical activity in a part or the entire brain. However, experiencing a single seizure does not necessarily mean a person has epilepsy.
The Comprehensive Epilepsy Care Clinic at Manipal Hospitals India is a dedicated facility that is primarily focused on all-around care including the diagnosis and management of symptoms, and follow-up care for epilepsy patients. Our clinic comprises a team of experienced epileptologists and neurologists committed to providing exceptional care and support to individuals with epilepsy. With state-of-the-art facilities and advanced treatment options, we strive to improve the quality of life for our patients and empower them to lead fulfilling lives.
As part of one of the top-ranked hospitals in India, we have cared for patients of all age groups with this spectrum disorder from all over the country and beyond. With this new separate entity, our centre extends our care with the help of a larger multidisciplinary team and the most innovative diagnostics and therapeutic modalities. We also provide extensive counselling and education to family members and caregivers to help them in their care.
Types of Epilepsy and Their Symptoms:
Epilepsy seizures can be classified into two main types: Focal/partial and generalised. Focal seizures affect a specific part of the brain and are characterised by symptoms such as aura (peculiar sensation), unresponsiveness, repetitive actions, and limb jerking. Generalised seizures involve the entire brain and manifest as convulsions, loss of consciousness, tongue biting, falls, brief stares, or isolated jerks of limbs.
Symptoms of focal seizures
Aura: Some individuals may experience a distinct sensation or warning sign before a seizure.
Unresponsiveness and unawareness: During a focal seizure, a person may become unresponsive and lose awareness of their surroundings.
Blank stare, repetitive actions of limbs, lip smacking, chewing: Focal seizures can cause a person to have a vacant gaze and engage in repetitive movements like lip smacking or chewing.
Repetitive jerking of any part of the body: Focal seizures may also lead to repetitive jerking motions involving any part of the body.
Generalised seizures involve the entire brain and present with different symptoms, such as:
Loss of consciousness, convulsions: Generalized seizures often include a loss of consciousness and convulsions, characterised by jerking movements of the limbs and rolling up of the eyes.
Tongue bite, involuntary urination, or defecation: These seizures can also cause a person to bite their tongue or experience involuntary urination or defecation.
Sudden falls with rapid recovery (atonic seizures): Some generalised seizures may result in sudden falls followed by a quick recovery.
Brief stare with unresponsiveness (absence seizures): Absence seizures are characterised by a brief period of staring and unresponsiveness.
Isolated jerks of limbs with preserved consciousness (myoclonic seizures): Myoclonic seizures involve isolated jerks of the limbs while the person remains conscious.
It's important to note that focal seizures can sometimes progress into generalised seizures. Seizures typically last for 1-2 minutes and are often followed by confusion. These seizures can occur in individuals in all age groups, irrespective of their gender. If someone experiences seizures or you suspect someone has a seizure, seeking medical attention and providing support are crucial steps.
Causes of Epilepsy
In many cases, the exact cause of seizures or epilepsy remains unknown. However, some common causes may include infections, brain tumours or injuries, stroke, drug addictions or withdrawal, and chemical imbalances in the blood. It's worth noting that genetic or hereditary causes are infrequent. Contrary to popular belief, stress is not a direct cause of seizures. The potential causes can occur at any point in life, including during the intrauterine period.
Medical Consultation and Investigations
If you experience a first-time seizure, it is crucial to seek medical consultation. A doctor will assess your condition and may recommend further investigations to understand your seizures better. These investigations can include an EEG (electroencephalogram) to record brain activity, a CT or MRI scan of the brain to identify structural abnormalities or other specialised tests. These tests help the doctor make an accurate diagnosis and develop an appropriate treatment plan tailored to your specific needs. Early medical consultation and thorough investigations are essential in managing seizures and epilepsy effectively.
When to Seek Consultation?
Not every seizure in an epilepsy patient on treatment requires immediate consultation. However, you should seek medical advice in the following situations:
Experiencing more than one seizure in a day.
Prolonged seizures lasting more than five minutes.
Unusual or non-habitual seizure type.
Prolonged unconsciousness or unresponsiveness, even after seizures have stopped.
Seizure accompanied by fever.
Seizures occur during pregnancy.
Injuries sustained during seizures.
To seek prompt medical care, book an appointment with our experienced neurologist or epileptologist at Manipal Hospital India.
Treatment for Epilepsy
While some seizures, like simple febrile seizures in children, may not require regular medications, treating even the first attack of most seizure types is generally recommended. This is because:
Seizures can be unpredictable and may lead to physical injuries or even death, depending on the circumstances.
Recurrent seizures can strengthen the epileptic circuits in the brain.
Frequent seizures can result in social stigma, affecting employment and education.
The psychological impact of recurrent seizures can be damaging.
Epilepsy medications are both safe and effective. The choice of medication depends on factors such as the type of seizure, age, gender, reproductive status, pregnancy, and other illnesses. Dosage is determined based on body weight and is usually initiated at a low dose. It's essential to start and stop medications gradually. In most cases, a single type of medicine is sufficient to control seizures, but in rare instances, multiple medicines may be required simultaneously. Injections and nasal sprays are typically reserved for emergencies.
Epilepsy Surgery and Other Treatment Options
Epilepsy medications do not cure the condition but rather help control it. However, epilepsy surgery offers the promise of a cure and even freedom from medications. Only patients who have failed medical therapy with two or more medications are considered for surgery. Patients with a well-defined point of origin for epilepsy signals in the brain may be candidates for surgery, which requires further tests such as recording seizures with Video EEG.
Treatment options available for epilepsy are:
Vagus nerve stimulation (VNS).
Responsive neuro-stimulation (RNS).
A ketogenic diet (especially in children).
Why Seizures May Recur During Treatment.
Seizures can recur even while on treatment due to various factors, such as:
Missing doses or irregular timing of medication (most common cause).
Inadequate sleep or poor food intake.
Alcohol or smoking.
Interaction between epilepsy medications and other drugs.
Inappropriate choice of medication or inadequate dosage.
Discontinuing Medications
In many cases, patients can successfully stop taking epilepsy medications. To do so, they should be "seizure-free" for at least three years while on medication. Medications should be tapered gradually under the guidance of a doctor. However, there are instances where prolonged treatment lasting several years may be necessary.
Dos and Don'ts During a Seizure
DOs
Ensure that the patient does not strike a wall or furniture while jerking.
Lay the patient flat on one side to allow secretions from the mouth to drain out.
DON'Ts
Do not insert fingers, cloth, or other objects into the patient's mouth to prevent tongue biting, as this can cause injury. Tongue bites are minor injuries and will heal completely in a few days.
Wait to feed the patient until complete recovery of consciousness occurs.
Do not attempt to control limb jerking with excessive force, as it can result in injuries, including muscle tears and joint dislocations.
Precautions for Patients with Epilepsy.
If you have epilepsy, it's essential to take certain precautions:
Get adequate sleep and maintain regular meals.
Each medication has a specific duration of action, so be consistent with your medication schedule.
Only drive or swim once permitted by your doctor.
Seizures can be unpredictable even while on regular medication, so constantly assess your safety about your surroundings.
Avoid smoking and alcohol consumption.
Inform all your doctors about your epilepsy and the medications you take to avoid potential medication interactions.
Seizures and Pregnancy
For women with epilepsy, it's crucial to consider the following during pregnancy:
Most women with epilepsy have normal pregnancies and deliver healthy babies with typical development.
Plan your pregnancy in consultation with your neurologist.
Relatively safe and effective medications are available for use during pregnancy.
The likelihood of a child developing medication side effects is very low (2-5%), and the chances of the child having epilepsy are also remote.
Medication side effects can often be detected through ultrasound scans.
The risk to the child is higher if the mother is on multiple medications or experiences frequent seizures during pregnancy.
For further information or to schedule a consultation, please contact an experienced neurologist or epileptologist at our Top Epilepsy Clinic in India.
