Epilepsy is a common neurological condition; it is estimated to affect around 0.5% of the population. The condition causes unpredictable seizures, which are caused by changes to electrical function in the brain. Seizures - which are often called “fits” - are classified into different categories:
- Grand Mal Seizures. A person experiencing a ‘grand mal’ seizure is experiencing a serious overload of electrical brain activity. The person usually falls to the ground, becomes stiff, shakes, froths at the mouth, and may bite their tongue or lose urine control.
- Partial Seizures. With partial seizures, only some areas in the brain are experiencing unusual electrical activity. The symptoms tend to vary depending on where in the brain the unusual activity is located.
- Simple Partial Seizure. A person experiencing a partial seizure is aware of the event; their limbs may jerk, and they may describe an unusual or odd sensation in their body. They will be able to remember that the seizure took place in the future.
- Complex Partial Seizure. Similar to a simple partial seizure in terms of symptoms, the main difference with a complex partial seizure is that the person will have no awareness, or memory, of the seizure.
Many cases of epilepsy are simply caused by abnormalities in the brain and its electrical systems in and of themselves, with no further damage or underlying problems.
Brain tumors and strokes are both known to cause epilepsy.
A head injury sustained following an accident may cause epilepsy.
Brain damage during birth can also cause the condition.
- Epilepsy can develop at any age.
- Children who develop epilepsy may find that the condition eases - or resolves entirely - as they age.
A family care physician, or pediatrician in the case of children, is usually the best point of contact for immediate care. For long-term care and treatment management, consulting an epilepsy expert or neurologist is advised.
The most common form of treatment for epilepsy is prescribed oral medication. These medications have advanced in recent years, and are now able to control the seizures of around 70% of people with epilepsy. The medications have few side effects and tend to be tolerated well. At present, there are more than 15 different types of medication that may be beneficial for people with epilepsy.
However, while these medications are incredibly useful and can allow people with epilepsy to live a normal life, they are not a cure: they merely control the symptoms of the condition.
For the 30% of patients that do not respond to medications, surgery may be considered.
- Take medications as regularly as possible, as a single missed dose is capable of providing the opportunity for a seizure to take place. If you miss a dose, then take it as soon as possible, before returning to your regular schedule for the next dose.
- Speak with your doctor if you are experiencing side effects from medication.
- Ensure you get as much sleep as you need; ideally, you should be aiming for between seven and eight hours of sleep per night. Adequate sleep is always important, but is particularly vital for those with epilepsy, as sleep deprivation is a common seizure trigger.
- Ask your doctor if it is safe for you to drive, swim, cycle, or handle heavy machinery.
- Exercise regularly.
- Change medication brands without first consulting your doctor or neurologist.
- Stop taking your medication - unless your doctor instructs you to do so.
- Drink alcohol or fast.
For friends and family of people with epilepsy, it can be helpful to learn how to cope with a seizure.
Major tonic-clonic seizure (grand mal) first aid
- Lay the person experiencing the seizure on a flat surface and turn them to one side.
- Remove any eyeglasses or objects that may be tied around their neck.
- Hold the person - very gently - to the ground, but do not seek to restrain them or try to stop the movements from happening.
- Look for an epilepsy bracelet on the person’s wrist, as this may contain further advice that you can then act.
- If a person with epilepsy experiences acute seizures, they may have emergency medication that can be used when a seizure occurs. Familiarise yourself with this medication and learn how to use it, preferably following advice from a trained professional.
- Do not place any object into the person’s mouth during a seizure, and allow them to drool if necessary.
- It is also helpful if you can note the time the seizure starts and concludes.
- Stay with the person until the seizure has completely stopped, calling for medical assistance if you feel this would be beneficial.
- Only offer food or water when the seizure has ended, and the person is fully awake and aware of their surroundings.
One of the most important points noted above is regarding restraint. As some seizures can be quite intense, and involve a rapid movement of the arms and legs, many people find that their first instinct is to try and restrain the person who is experiencing the seizure. As a general rule, this is inadvisable, as it can cause harm rather than prevent it. You should apply gentle pressure to the person’s body, but allow them to convulse with the seizure rather than attempting to “stop it” - keep them safe, but don’t interrupt the movements themselves.
Partial seizure first aid
With a partial seizure, the person will almost always be aware of what is happening, so the first aid required is different:
- If you notice the signs of a seizure, or the person directly informs you they believe they are experiencing a seizure, then try to remain calm.
- Ask if they have a Seizure Action Plan or any medication to take; if they do, then assist them with this as is necessary.
- Direct the person to a quiet space, ideally where they can sit down in order to limit the risk of falling.
- If you are with others, quickly tell them what is happening and then ask for space.
- The person experiencing the seizure should cease all activity. Partial seizures can cause issues with vision, thinking, emotions, and movement, so the goal is to ensure they can sit quietly and wait for the seizure to pass.
- It may be helpful, if possible, to encourage the person to take deep breaths in an effort to relax.
This is a difficult question to answer, as the choice is primarily one you have to make based on the moment. It is usually best to speak to the person with epilepsy about what they would prefer that you do when a seizure occurs.
However, regardless of this conversation, if any of the following points are applicable, then you should call for emergency medical help:
The seizure lasts for more than five minutes
The person has no history of epilepsy, as far as you are aware, and has never had a seizure before
The seizure occurs when the person is in water (e.g., swimming)
The person is struggling to breathe or walk after the seizure
A second seizure occurs rapidly after the first
The person is injured during the seizure
The person has an underlying medical condition, such as heart disease
In India, it is currently estimated that there are over five million people diagnosed with epilepsy; of those instances, over a million are considered to be “medically refractory” - a term used to describe people who experience seizures that are very difficult to control. For the 500,000 people with focal epilepsies, surgery has proven to be the most effective method of managing, or even curing, the condition.
In terms of treatment, those living in urban areas tend to see the best outcome, thanks to specialist care from doctors and specialist neurologists. However, cases of epilepsy in more rural areas are far less likely to be diagnosed, and thus far less likely to be treated. It has also been suggested that the reason for the lack of treatment in rural areas is also linked to the cost of antiepileptic medications, as well as cultural influences.
More than 45,000 children - those under the age of 18 - are diagnosed with epilepsy every year.
Children who experience epilepsy - known as pediatric epilepsy - require special care and attention to ensure effective treatment and management of the condition. This often involves work not only in terms of medical treatment, but also adds support for psychological, social, and education issues that may present as a result of the condition.
Children may experience seizures somewhat differently when compared to adults. Common symptoms include:
Staring into space and a lack of response to stimuli
Confusion or wandering
Jerks and twitches across the body, but particularly in the limbs
Shaking or falling
Many parents worry that their children will not be able to lead a “normal” life after being diagnosed with epilepsy. While this is an understandable concern, it is vital that parents are aware of the advances that have been achieved just in the last few years of epilepsy treatment. These advances, combined with a new medical understanding of the disorder and its treatment options, mean that many children with the condition will be able to live a life that is little different from those of their peers.
For parents who wish to ensure their child has the best chance of achieving a normal life, it’s helpful to focus on providing an overall healthy lifestyle. This should include a good diet that is rich in nutrients, as well as active hobbies such as indoor and outdoor sports. While it’s advisable to provide some level of seizure precautions where necessary - and particularly for activities such as swimming or anything involving motor vehicles - these can usually be accommodated with relative ease. If you are confused or concerned about what your child can and cannot do, then discuss your concerns with your child’s treatment team, as they will have the best insight into what is - and isn’t - suitable.