Epilepsy

Seizures can be classified into two types depending on area of the brain affected.

• Generalized seizures affect both sides of the brain. These can be further divided into:
  • Absence or petit mal seizures – They cause rapid blinking for a few seconds or a blank staring into space.
  • Tonic-clonic or grand mal seizures – They can cause a person to lose consciousness, have muscle spasms and fall to the floor. These seizures leave behind a feeling of weakness.
• Focal seizures affect just one area of the brain and hence are also called partial seizures. These can be further divided into:
  • Simple focal seizures that affect a small part of the brain and cause twitching or a strange sensation.
  • Complex focal seizures that affect a larger area of the brain and cause confusion in a person with epilepsy.

Epilepsy symptoms depend on the type of seizure, but a person with one type of epilepsy has the same symptoms in every episode.

Common epilepsy signs and symptoms include:

• Confusion
• Muscle spasm
• Jerky movements of arms and legs
• Loss of consciousness or awareness
• Spell of blank staring
• Fear and anxiety

In a majority of people with epilepsy there is no known cause. However, the condition can be traced to one of the following factors:

• Heredity – Some types of epilepsy run in families and have a genetic influence
• Prenatal injury – Brain damage due to infection or poor nutrition of the mother
• Trauma – Head trauma due to accident or injury
• Brain disorders – Brain tumours or malformations
• Infections – Bacterial, parasitic or viral infections affecting the brain

There are certain factors that can increase the risk. Epilepsy risk factors include:

• Age – Epilepsy is common in children and young adults.
• Family history – If anyone in the family has epilepsy, it increases the risk of developing a seizure.
• Stroke and vascular diseases – Any disorder of the blood vessel that causes brain damage can trigger epilepsy.

Epilepsy diagnosis is made based on signs and symptoms, neurological examination and imaging tests. It is important to diagnose the type of epilepsy and seizure to plan the treatment.

• Electroencephalogram
  (EEG) records the changes in the pattern of the brain waves.
• Computerized tomography
  (CT) scan reveals structural abnormalities in the brain like tumours or cysts.
• Magnetic resonance imaging
  (MRI) detects lesions or abnormalities in the brain.
• Functional MRI
  (fMRI) is done before surgery to identify the exact locations of critical function areas in the brain to avoid injury to those places while operating.
• Positron emission tomography
  (PET) helps visualize metabolic activity of the brain and detect abnormalities.
• Single-photon emission computerized tomography
  (SPECT) is done to get a detailed 3D map of the blood activity in the brain. It is usually done if MRI and EEG are unable to pinpoint the location of the brain where the seizures are originating.

Epilepsy treatment includes antiepileptic medications, surgery or alternative therapies.

Medication

Most people with epilepsy can be seizure-free by taking one or more antiepileptic medications. Children with epilepsy who aren’t experiencing any symptoms can eventually discontinue medications. Many adults too can discontinue medications after two or more years without seizures. However, selecting the most suitable epilepsy medicine from the extensive range of over 20 options poses a considerable challenge. The choice of different anti-epileptic medications is tailored to factors such as the patient's age, seizure type, and overall health.

Surgery

When epilepsy medications do not provide adequate control over seizures, a surgery may be required. A surgery is performed only if the origin of the seizure is in a well-defined area of the brain and operating in that area does not interfere with any vital functions.

During surgery, the area of the brain that is causing the seizures is removed. This epileptic seizure treatment is usually done using minimally invasive MRI-guided stereotactic laser ablation. Some medications need to be continued after surgery but at a lower dosage.

Therapy

• Diet
  A ketogenic diet high in fat and low in carbohydrates is shown to have reduced seizures in children.
• Vagus nerve stimulation
  A battery powered nerve stimulator is placed under the skin of the chest and connected to the vagus nerve. Bursts of electrical energy are sent through the vagus nerve and to the brain. This vagus nerve stimulation therapy is said to reduce seizures by 20-40%.
• Deep brain stimulation
  Electrodes are implanted into the thalamus and connected to a generator implanted in the chest. Electrical pulses are sent to the brain at timed intervals, which helps in reducing seizures.

The Centre for Neurosciences at Kokilaben Dhirubhai Ambani Hospital, Indore has a Comprehensive Epilepsy Programme that provides the best medical and surgical treatment for epilepsy. The expert team at the Neuroscience Centre extends support beyond treatment by creating awareness about epilepsy via support groups and patient education programs. These initiatives aim at removing the fear and stigma surrounding epilepsy.