Is there any difference between seizure, convusion, fits & epilepsy?

“seizure” is an alternative term for “epileptic attack”. The terms like convulsion or fits etc are used for the same only.

What are the types of epilepsy?

Grossly we can divide epilepsy into two types.

Focal or partial epilepsy: In this condition the seizures start from a particular part of the brain and then can spread to involve whole of the brain.

Generalized epilepsy: where there are no apparent single foci of for the origin of the seizures.

Is epilepsy curable?

Epilepsy is treatable in majority of the cases. Majority of the people with seizures have very good improvement with single drug though some may require addition of another drug. If the seizures are not controlled with medicines then there is a possibility of surgery to treat seizures. If the seizures are starting from a single point of the brain, then it can be treated by removing that point of the brain.

What to do if I have epilepsy?

You should consult a neurologist who is expert in epilepsy. Once the diagnosis and type of epilepsy is confirmed, take appropriate medicines regularly and don’t miss them even for a single day. Even if you are not able to meet your doctor on the appointment date, do not stop your medicines and continue them as before.

What are the factors which can provoke seizure?

  • Missed medication
  • Lack of sleep
  • Illness (both with and without fever)
  • Severe psychological stress
  • Heavy alcohol use
  • Use of cocaine and other recreational drugs such as Ecstasy
  • Over-the-counter or prescription medications or supplements that decrease the effectiveness of seizure medicines, Antibiotics
  • Nutritional deficiencies: vitamins and minerals
  • The menstrual cycle

What to do during the Seizure (First aid during seizure)?

  • Remove-Move things out of the way so the person won’t injure him or herself.
  • Loosen any tight clothing around the neck.
  • Reposition-Put a pillow or something soft under the head.
  • Lay him or her on one side once seizure is over.
  • Record-Time the seizure duration.
  • Reassure-Stay with the person until recovery is complete. Reassure others.

Don’t Restrain

  • Do not attempt to force a hard object (spoon or metal) between the teeth. You can cause more damage than you can prevent.
  • Do not try to hold the person down during the seizure.
  • Turn the person to the side while sleeping after the seizure is over.
  • If the person having a seizure turns blue or stops breathing, try to position their head to prevent their tongue from blocking their airways. Breathing usually starts on its own once the seizure is over.
  • CPR or mouth-to-mouth breathing is rarely needed after seizures and cannot be performed during the seizure.
  • Stay with the patient until he/she regains consciousness
  • Most epileptic seizures are over so quickly that you don’t really have much time to do anything. After it’s over, you simply make sure that the person wasn’t injured.
  • Keep track of the date and time the seizure started, how long it lasted, whether or not you lost consciousness, a description of your body movements, what provoked the seizure (if known), and any injuries you suffered.

Call an ambulance about a seizure if:

  • The seizure lasted longer than five minutes.
  • The person was injured during the seizure.
  • If it seems like one seizure is immediately following the previous one. And the person is not regaining consciousness in between.

Facts about a seizure episode

  • Dont last long-Most seizures last for 1-2 minutes
  • End spontaneously-Mostly brain control seizure by its own after 1-2minute
  • You can’t stop a seizure-let’s wait for the seizure to run its course and try to protect the person from harm. Only drugs can bring a seizure to stop in case it is not ending on its own.
  • Not dangerous to others-It is unlikely that during seizure the patient will harm to others.

If I have epilepsy will it affect my kids?

In most of the people with epilepsy there is no problem with regard to kids. There are high chances of having a normal pregnancy. The chances of epilepsy or antiepileptic drugs affecting kids are very low. If you are on antiepileptic drugs it is very important to consult your doctor before planning for pregnancy as you may require medication adjustment and adding of multivitamin like folic acid.

What is the latest advancement in epilepsy?

There are many newer antiepileptic drugs available which are very effective and have lesser side effects. In addition there is availability of high quality MRI and video-EEG which makes the diagnosis easy. The people who have no control of seizures despite taking adequate medicines there is a possibility of surgical treatment.

What to do if my seizures are not controlled with medications?

The reason for the poor control of seizures can be many:

  1. Whether your diagnosis of epilepsy is proper? – Diagnostic error
  2. Are you being given too many medicines in inadequate doses? – Inadequate doses
  3. Are you taking appropriate medication for the type of epilepsy you have? – Inappropriate assessment.

Before labelling a patient as medically refractory epilepsy, he/ she should have been tried on at least two appropriate antiepileptic drugs in appropriate doses.

What can be done for the patients whose seizures are not getting controlled despite multiple medications (drug resistant epilepsy)?

These patients definitely require pre-surgical evaluation for the possibility of surgery to control their seizures.

I have seizures what next?

A detailed clinical history is required to know whether it is a seizure or not. Though the with advance technology it is easy to establish the diagnosis of epilepsy, it is still the clinical history which is crucial for the diagnosis of epilepsy. It is very important to have the details of the seizure so description by an eyewitness (Home videos) is very helpful in diagnosis of epilepsy.

How to diagnose epilepsy?

The relevant investigations include MRI brain and EEG , other than simple blood investigations. MRI brain should be of good quality (>/= 1.5Tesla) and should include special images for the epilepsy. It is equally important to have a very good EEG record and ideally should be of atleast half an hour. A sleep record with sleep deprivation in the previous night should be there in EEG as many abnormalities can be missed in an only awake record.

What are the treatment options?

Epilepsy is primary treated with medicines. There are numerous newer antiepileptic drugs which are very safe to use for long term. Majority of the people with seizures have very good improvement with single drug though some may require addition of another drug. Type of medicine will depend on the type of epilepsy.

What is the duration of treatment?

Usual duration of treatment is 3-5 years but some patients may require treatment for only 6 month to one year (neuro-cysticercosis). However some patients may have to continue treatment for many years and even life long (like Juvenile myoclonic epilepsy). Most important precaution is that the medicines should be stopped only after proper consultation as sudden stopping of medicines can result in seizure relapse even after good control of seizures for 3-4 years.

Is epilepsy curable?

Epilepsy is treatable in majority of the cases. Majority of the people with seizures have very good improvement with single drug though some may require addition of another drug. If the seizures are not controlled with medicines then there is a possibility of surgery to treat seizures. If the seizures are starting from a single point of the brain, then it can be treated by removing that point of the brain.

Uncontrolled seizures what next?

If the seizures are not controlled with medicines next step is to know why the seizures are happening. The root cause of seizures can be detected by doing a good quality MRI of the brain with epilepsy protocol. Next step is to record the seizures by doing video-EEG. In video-EEG the patient is admitted and the medicines are slowly stopped so that seizures can be recorded. By analyzing the video and EEG one can pin point the focus of origin of seizure and if feasible that focal can be removed surgically.

The other options are ketogenic diet a special type of diet which can help in controlling seizures especially in children.

Myths about epilepsy

Having epilepsy is not as problematic as facing the stigma associated with epilepsy. Some common misconceptions about epilepsy include:

  • Only kids get epilepsy. Although epilepsy is more common in children and young adults, epilepsy can happen at any age. People with a history of stroke, heart disease, or Alzheimer’s disease are more prone to develop epilepsy in old age.
  • Epilepsy is contagious. Epilepsy cannot be “Caught” from being in contact with a person with epilepsy.
  • People with epilepsy cannot/should not be employed- People with epilepsy are employed and successful in all types of professions. Even today people with epilepsy often do not discuss their medical disorder with co-workers for fear of being ostracized.
  • People with epilepsy are physically limited in what they can do. In most cases epilepsy is not a barrier to physical achievement. An excellent case example is Ex South African cricketer Jonty Rhodes who has overcome epilepsy to emerge as one of the best all rounder in the cricket , a superb fielder and batsman.
  • Force something into the mouth of someone having a seizure so that they do not swallow their tongue. It is difficult to prevent tongue bite. It is impossible to swallow your tongue. However, a cloth may be placed between the teeth to prevent tongue biting if we can do it before full blown seizure.

Facts & Myths:

  • Epilepsy is a neurological disorder and is not a psychiatric problem
  • People with epilepsy are seldom brain-damaged.
  • People with epilepsy are not usually cognitively challenged.
  • People with epilepsy are not violent or crazy.
  • People with epilepsy are not mentally ill.
  • A single seizure episode usually do not cause brain damage.
  • Epilepsy is not necessarily inherited.
  • Epilepsy is not necessarily a life-long disorder.
  • Epilepsy is not a curse.
  • Epilepsy should not be a barrier to success
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