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Epilepsy and Seizures

Epilepsy is a neurological disorder characterized by recurrent, unprovoked seizures. Seizures are sudden, uncontrollable electrical disturbances in the brain that can manifest in various ways.

Causes of Epilepsy
Epilepsy can be caused by a variety of factors, including:

  • Idiopathic: In many cases, the exact cause of epilepsy remains unknown, and it is termed idiopathic epilepsy. It may have a genetic component, as it can run in families.
  • Symptomatic: Some individuals develop epilepsy as a result of an underlying brain condition, such as brain tumors, infections, traumatic brain injuries, or congenital brain abnormalities.
  • Provoked: Certain factors, such as alcohol withdrawal, drug use, high fever in children (febrile seizures), or metabolic imbalances, can trigger seizures. These are considered provoked seizures and may not lead to epilepsy if the underlying cause is treated.

Types of Seizures
Seizures can be categorized into two main types: focal (partial) seizures and generalized seizures.

  • Focal Seizures: These seizures originate in a specific area of the brain and can be further divided into two subtypes:
    • Focal Onset Aware Seizures (formerly Simple Partial Seizures): During these seizures, a person remains conscious and aware of their surroundings but may experience unusual sensations or movements, such as tingling or jerking of a limb.
    • Focal Onset Impaired Awareness Seizures (formerly Complex Partial Seizures): These seizures often involve altered consciousness, leading to confusion or even loss of awareness. Automatisms (repetitive, purposeless movements) may occur.
  • Generalized Seizures: These seizures affect the entire brain from the onset and include several subtypes:
  • Absence Seizures: Commonly seen in children, these seizures result in brief lapses of consciousness, often mistaken for daydreaming.
  • Tonic Seizures: Characterized by stiffening of the muscles.
  • Atonic Seizures: These seizures cause a sudden loss of muscle tone, leading to falls or head drops.
  • Clonic Seizures: Involve repetitive, rhythmic jerking movements.
  • Myoclonic Seizures: Brief, sudden muscle jerks or twitches.
  • Tonic-Clonic Seizures (formerly Grand Mal Seizures): These are the most widely recognized seizures, involving loss of consciousness, stiffening (tonic phase), followed by rhythmic jerking (clonic phase).

Diagnosis of Epilepsy
Diagnosing epilepsy involves a comprehensive evaluation, including:

  • Medical History: Gathering information about the patient's seizures, their frequency, duration, and any triggers or auras (warning signs) they may experience.
  • Electroencephalogram (EEG): This test records electrical activity in the brain and can help identify abnormal patterns indicative of epilepsy.
  • Imaging Studies: Brain imaging, such as MRI or CT scans, can detect structural abnormalities or lesions that may be causing seizures.
  • Blood Tests: These tests can help identify metabolic or genetic factors associated with epilepsy.
  • Video Monitoring: In some cases, long-term video monitoring in an epilepsy monitoring unit (EMU) may be necessary to capture and analyze seizures.

Treatment of Epilepsy
Treatment for epilepsy aims to reduce the frequency and severity of seizures and improve the individual's quality of life. Treatment options include:

  • Medications: Antiepileptic drugs (AEDs) are the most common treatment for epilepsy. The choice of medication depends on the type of seizures and the patient's response. It may take time to find the most effective medication and dosage.
  • Ketogenic Diet: This high-fat, low-carbohydrate diet has been shown to be effective, particularly in children with drug-resistant epilepsy.
  • Surgery: Surgical options may be considered for individuals with specific types of epilepsy that do not respond to medications. Surgical procedures can involve removing the epileptic focus or implanting a device to control seizures.
  • Vagus Nerve Stimulation (VNS): This therapy involves implanting a device that delivers electrical impulses to the vagus nerve, helping reduce the frequency and intensity of seizures.
  • Lifestyle Modifications: Managing stress, getting adequate sleep, and avoiding seizure triggers can be essential for people with epilepsy.
  • Seizure Alert Devices: Some devices can alert caregivers or individuals to the onset of a seizure, providing added safety and peace of mind.

Living with Epilepsy
Epilepsy is a chronic condition that requires ongoing management and support. People with epilepsy can lead fulfilling lives by adhering to their treatment plans, understanding their triggers, and seeking emotional support when needed. It's crucial for individuals with epilepsy to work closely with their healthcare providers to optimize their treatment and minimize the impact of seizures on their daily activities.

Dr. Sunil Singla, Director and Head of the Department


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