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What is Epilepsy - It's Causes & Treatment

Epilepsy or Seizure Disorder is a non-communicable disease caused due to disturbed or irregular nerve cell activity in the brain which leads to seizures. Epilepsy affects people of all ages; nearly 50 million people suffer from it across the world: making it one of the most common non communicable neurological diseases. It can be caused due to genetic disorders or in some cases through trauma or injury to the brain. 

While enduring seizures, people may experience a host of different symptoms such as abnormal behaviour, sensations, loss of consciousness and bowel / bladder functions. Symptoms may also include temporary confusion and long spells of staring. The psychic symptoms include excessive fear, anxiety and severe deja vu. Physical manifestations include muscle spasm accompanied by intense jerking movements of the arms and legs. Seizures can vary from the briefest lapses of attention or muscle jerks to severe and prolonged convulsions. Seizures can also vary in frequency, from less than 1 per year to several per day. Epilepsy is diagnosed after experiencing two or more unprovoked seizures (10% of the global population has experienced one seizure during their lifetime). There are other collateral issues that may arise owing to epilepsy as well. People with epilepsy tend to have more pronounced physical problems (such as fractures and bruising from injuries related to seizures, along with slower healing processes) as well as higher rates of psychological conditions, including anxiety and depression. People with epilepsy face a higher risk of premature death: up to three times higher than in the general population, with the highest rates of premature mortality found in low- and middle-income countries and in rural areas (India reports more than a million cases of epilepsy per year). 

Epilepsy is not communicable (or contagious) and the cause of disease is still unknown in about 50% of the cases. 

Causes of Epilepsy

The causes can be broadly divided into genetic, structural, metabolic, infectious, immune and unknown. These include the following - 

  • • prenatal or perinatal brain damage (e.g. a loss of oxygen or trauma suffered during birth, low birth weight);
  • • genetic conditions or congenital abnormalities with associated brain malformations;
  • • suffering severe head injury;
  • • a stroke that restricts the amount of oxygen to the brain;
  • • an infection of the brain such as meningitis, encephalitis or neurocysticercosis,
  • • certain genetic syndromes; and
  • • a brain tumour.

Treatment of Epilepsy

There is no guaranteed course of treatment which cures epilepsy but the occurrence of seizures can most definitely be controlled. Epilepsy is self-diagnosable if people are made aware of the symptoms as stated above; this can enable them to lead normal lives and avoid the triggers that cause seizures. Up to 70% of people living with epilepsy could become seizure free with appropriate use of antiseizure medicines. Low-cost treatment is available, with daily medication that costs as little as US$ 5 per year (300 odd rupees). Discontinuing anti-seizure medicine must be taken into consideration after 2 years without seizures and should take into account relevant clinical, social and personal factors. A documented etiology of the seizure and an abnormal electroencephalography (EEG) pattern are the two most consistent predictors of seizure recurrence. It is possible to diagnose and treat most people with epilepsy at the primary health-care level without the use of sophisticated equipment. Unfortunately, antiseizure medicines are not easily available in low to middle income countries and this causes what is known as the “treatment gap”.

Prevention- approximately 25% epilepsy cases are preventable. Spreading awareness and good health governance can go a long way in stalling the rise of epilepsy among masses. Some conventional preventive measures are - 

  • •Preventing head injury is the most effective way to prevent post-traumatic epilepsy.
  • •The use of drugs and other methods to lower the body temperature of a feverish child can reduce the chance of febrile seizures.
  • •Adequate prenatal and perinatal care can reduce new cases of epilepsy caused by birth injury.
  • •Epilepsy associated with stroke can be prevented by reduction and avoidance of cardiovascular risk factors such as high blood pressure, smoking, narcotics, diabetes, excessive alcohol consumption and stress. 
  • •Central nervous system infections are common causes of epilepsy in tropical areas (India included) where many low- and middle-income countries are concentrated. Elimination of parasites in these environments and education on how to avoid infections can be effective ways to reduce epilepsy worldwide. 

There is unfortunately a huge amount of stigma attached with people who suffer seizures (not epilepsy: which is the cause) across the world. Social ostracism and shame further halt the prevention and treatment associated with this disease. Greater awareness needs to be raised on epilepsy, especially in suburban and rural landscapes; government subsidies need to be provided for antiseizure drugs and easy availability needs to be made reality.   

We can do our part by sharing awareness in a compassionate manner and contributing in any way, shape or form towards the prevention and treatment of this most unfortunate disease. 

Dr. Madhukar Bhardwaj
Senior Consultant
Neurology

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