Epilepsy is seizure disorder. Like heart, the brain also has electrical activity and a seizure is an overloading of that. A seizure (fit or convulsion) is an excessive electrical discharge of the nerve cells leading to abnormal posturing of limbs, just drop attacks or clenching of teeth and even unconsciousness. They are of varied types. Some patients may just have blank spells and some may have abnormal postures with or while not loss of consciousness.

The two main types are:

a. Partial seizures.

b. Generalized seizures.

Partial seizures:

The electrical discharge begins in one a part of the brain leading to involvement of only one side of body. They are also known as focal seizures. If the patient remains conscious throughout the episode it is known as simple partial seizure and if becomes unconscious, it is known as complex partial seizure. A fit that starts in one a part of the body and then involves entire body due to spread of electrical discharge to other parts of brain is called as partial seizure changing into secondarily generalized.

Generalized seizures:

Here, the electrical discharge involves almost the complete brain and patient has fits of entire body associated with loss of unconsciousness. Absence seizures are a form of seizure during which a patient has a brief spell of staring blankly and becoming unresponsive for a few seconds to minutes. And yes, prolonged seizures can be life threatening! Because if unstopped, they lead to decreased oxygen supply to the brain. Fortunately, that is very rare. Epilepsy is a seizure disorder where due to low threshold for a nerve cell to throw an electrical discharge, there’s a lot of vulnerability to too discharge. The cause of most kinds of epilepsy is not known. It isn’t contagious at all. However, some types of epilepsy are inherited and have a strong familial pattern! Quite obviously, more the duration of seizures, more brain damage they cause. They can lead to a social handicap in terms of mobility and jobs that require being totally avoided are driving, working close to electricity, working at heights or working underwater. Some patients might even develop poor memory due to either the disease or the treatment.

So, what triggers these seizures?

There are various conditions to blame like low blood sugar, high blood pressure, meningitis (infection of the brain), brain tumor etc. except for epilepsy itself. Alcohol in giant amounts as well as alcohol withdrawal can trigger a seizure. Excessive stress, worry and anxiety may also precipitate seizure. Sometimes epilepsy is also related with a metabolic disorder in which case certain food items may have to be omitted. Lack of sleep can also precipitate seizures. The flickering light in video games and changing patterns of images can become precipitators too. Certain drugs such as antidepressants, antibiotics, theophylline may provoke a seizure. If you are worried that your epileptic child will have problems at school, then you should know that most children with well-controlled seizures and no additional handicap can attend a normal school. Of course, extra-curricular activity like climbing, swimming and cycling on road are a total no no. Inform the school teacher regarding the child’s disorder so that it’ll help them to know what to expect when a child has a seizure and decide what to do.

Epilepsy treatment consists of giving a class of drugs called anti-convulsant drugs. Prior to starting therapy, your doctor might advise certain tests such as EEG, CT SCAN of brain or MRI to decide what seizure kind is it and decide on best treatment option. Now, EEG may be abnormal in only about 60% of patients with epilepsy. Also, a small proportion of general population might have epileptiform abnormalities in EEG. So, EEG can’t be relied for the identification of epilepsy, but, is useful in identifying type, detecting a structural brain abnormality and differentiating between true seizures and pseudoseizures. Most children with epilepsy stop having seizures once they are put on treatment. If seizure free, doctors continue treatment for 2-3 years and then gradually taper it off. But remember, the chance of having another seizure is minimum but still exists. There is increased recurrence risk after the treatment is stopped when age greater than 16 years at onset of seizures, there are break through seizures on treatment and the EEG is abnormal. If the seizures are continuing despite treatment, there can be several reasons. Either the drug you are taking is inappropriate for your kind of seizure, or there is incorrect dose of drug or you are not taking the treatment regularly. It can also mean worsening of the underlying condition. Sometimes, the patient might not even have epilepsy at all and seizures are occurring due to some other condition. The last of course is that the patient has true drug resistant seizure. Now, let’s say that your child missed his drug dose. If only one dose has been forgotten, the next dose can be doubled except for carbamazepine.

For carbamazepine, there ought be a gap of a couple of hours between regular dose and extra dose.Anti-convulsant drugs have lots of side-effects. Some such as phenobarbitone or phenytoin can cause memory disturbance. Others might cause cosmetic side effects like increase in gums or weight gain. Sometimes, if the patient doesn’t respond to multiple drugs and appropriate anti-seizure medication, doctors consider them for epilepsy surgery. Few patients respond to diet modifications too. Ketogenic, i.e., high fat diet is used in small group of children with resistant seizures. So, if there is an epileptic in your family, it’s your duty to be fully aware about the first-aid for a seizure.

Once a patient has seizures, clear the mouth to forestall problem in breathing. Put nothing in the mouth as it won’t prevent biting however may obstruct breathing. Turn the patient on the side so that tongue doesn’t fall back & hinder the airway. Do not try to hold the tongue. Imply a doctor and ambulance if seizures last more than 10 minutes! Like the two sides of a coin, epilepsy can also only have two outcomes, good or bad. There are higher chances of bad outcome when the epilepsy is difficult to control, more than one anti-seizure drugs are being used to control seizures, there is associated with structural brain damage, mental retardation or cerebral palsy, there are repeated episodes of prolonged seizures or the seizures have started early (before 2 years of age). On the other hand, epilepsy starting between 5 and 13 years of age, inherited epilepsy, easily controlled and requiring only one drug are associated with good outcome. That’s the crazy thing regarding epilepsy: we can’t see inside the brain, and that we just have to wait and see how it develops.

Sources (s): http://www.pediatriconcall.com/fordoctor/Diseases_a_z/article.aspx?artid=188