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Epilepsy Treatment in India

What is Epilepsy ?

Epilepsy is a chronic disorder, the hallmark of which is recurrent, unprovoked seizures. A person is diagnosed with epilepsy if they have two unprovoked seizures (or one unprovoked seizure with the likelihood of more) that were not caused by some known and reversible medical condition like alcohol withdrawal or extremely low blood sugar.

Seizures in epilepsy may be related to a brain injury or genetic predisposition, but often the cause is completely unknown. The word “epilepsy” does not indicate anything about cause of the person’s seizures or their severity.

Many people with epilepsy suffer from more than one type of seizure and may have other symptoms of neurological problems as well. Sometimes EEG (electroencephalogram) testing, clinical history, family history, and outlook are similar among a group of people with epilepsy. In these situations, their condition can be defined as a specific epilepsy syndrome.

Causes of Epilepsy

Epilepsy has no identifiable cause in about half the cases. For the rest, the condition may be traced to various factors including:

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  • Genetic influence. Some types of epilepsy (categorized by the type of seizure you experience or the part of the brain that is affected), run in families. In these cases it's likely there's a genetic influence. Researchers have linked some types of epilepsy to specific genes, but for most people, genes are only part of the cause of epilepsy. Certain genes may make a person more sensitive to environmental conditions that can trigger seizures.
  • Head trauma. Head trauma as a result of a car accident or other traumatic injuries can cause epilepsy.
  • Brain conditions. Brain conditions that cause damage to the brain, such as brain tumors or strokes can also cause epilepsy. Stroke is a leading cause of epilepsy in adults over 35.
  • Infectious diseases. Infectious diseases, such as meningitis, AIDS and viral encephalitis, can cause epilepsy.
  • Prenatal injury. Even before birth, babies are sensitive to brain damage. This can be caused by several factors including an infection in the mother, poor nutrition or oxygen deficiencies. Brain damage can result in epilepsy or cerebral palsy.
  • Developmental disorders. Epilepsy can sometimes be associated with developmental disorders such as autism and neurofibromatosis.

Symptoms

Because epilepsy is caused by abnormal activity in the brain, seizures can affect any of the processes your brain coordinates. Symptoms of seizures may include:

  • Temporary confusion
  • Long spells of staring blankly
  • Uncontrollable jerking motions of arms and legs
  • Loss of consciousness
  • Psychic symptoms such as fear, anxiety or deja vu

Symptoms vary depending on the type of seizure. In most cases, a person with epilepsy tends to have the same type of seizure each time, so symptoms too will be similar from episode to episode. Doctors generally classify seizures as either focal or generalized, based on how the abnormal brain activity begins.

Focal seizures

When seizures result from abnormal activity in just one specific area of your brain, they're called focal (partial) seizures. These seizures fall into two categories:

  • Focal seizures without loss of consciousness. Previously known as simple partial seizures, these seizures don't cause loss of consciousness. But they can alter emotions or change the way things look, smell, feel, taste or sound. They can also result in involuntary jerking of body parts like an arm or a leg and spontaneous sensory symptoms such as tingling, dizziness and flashing lights.
  • Focal seizures with impaired awareness. Also known as complex partial seizures, these seizures involve a loss of consciousness or change in awareness. During a complex partial seizure, you may stare into space without responding normally to your environment or perform repetitive movements such as hand rubbing, chewing, swallowing and walking in circles.

Symptoms of focal seizures may be confused with other neurological disorders such as migraines, narcolepsy or mental illness. Thorough examinations and testing are needed to distinguish epilepsy from other disorders.

Generalized seizures

Seizures that involve all areas of the brain are called generalized seizures. There are six types of generalized seizures.

  • Absence seizures. Absence seizures, previously known as petit mal seizures, often occur in children. Symptoms include staring into space or subtle body movements such as eye blinking and lip smacking. These seizures occur in clusters and can cause a brief loss of awareness.
  • Tonic seizures. Tonic seizures cause stiffening of your muscles. These seizures usually affect muscles in your back, arms and legs and may cause you to fall to the ground.
  • Atonic seizures. Atonic seizures, also known as drop seizures, cause loss in muscle control, which can make you suddenly collapse or fall down.
  • Clonic seizures. Clonic seizures are associated with repeated or rhythmic jerking muscle movements. These seizures usually affect the neck, face and arms.
  • Myoclonic seizures. Myoclonic seizures usually appear as sudden brief jerks or twitches in your arms and legs.
  • Tonic-clonic seizures. Tonic-clonic seizures, previously known as grand mal seizures, are the most severe type of epileptic seizure and can cause abrupt loss of consciousness, body stiffening and shaking, and can even result in loss of bladder control and biting your tongue.

Diagnosis and Tests for Epilepsy

Patient are required to have an electroencephalograph (EEG), which is carried out to read the electrical activity of the brain. Seizure presence is confirmed by taking this test. It is essential to conduct prolonged EEG monitoring as EEG can return to normal between seizures. In order to locate any damaged brain tissue or scar tissue, computer tomography (CT) scanning and magnetic resonance imaging (MRI) can be done. Most times PET (positron emission tomography) can also be performed for examining blood flow to the brain.

Surgery for Epilepsy

Surgery is only performed after different tests confirm that the seizures develop in a well defined area of the brain without disturbing vital functions like motor function, hearing, vision, language or speech. During the surgical procedure, the affected area of the brain that causes seizures is removed. A different type of surgery is required when seizures occur in a part of the brain that cannot be removed. In such a case, the surgeon makes cuts in the brain in order to prevent spread to different parts.

Epilepsy Treatment Options

Treatment for epilepsy does not begin till the patient has a second seizure. Quite often a person may have one seizure and never a second one. Medicines do not cure epilepsy, they prevent recurrence of the seizures. These medicines changes the chemical and electrical transmissions in the brain in a way that decreases the chance of a seizure.

Vagus Nerve Stimulation (VNS) : VNS therapy is recommended when medicines are unable to control epilepsy. During the surgical procedure, an electrical device is implanted underneath the skin. The lead of this device is wrapped around one a nerve on the left side of the neck. This is the vagus nerve. The device continuously passes an electric dose to the nerve in order to stimulate it. This process reduces severity and frequency of seizures. If a person is feeling a warning symptom of a seizure, then extra stimulation is provided to prevent recurrence.

Ketogenic Diet : Also considered as one of the treatments for epilepsy, the ketogenic diet is recommended for children. It involves a diet low in proteins & carbohydrates and high in fats. The chemical balance of the brain can be altered to reduces the chance of having a seizure. Ketogenic diet is not meant for adults as the diet can result in serious medical condition like heart disease, high blood pressure or strokes.