Epilepsy is one of the most common neurological disorders with hugely varied presentations. There are about 70 million people with epilepsy worldwide and of these 12 million people live In India. Traditionally, our perception of seizures is limited to the dramatic ‘Grand mal’ seizures (now tonic- clonic seizures). In reality, the disease encompasses a large number of other seizure types.

What is a Seizure?

A seizure is a transient occurrence of signs and/or symptoms due to abnormal excessive neuronal activity in the brain.

What is Epilepsy?

Epilepsy refers to enduring predisposition to generate seizures and the consequences (neurobiological, cognitive, psychological, and social) of this condition. In other words, a seizure is an event and epilepsy is the disease involving recurrent unprovoked seizures. We consider epilepsy when a person comes with at least 2 unprovoked seizures occurring more than 24 hours apart; or already has features suggesting an epilepsy syndrome.

Classification of epilepsies

The International League Against Epilepsy (ILAE) presents a revised framework for the classification of the Epilepsies, designed to work with the classification of seizure types. We consider:

• Levels of diagnosis: seizure type, epilepsy type (focal, generalized, combined generalized and focal, unknown) and epilepsy syndrome
• An etiologic diagnosis (for the cause of seizure) should be considered from when the patient first presents, and at each step along the diagnostic pathway as it aids management.

A systematic approach to patients who present with a first seizure helps distinguish between an acute symptomatic seizure, a provoked or unprovoked seizure, and potential mimics. Routine testing with EEG and MRI may reveal a predisposition for further seizures and help to establish the underlying epilepsy syndrome. An acquired cause can be identified in about one third of patients with established epilepsy. The remaining 70% of patients have a presumed genetic etiology.

Management of epilepsies

Pharmacologic treatment:

Various antiepileptic drugs are available in the current era. The choice of drug depends on the type of epilepsy, pregnancy or other vulnerable physiological states, and the presence of comorbidities such as psychiatric illnesses or obesity. Valproate, phenytoin and levetiracetam are amongst the many drugs available.

Nonpharmacologic treatment:

Ketogenic diet, avoiding stressful lifestyle, proper sleep hygiene, avoiding alcohol will help in seizure control. Proper patient education and counselling goes a long way in preventing morbidity. Particularly in patients with specific epilepsy syndromes or suspicion for an autosomal dominant inheritance, genetic testing and counselling should be considered.

Epilepsy surgery

In certain epilepsies where there is structural defect in the brain, resection of epileptic zone is helpful in controlling seizures. Practical Strategies advised to Reduce Risk of Seizure - related Injury

• Wear a helmet when biking or horseback riding
• No unsupervised swimming
• Use a shower rather than a bathtub
• Adjust the temperature on the hot water heater to lower the risk of scalding
• Use a microwave versus a stovetop
• Avoid locking the bathroom or bedroom door
• Place bed mattress on the floor
• Use an epilepsy safety pillow (designed to reduce risk of suffocation if lying face down)
• Use soft or padded furniture
• Avoid high ladders
• Follow driving regulations for people with epilepsy
• Take medication as prescribed

Conclusion

Epilepsy is a treatable condition and we should guide these patients towards proper treatment modalities. Finally it’s our duty to help these patients live normal lives without any social bias.