By Dr. Dhairyashil Saste

Epilepsy…what everyone should know

Epilepsy affects almost 1.2 crore people in India. Though many people have encountered or have seen people getting fits (known in medical language as seizure), very few people know what to do. Members of the public are in the first line to help a patient, and it is important that we are all more aware about Epilepsy as a society

What is the difference between Epilepsy and seizures?

• A Seizure is a motor or non-motor manifestation of abnormal excessive electrical discharge in brain. It is a single event.
• Epilepsy is the tendency to have recurrent seizures and associated neurobiological, social and emotional effects of having these recurrent episodes.
• It’s clear that Epilepsy is a brain disease and not heart disease as many people believe it to be.

What should you do when you see someone getting seizure/ fits?

• Whenever you see someone having a seizure, don’t try to put anything in their mouth, don’t try to stop the fits by applying counterforce or don’t try to put keys in their hand or use chappals or onion for the patient to smell.
• Instead make the seizing patient lie on the ground. Then try to move them away any sharp objects. If it’s a first time seizure try to video record the event, which will be useful for accurate diagnosis for your doctor.
• Usually most fits stop in less than a minute or two. Many patients lose consciousness and are confused after getting a fit and this is the time when relatives should make him lie on one side so that all the saliva comes out of the angle of mouth and patient does not choke on his own saliva.
• Don’t try to feed the person unless he regains consciousness.

What should you do next?

• Most of patients get one seizure at a time and become all right in 10 to 15 minutes. Once a patient is conscious, take him to the nearest doctor or if possible show him/her to a neurologist.
• Some patients get repeated seizures and do not regain consciousness: this is an emergency situation and the patient needs to be rushed to the nearest hospital.

What investigations are needed to diagnose cause of seizures?

• The usual investigations are routine blood tests as various electrolyte abnormalities can cause seizures.
• Next special investigations is an Electroencephalography ( also known as EEG by its short form), it helps to differentiate generalized seizures from partial onset seizures.
• This differentiation is necessary from the treatment point of view.
• The last and most important investigation is Magnetic Resonance Imaging ( known by its short form MRI). It helps to identify structural causes for seizures like brain tumor or bleeding inside the brain and various other causes.
• In certain patients of Epilepsy the doctor may advise tests like video EEG, functional brain MRI and other tests.

How do you treat Epilepsy?

• Once diagnosed as true Epilepsy and its type characterised, a doctor starts the patient on appropriate antiepileptic medication depending on the patient’s weight, age and any associated co morbid conditions.
• How long does a patient need to take treatment?
• The usual duration of treatment for Epilepsy is 2 to 3 years. After 2 to 3 years if there is a seizure free period the doctor may advise the patient to taper and stop medication.
• In certain types of epilepsies patients might need lifelong treatment.

What are the other treatment modalities other than medications?

• Few patients whose seizures are not controlled by medicines have the option of being cured or obtaining better control of seizures by certain brain surgeries. But keep in mind , these surgeries are to meant complement control by medicines and they are not a substitute treatment for medications.

What precautions should patients take while they are on treatment?

• Epileptic patients should take adequate sleep and avoid late nights, as it might trigger fits even while the patient is taking regular medicines.
• Patients should also avoid driving, swimming and adventure sports until their seizures are completely controlled.
• Patients should avoid alcohol consumption and instead can be benefitted by Yoga and Pranayam.
• Contrary to popular belief ketogenic diet is advised only in very serious cases of refractory epilepsies.

Dr. Dhairyashil Saste

Associate Consultant, Neurology