There are over 10 million people living with epilepsy in India. Many people with active epilepsy do not receive appropriate treatment, resulting in a significant treatment gap. The treatment gap is exacerbated by a lack of knowledge about antiepileptic drugs, poverty, cultural beliefs, stigma, poor health infrastructure, and a shortage of trained professionals. Infectious diseases play a significant role in the long-term burden of seizures, causing both new-onset epilepsy and status epilepticus. In a country like India, proper education and health care services can make a huge difference. Throughout India, there have been numerous original studies on various aspects of epilepsy. On this International Epilepsy Day, let’s understand the causes, symptoms, and possible treatment options to spread awareness and end the stigma associated with this neurological health disorder.
What is Epilepsy?
Epilepsy is a neurological condition that affects the brain and makes people more prone to seizures. It is one of the most common nervous system disorders, affecting people of all ages, races, and ethnic backgrounds. Seizures can be caused by anything that disrupts the normal connections between nerve cells in the brain. This includes a high fever, low blood sugar, high blood sugar, withdrawal from alcohol or drugs, or a brain concussion. Anyone can have one or more seizures under these conditions. When a person has two or more seizures, he or she is diagnosed with epilepsy.
What Causes Epilepsy?
Some types of epilepsy are caused by problems with the foetal brain's early development, while others are caused by inborn metabolic problems or early oxygen deprivation, which leads to scarring. Other epilepsies are caused by brain trauma, stroke, infection, tumour, or genetic predisposition. A few others have no obvious cause. Three out of every ten people who have epilepsy have structural changes in their brain that cause chronic seizures. These changes can be congenital (present at birth) or acquired later in life. Researchers are investigating the role of genes in epilepsy, but the relationship is complex, and genetic testing may not reveal a specific cause. Most epilepsy can be treated with medication, diet, nerve stimulation, or, in some cases, surgery.
Types of Epilepsy
GLUT-1 Deficiency Syndrome
A metabolic problem can cause epilepsy such as GLUT-1 deficiency syndrome. GLUT-1 deficiency syndrome is characterised by problems with glucose transport to the brain. Speech may be especially affected. A lumbar puncture can aid in the diagnosis of the condition. A ketogenic diet, which is high in fat and protein and low in sugar and carbohydrates, can be used to treat GLUT-1 deficiency. Children who begin the diet early and stick to it can see significant improvements. If seizures continue, the doctor may prescribe medication.
As a foetus develops in the womb, neurons migrate from the innermost parts of the brain and organise to form the cortex, or outer layer of the brain. Cortical dysplasia cells can develop if this process is disrupted. The misplaced neurons send out abnormal signals to one another, resulting in recurring seizures. Anti-seizure medications are typically used to treat seizures caused by cortical dysplasia. If these medications fail to control the seizures, surgery may be recommended.
Hemimegalencephaly is a rare form of cortical dysplasia. This condition, which is present at birth, is characterised by one hemisphere (half) of the brain being larger than the other. Hemimegalencephaly can result in frequent seizures as well as developmental delays. Surgeons can remove the affected hemisphere of the brain, allowing the healthy hemisphere to adapt and take over the functions of the other hemisphere. The ability of healthy brain tissue to compensate for damaged areas is known as neuroplasticity.
Mesial Temporal Sclerosis
The temporal lobe is a part of the brain located on the side of the head beneath the temples. Mesial temporal sclerosis occurs when scars form in the inner, or mesial, portion of the temporal lobe known as the hippocampus. Head trauma or a brain infection can also prevent oxygen from reaching the temporal lobe, causing brain cells to die. Scar tissue can form in the hippocampus and amygdala, two brain regions that govern short-term memory and emotions. A person suffering from this condition may develop temporal lobe epilepsy with partial (focal) seizures that can spread to other areas of the brain. Anti-seizure medications, a low-carb diet, surgery, or nerve stimulation are all possible treatments.
Traumatic Brain Injury
People who have had head injuries from falls, car accidents, sports injuries, and other accidents are more likely to have seizures or epilepsy than those who have never had a head injury. The more head trauma a person has, the more likely he or she is to have seizures. Post-traumatic epilepsy may also be influenced by genetic factors. Medication, diet, surgery, or neuro-stimulation may all be used in treatment.
Symptoms of Epilepsy
Seizures are a symptom of epilepsy (fits). These are episodes of altered electrical activity in the brain that can vary greatly depending on which part of the brain is involved. Seizures can result in symptoms such as loss of consciousness (passing out), unusual jerking movements (convulsions), and other unusual feelings, sensations, and behavioural patterns. Seizures come in a variety of forms. Because generalised seizures affect the entire brain, the entire body is affected. Only a portion of the brain is involved in focal seizures.
Generalised tonic-clonic seizures
These types of seizures, formerly known as "grand mal seizures," are the most well-known. The seizure begins with a sudden loss of consciousness, followed by stiffness and muscle jerking. Common symptoms include turning red or blue, tongue-biting, and loss of bladder control. When you regain consciousness, you may experience confusion, drowsiness, memory loss, headache, and agitation.
Absence seizures were previously known as 'petit mal seizures,' and they typically begin in childhood but can occur in adults. These seizures are brief and characterised by staring, loss of expression, unresponsiveness, and cessation of activity. Eye blinking or upward eye movements are occasionally observed. The person usually recovers quickly and resumes their previous activity, with no recollection of the seizure.
Partial seizures, as they were previously known, begin in one area of the brain and affect the parts of the body controlled by that area of the brain. Seizures can cause abnormal movements, feelings, sensations, or behaviours. During focal seizures, people's levels of consciousness can vary.
Febrile convulsions are common seizures that occur in approximately 3 out of every 100 healthy children aged 6 to 12. The seizures are caused by an illness that causes a fever, such as a viral infection, and are generally harmless. This is usually handled by treating the seizure and, if necessary, the cause of the fever. If no other risk factors for epilepsy exist, children who have febrile convulsions have a similar risk of developing epilepsy as the general population.
Diagnosis of Epilepsy
An individual’s seizure history is used to make an epilepsy diagnosis. The doctor will ask you what you remember and if you had any symptoms prior to the seizures, such as feeling strange or any other warning signs. It may be beneficial to speak with anyone who witnessed your seizure and ask them what they saw, especially if you are unable to recall the seizure. Your doctor may also order blood tests, an EEG (electroencephalogram), and brain scans (like a CT scan or an MRI). You could have epilepsy even if the EEG and brain scans are normal. However, abnormal findings can aid in classifying the type of epilepsy present. If your child or someone you know has a seizure, you should record it on your phone. This can assist your doctor in making a more precise diagnosis.
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Early medication treatment can help reduce seizure frequency and the likelihood of serious complications. Meanwhile, most epilepsy surgeries are considered curative. There are dozens of other avenues of research into the causes, treatment, and potential cures for epilepsy. Although there is currently no cure, the right treatment can result in a significant improvement in your condition and quality of life.