There is an urgent need to remove the many misconceptions regarding epilepsy. People with epilepsy can excel both intellectually and physically, and can enjoy most sporting and recreational activities, writes DR HOOSAIN PARUK.
EPILEPSY is a brain condition characterised by a tendency to have recurrent, unprovoked seizures. The term ‘unprovoked’ is used to differentiate the seizures in epilepsy from those that occur due to reversible medical conditions, such as alcohol withdrawal or low blood sugar.
Epilepsy affects one out of every 100 people in South Africa at any age, although three-quarters of people with epilepsy experience their first seizure before the age of twenty. There are various causes of epilepsy, including head trauma, complications at birth, brain tumours, infections and developmental problems of the brain. However, no cause is identified in the majority (66 per cent) of people with epilepsy.
A seizure refers to the episode during which there is sudden excessive electrical discharge of a group of brain cells. More commonly, seizures are referred to as fits or convulsions. However, there are different types of seizures and not all may result in convulsive jerking of the limbs. Seizures are generally divided into two major categories, depending on where the abnormal discharge from the brain originates. Seizure activity that involves both sides of the brain from the onset is referred to as a generalized onset seizure as opposed to activity from a group of cells on one side of the brain, which is referred to as focal onset seizure.
Loss of consciousness at onset is typically seen with generalised seizures while awareness may or may not be preserved with focal onset seizures. The prototypical seizure of stiffening of limbs followed by jerking is well known but not all seizures require convulsive movements. Some may be restricted to abnormal sensations, and in others awareness may be impaired without any other features. Seizures usually last between thirty seconds and two minutes.
A diagnosis of epilepsy is usually based on the description of the events from the person experiencing seizures and/or witnesses to the event. Investigations such as imaging of the brain, recording of electrical brain waves activity and selected blood investigations may also be performed to confirm the diagnosis and assist in establishing a possible cause for the epilepsy. Neurologists typically diagnose and treat epilepsy.
Once epilepsy is diagnosed, it is essential that an appropriate management plan is established. This includes the selection of appropriate anti-epileptic medication for an individual and should consider type of seizure, age and gender among other factors. Most people with epilepsy can be well controlled provided they use their medication correctly. It is also important to recognise triggers for seizures, and these would include intercurrent illness, dehydration, sleep deprivation and alcohol or drug use.
There are a few precautions that people with epilepsy need to be aware of. They should avoid working at heights or with dangerous machinery and equipment. Activities such as swimming or sailing should not be performed alone and the opinion of the treating neurologist should be sought with regard to driving a motor vehicle. However, people with epilepsy can enjoy most sporting and recreational activities with relatively little or no adjustment.
There are a few issues that are of special concern to women with epilepsy. A major source of anxiety is the concern that epilepsy can be transmitted to the child. While there is a slightly increased risk of a child born to a mother with epilepsy of also developing the condition, it is not sufficient to prohibit such women from having children.
Second is the effect of anti-epileptic medication of the developing foetus. Some of the medications are more likely to be associated with malformations and are not recommended during pregnancy. It is crucial to discuss this issue with one’s treating doctor prior to conception as changing medication during pregnancy may lead to an increased frequency of seizures, which may pose greater harm to the developing baby.
First aid treatment of seizures is simple and aims to prevent further injury to the person experiencing a seizure. The first step should be to ensure safety of the environment by moving either the person or potentially harmful objects. Placing an object such as a key in the mouth is an action that is commonly promulgated. However, such an action may lead to greater injury and should be strictly avoided.
Most seizures terminate spontaneously within two minutes and no further action beyond assisting the person to lie on their side and providing reassurance is necessary. Medical assistance should be called if a person is not known to have epilepsy, has a prolonged seizure lasting more than five minutes or has recurrent seizures without regaining full consciousness in between.
People with epilepsy have been stigmatised and discriminated against by society in learning, social and occupational settings. There is an urgent need to remove the many misconceptions regarding epilepsy. People with epilepsy can excel both intellectually and physically. They should be encouraged and afforded the opportunity to lead active and full lives.
- Dr Hoosain Paruk (MBChB/ FCN) is a specialist neurologist.