Epilepsy is a chronic disorder of the brain that is characterized by recurrent seizures due to abnormal neuronal activity. In epilepsy, any alterations in the brain function or its structure cause seizures. The changes in the brain function might be due to an imbalance of transmitters, local structural changes in the brain, infections like Neurocysticercosis or tuberculosis, brain tumors due to brain injury secondary to stroke or trauma
What is a Seizure?
A seizure is a sudden rush of electrical activity that takes place within the brain. This electrical activity can remain localized to one part of brain (focal) or spread to other brain parts and then whole brain (generalized). This can lead to various manifestations ranging from brief abnormal movements to loss of consciousness. Prolonged and recurrent seizures can lead to various injuries and can even be life threatening.
Symptoms Associated with Epilepsy
Epilepsy is characterized by repeated seizures that make up for the primary symptoms. However, there are more epilepsy symptoms including:
- Abnormal jerky or twisting movements of one limb or part of body
- Twisting movements of all four limbs
- Brief moments of blackout or unresponsiveness specially in children
- Unable to follow or respond to instructions
- Falling for no explainable reason
- Rapid instances of chewing, or clenching jaw for no reason
- Repetitive movements that are usually inappropriate
Types of Epilepsy
Epilepsy is a brain disorder that takes place when individual nerve cells in the brain start misfiring. The kind of seizure characterizes the type of epilepsy. All sorts of epilepsy have seizures as a symptom. We can categorize epilepsy as below:
In generalized epilepsy, seizures start on both sides of the brain, or it can start on one side but quickly spread to the network of brain cells on both the sides. Generalized epilepsy has two kinds of seizures:
- Generalized Motor Seizures – Generalized motor seizures cause the body to move in ways that are out of control. It usually makes the movement dramatic where the muscles stiffen up and jerk. They are further classified into:
- Tonic-clonic Seizures – In this subtype, loss of consciousness is accompanied by body stiffness and shaking
- Clonic Seizures – This subtype causes a patient to experience rhythmic and jerky movement
- Tonic Seizures – In this subtype, muscles become stiff which leads to falling
- Generalized Non-Motor Seizures – Also known as absence seizures, generalised non-motor seizures leads a patient to repeat similar movements. It also makes them feel like they are not really there and forces them to stare into space. They are further classified into:
- Absence Seizures – There is a brief period of lapses in consciousness where a person appears to be staring into space.
- They are of two types – typical and atypical.
- Myoclonic Seizures – These seizures are classified by involuntary twitching of muscles or a group of muscles. Usually present as jerky movements of upper limbs. These types of seizures cause the muscles to tense.
- Atonic Seizures – Loss of muscle control (limp muscles) which leads to a fall.
As opposed to generalised epilepsy, focal epilepsy causes seizures to develop on one side of the brain. Also known as partial seizures, focal seizures are further classified into four categories:
- Focal Aware Seizures – They are also known as simple partial seizures and are characterised by an awareness of the surroundings with abnormal movements of one limb or part of body. Here, the patient is aware what is going on around them.
- Focal Impaired Awareness Seizures – In this seizure, the patient is confused, and their consciousness is impaired. It is also known as complex partial seizure, and the patent has only a vague memory of the seizure episode.
- Focal Motor Seizures – In this type of seizure, the patient’s movement is limited. It is characterised by spasms, twitching, rubbing hands and walking around.
- Focal Non-Motor Seizures – In this type, there is no movement or twitches. Instead, it leads to a change in how a patient thinks or feels. It is characterised by a range of intense emotions accompanied by goosebumps or waves of cold or heat.
- Generalized and Focal Epilepsy – In this type of epilepsy, a person has both generalised and focal seizures.
- Unknown if Generalized or Focal Epilepsy – In this type of epilepsy, the doctors know that a person has epilepsy but are not sure if the person has had focal or generalised seizures. It happens when the patient is alone during a seizure and is unable to describe its intricacies. Doctors must know the epilepsy causes and detailed medical history to diagnose the type of epilepsy.
Epilepsy treatment in India at Max Healthcare is one of the best in the country. Max Institute of Neurosciences provides comprehensive treatment options, and the epilepsy treatment is carried out by an epileptologist. Epilepsy patients require comprehensive evaluation which starts from detailed clinical examination, imaging (MRI Brain), EEG or Video EEG, Nuclear Imaging(SPECT/PET) along with support from clinical psychologist and Neurosurgery. Once a person is diagnosed with epilepsy, the treatment options are chosen by the epileptologist depending on the type of epilepsy. Remember, the best treatment for epilepsy varies from case to case. So, if something works for one person, it may not necessarily work for someone else. Treatment options include
- Medications – Medications help in controlling seizures, and almost all patients with epilepsy are prescribed anti-seizure or anticonvulsant medications. These medications change the way brain cells work and send messages to them. A large number of medications are available and which medicine will work for a particular patient requires a lot of factors to be considered, including age, sex, type of seizures and number of seizures. At times even 2 -3 different medications can be given to same patient.
- Ketogenic Diet – The ketogenic diet is low in carbohydrates and high in fats. However, this diet is prescribed to patients after identifying the type of seizure. This diet is usually more suited to children when medications do not make a difference to the seizures.
- Nerve Stimulation – Nerve stimulation is the use of electric current to stimulate nerves and control the seizures. Nerve stimulation is used in Epilepsy patients who are not responding to medications and are also not suitable for an epilepsy surgery. It is of two types:
- Vagus Nerve Stimulation – Vagus nerve is a cranial nerve that runs from the chest and abdomen through the neck to the lower part of the brain. This nerve controls the automatic processes in the body such as the heartbeat. A neurosurgeon connects a device called a vagus nerve stimulator to the nerve under the skin around the chest area. This device sends small bursts of electricity to the brain through the nerve which helps in preventing seizures. However, medications are still required even after this epilepsy treatment.
- Responsive Neurostimulation – A neurostimulator is put under the scalp which scans the brain for various activities that can lead to a seizure. As soon as the neurostimulator identifies a pattern that can potentially lead to a seizure, it sends out a pulse of electricity that interrupts it.
- Surgery – Epilepsy treatment in India is also carried out using surgery. In certain types of epilepsy, surgery is having benefit in as much as 90 % of patients. Surgery is usually advised to patients how are refractory to medications. It requires comprehensive evaluation and assessment. There are two main kinds of surgery, including:
- Resective Surgery – In this surgery, the neurosurgeon removes a part of the brain that causes seizures. It is only done in cases where the part of the brain causing the seizures is small and does not interrupt other processes in the body such as movement, sight, speech or even hearing.
- Disconnective Surgery – In disconnective surgery, the neurosurgeon cuts the path between the nerves that cause seizures.