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Seizures and epilepsy? What is the difference between the two terms? The brain normally has electrical currents in the brain, which help the brain to control different functions of the body. Sometimes these electrical currents increase suddenly; this is conducted to the body and produces actions and behaviors, which are called seizures. There are many different types of seizures depending on the area of the brain where the seizures occur. They can manifests as: • Impairment or loss of consciousness • Abnormal motor activity (like jerking) • Behavioral abnormality • Abnormal sensations Seizures occur because of many reasons like: • Metabolic events • Brain Infections • Drug intoxication/side effects • Hypoxia or lack of oxygen delivery to the brain • Head Injury • Febrile seizures or seizures due to fever Epilepsy, on the other hand, means recurrent seizures without an immediate precipitating cause. Epilepsy results from old damage to the brain or genetic causes.
2. How can we diagnose epilepsy?
Diagnosis of epilepsy is clinical. Investigations or tests are used only to support the diagnosis. Clinical diagnosis means asking for details of the event, when and how the event started and progressed, how long it was and how it ended.
Besides this, birth, development and family history are also taken in detail.
3. What tests are required?
MRI of the brain and EEG (Electroencephalogram) are important tests. Other tests of blood, biochemistry tests and genetic testing may be required, and will be decided by the doctor.
4. What is an EEG? And how does it help? Can EEG be normal in Epilepsy? An EEG is an electrical recording of the brain currents. Just as you have an ECG for the heart, EEG studies currents of the brain. But it is much more complicated, and has many channels or lines. The procedure typically takes 30 minutes to one hour, but can be done for longer periods, depending on the case. It gives information about the type of epilepsy and can suggest what type of treatment would be best. The first EEG can be normal in about 40-50 per cent of the people with epilepsy. It may become abnormal only when a seizure is occurring. Repeating an EEG 2 or 3 times may be required sometimes to get a positive report. Also, about 10% of normal people may have an abnormal EEG. 5. What is an MRI? How does it help? Can an MRI be normal in Epilepsy?
An MRI is a detailed image of the brain. It shows the structure of the brain, and can suggest why seizures are occurring. Many types of MRI are available. The 3 Tesla MRI may sometimes be required. The MRI may be normal in many cases of epilepsy, usually the genetic epilepsies.
6. What is the role of genetics in Epilepsy?
The genes of the child may be abnormal, and this may cause epilepsy. The genetic abnormality may be inherited, but may also occur in the child for the first time.
7. Can there be other problems along with epilepsy?
Epilepsy may be associated with developmental delays or intellectual disability, cerebral palsy, autism, learning disorders and behaviour problems. 8. Seizures are an emergency. What should parents do if a seizure occurs at home?
• In case of seizures — put on the side, and nothing should be put into the mouth — no finger, spoon, water, milk. No odd procedures like shoe smelling or onion smelling under the nose.
• The time should be noted, and video recording of the seizure should be made with the cell phone. • If the child is a known case of seizures or epilepsy, the doctor will prescribe medicine for spraying into the nose. • In case the seizure does not stop, in 5 minutes, the child should be taken to the hospital.
9. How is epilepsy treated?
The child will be given treatment with anti- seizure drugs. There are many types of drugs. The drug given will depend on the seizure type and the underlying cause.
10. Can seizures occur even if treatment is going on?
Yes, seizures can occur even if the medicines are going on. Many times, the parents stop the drug suddenly or forget to give the dose. At that time, seizures may occur. At other times, the child probably needs a higher dose of the drug, and this will be increased by the doctor according to the requirement. Sometimes multiple drugs are required for control.
11. How long should the treatment be given? The treatment is typically given for 2 -3 years seizure free period. In some children, the duration may be shorter – 1–1.5 years. 12. Can we say at the end of treatment, when we stop the medicine, that the child is cured? The medicines do not cure epilepsy, they only suppress seizures. The only way to find out is to stop the drugs and see. The medicines have to be stopped gradually. Recently, the concept is that epilepsy is considered cured only if there are no seizures for 10 years, and of this at least 5 years should be without medicines. 13. What are seizure precautions? These are precautions which are taken either to: a. avoid situations that precipitate seizures in certain types of epilepsies eg flickering lights in some epilepsies. b. Prevent injuries during a seizure eg swimming, cycling, swings, or going near fire 14. Epilepsy is a chronic disease. Does the government give it weightage in the disabilities act? Are there any schemes for children with epilepsy? Epilepsy is not considered a disability under the Rights of Persons with Disabilities Act of 2016. However, epilepsy with uncontrolled seizures may be considered a disability as a chronic neurological disorder, under the act. This will depend on the medical board giving the certificate. This entitles the parents to avail of Income Tax Deductions under Section 80 DD. Additionally if there are associated disabilities like developmental delay, Cerebral Palsy or autism, then the Insurance scheme called Niramaya may be availed. There are also many government schemes that are available.
Additional Director – Pediatric Neurology
Madhukar Rainbow Children’s Hospital, New Delhi