Seizure disorder

http://www.telegraphindia.com/1160208/jsp/knowhow/story_67973.jsp

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Your Health - Dr. Gita Mathai

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Epilepsy is scary to see. In a typical "grand mal" seizure there is uncontrolled flaying of hands and legs, rolled up eyes, a guttural sound, and a chance of the tongue getting bitten. The person usually falls to the ground, bowel and bladder control may be lost and there may be loss of consciousness. The seizure ends with the person waking up in a few minutes, unaware of the occurrence. Small wonder that in ancient times epilepsy was equalled with demon possession!

If you witness such an attack, don't try to hold the victim down. Seizures are usually self-limited. The best thing to do is turn the person to one side, clear the immediate area of sharp objects and remain with the person till the "fugue" or confused state wears off.

All the muscles in our body are controlled by electrical signals originating in our brain. If electrical signals become uncontrolled with rapid firing, the muscles respond with twitches or seizures. Once the "fuse" blows, the movements stop.

Typical "grand-mal" seizures involve the whole body. Partial seizures involve only one half of the brain or sometimes just a small area. There may be sudden repetitive movements in certain voluntary muscle groups. The person may wander off or see, say, hear and do things they have no recollection of later. They may suddenly find themselves in strange surroundings. They may just stare blankly and be unresponsive for a few seconds or suddenly drop to the ground. There may be twitching of a limb or a side of the mouth.

The uncontrolled movements during a seizure can result in injury. A seizure while driving or swimming can be fatal. If a seizure occurs during sleep it can cause SUDEP (sudden unexplained death in epilepsy).

Epilepsy is confirmed with tests like the EEG (Electroencephalogram), X-rays, CT, MRI and special brain scans.

About five per cent of children between the ages of six months and five years develop febrile seizures when their temperature rises to 101°F or 38.3°C. The seizures can recur with the next episode of fever, unless the temperature is aggressively brought down with paracetamol and tepid sponging.

Most children outgrow their febrile seizures but about 10 per cent do go on to develop epilepsy, especially if the seizure has lasted for more than 10 minutes or recurred within 24 hours.

Epilepsy is usually "idiopathic" which means that there is no identifiable cause. In some families many members are affected, and around 500 genes have been linked to it. It may be part of the spectrum of other conditions like autism or neurofibrosis. It can be a result of a head injury during birth or in sports or traffic accidents. It may be a sequel of infections of the brain like meningitis or encephalitis. In older adults it may be due to a stroke or a tumour. It can be due to the use of illegal drugs or alcohol. It can be precipitated by low blood sugars or electrolyte disturbances in the blood that occur with vomiting, diarrhoea or heat stroke.

Many medications are available to treat seizures. Usually a single drug is started and after the maximum permissible dose is reached, a second medication is added. It is important to take medications on time and not miss doses while fasting or travelling. Once good control is achieved, epileptics can lead normal productive lives.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in