World Epilepsy Day (13 February 2017): Seizures vs Epilepsy

2017-02-12 20:07

Picture: Medicaldaily

Seizures

Most people think of seizures as involuntary muscle movement characterized by violent jerky movement of all limbs. That is actually only one manifestation of seizures called convulsions. A seizure can present in other ways and can sometimes only affect small parts of the body or some limbs. There may be loss of consciousness in some cases or simply altered awareness of one's surrounding. To some, abnormal senses like smells or a feeling of familiarity in a place or situation (déjá vu) may be indicative of electrical activity leading to a seizure. A seizure is what happens in the brain when nerves are firing abnormally and are unregulated. This is accompanied by impaired brain functioning.

What Can Cause a Seizure?

It is said that 2% of adults may have a seizure at some point in their life and the majority of them (2/3) will never have another seizure. And those people do not have epilepsy. A diagnosis of epilepsy is made when one experiences 2 or more seizures and they become recurrent. The definition also excludes reversible causes. People with stroke or brain tumours may get what is called symptomatic epilepsy if they get recurrent seizures as a result of those acquired brain disorders. Reversible causes of seizures include:

  • decreased blood supply to the brain (if temporary)
  • infections like sepsis, malaria, meningitis, viral encephalitis, rabies or tetanus
  • trauma (birth injury in babies or head injuries in adults)
  • brain swelling (oedema) from uncontrolled high blood pressure
  • drugs (recreational or prescription drugs)
  • metabolic conditions like low calcium, sugar, sodium or magnesium
  • metabolic conditions with high bilirubin, urea, sugar or sodium
  • fever (especially in children)
  • alcohol withdrawal

Those are some reversible causes of seizures worth mentioning. Some of them are preventable. Decreased blood supply to the brain can be seen in people who almost drown, suffocate from hanging or suffer carbon monoxide poisoning; these causes can be self-inflicted. With continued exposure and persistent decreased blood supply to the brain, these individuals can get permanent brain damage (irreversible cerebral ischaemia) that can predispose them to recurrent seizures. The same principle applies to the other causes if not corrected. With severe forms of head injuries, some people have to continue taking anti-epileptic drugs. Birth complications that are known to drop the blood supply to the foetus (baby in the uterus) can cause seizures in newborn babies, a condition called Hypoxic Ischaemic Encephalopathy (HIE). HIE if poorly managed can lead to cerebral palsy and disability later in life. Good pregnancy routine checkups and early care is crucial to anticipate and prevent most birth complications. The importance of monitoring during labour and having a trained attendant at birth should not be undermined as well.

The Pig and Epilepsy

Some brain infections can cause recurrent seizures and epilepsy. A condition called neurocysticercosis is caused by a tapeworm commonly found in pork. According to data from the Epilepsy South Africa group, approximately 20 of 100 people are infected by tapeworms in the Eastern Cape. Other rural provinces might have similar or higher figures. With poor sanitation, the tapeworm cycle is not broken as pigs may eat human faeces infested with tapeworm eggs. Basics of hand washing, good sanitation practices and cooking meat well remain relevant. Pigs should also be locked up and not be allowed to roam around.

Picture:Epilepsy South Africa

Diabetes and Seizures

Poor sugar control on both ends can trigger seizures. When the sugar is too low (hypoglycaemia), one can be at a risk of fitting. Hyperglycaemia (high sugar) in diabetes type 1 or 2 may also cause seizures. One should therefore keep a normal glycaemic (sugar) control range with the help of their doctor or local clinic. Adherence to one's treatment and regular checkups are mandatory. If one wishes to change doctors or clinics, one should request a transfer letter that would indicate specifics about one's treatment at their previous centre. It will be a good investment to get a glucose machine to use at home for days when one feels unwell.

The Heart and Seizures

People with specific heart conditions like arrhythmias may also be at risk of getting seizures if not well controlled. Hypertensives (with high blood pressure) are increasing in numbers because of our lifestyle, inactivity and poor dietary choices. The principles of taking a chronic treatment remain the same as those of diabetics. Pregnant women with hypertension in pregnancy should be urgently rushed to the nearest clinic or hospital if they start fitting. Both lives, mother and child's, are at an increased risk if the mother fits.

Seizures in Children

Not all children that fit have or will have learning disabilities. Although epilepsy is sometimes commonly seen in children with disabilities, it is important to note that there are other causes of seizures and epilepsy in children as well. Some children are born with genetic disorders, developmental defects, brain malformations or metabolic disorders. These conditions are usually diagnosed by specialists and require more extensive workup and tests. Some children may develop fits after having untreated or high levels of bilirubin (jaundice). The physical manifestation is a yellowish discolouration of the eyes, mucous membrane and skin in high levels. Any baby with jaundice should be seen by a healthcare professional to exclude high levels of bilirubin.

How are Seizures Classified?

If the electrical activity in the brain is seen to involve both brain hemispheres on an EEG (electroencephalogram) from the onset of the seizure, that is a generalized seizure. A partial seizure occurs when electrical discharge seems to originate from one brain hemisphere or a specific focal point in the brain.

Generalized seizures present with convulsions and loss of consciousness, increased tone, decreased tone or jerky movements without loss of consciousness. Another commonly missed form of generalized seizures is absence seizures where for 10-30 seconds, someone stops what they are doing and they seem to stare into open space without being responsive. Most times they don't fall down and they don't convulse (fit). When they resume their activities, they are not aware of what just happened. This condition is common in children.

Partial seizures have 2 broader groups: simple and complex. Simple partial seizures occur without loss of consciousness. Partial seizures may involve abnormal movements of one side of the body sometimes only limited to the hand or face. It might seem like funny movements to the observer and school children may be accused of being disruptive. Other sufferers may present with lip smacking or involuntary chewing movements. Some may seem like psychiatric patients, displaying bizarre behaviour and making unexplained gestures with their hands. Complex partial seizures are usually associated with loss of consciousness and sufferers of this condition may describe abnormal smells, sensation of fear or other symptoms before getting a fit. A feeling of déjá vu may also be described. Other may have psychic sensations and describe seeing flashing lights or hearing buzzing sounds.These phenomenons are called auras.

Picture: Emma4facs

Living with Epilepsy

Mixing Medication

Epileptics may have some of the seizure disorders listed above. There are different classes of anti-epileptic drugs for different seizure types. Most epileptic drugs interact with other prescribed, over the counter or recreational drugs. Herbal, traditional or alternative medication may also affect levels of epileptic drugs in the blood. These interactions can lead to either a low available dose in the blood or toxic levels of either epileptic drugs or other co-administered medication. It is therefore very important to speak to your doctor before starting anything else while on anti-epileptic medication. Any supplement you may think of, even if it seems harmless. Your doctor will check it for you on a list of medicines, supplements and herbal products with potential or known interaction with epileptic drugs.

Precautions

There are places that people with epilepsy should avoid, especially if their epilepsy is uncontrolled. Open fires and swimming pool areas should be avoided. Supervision for young kids is necessary. When using bathrooms, it is advisable not to lock the door. If one gets fits during their sleep, some advise sleeping without a pillow. The South African National Road Traffic Act restricts anyone with uncontrolled epilepsy from driving. Please visit your doctor or neurologist for assessment before getting your driver's license. It is advisable for the family to join support groups for more practical advice on epilepsy care and treatment.

Please visit www.epilepsy.org.za for more information.

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