Epilepsy - Facts, Symptoms, Causes and Care

Epilepsy is a chronic noncommunicable disease of the brain that affects people of all ages

Overview 

Every year on the second Monday of February different organization and people join together to celebrate International Epilepsy Day. This was started and organized by the  the International Bureau for Epilepsy (IBE) and the International League Against Epilepsy (ILAE). IBE and ILAE are the two epilepsy nongovernmental organizations in collaboration with WHO.

International Epilepsy Day is an opportunity to raise awareness on epilepsy, what it is, how it can be treated, and what is needed to bring treatment to all people who need it. The ability of health workers to diagnose epilepsy, the availability of medicines and research into the health and social care response to epilepsy are just three areas of action for WHO and partners.

Samuel Wiebe, ILAE President and Martin Brodie IBE President put a joint statement

We're working together to ensure that health professionals, patients and their care providers, governments and the public have the educational and research resources that are essential in understanding, diagnosing and treating persons with epilepsy.

Epilepsy is a group of neurological disorders characterized by epileptic seizures. 

Key Facts

 WHO have identified the following facts of Epilepsy :

• Epilepsy is a chronic noncommunicable disease of the brain that affects people of all ages.
• More than 50 million people worldwide have epilepsy, making it one of the most common neurological diseases globally.
• Nearly 80% of people with epilepsy live in low- and middle-income countries.
• It is estimated that 70% of people living with epilepsy could live seizure- free if properly diagnosed and treated.
• About three quarters of people with epilepsy living in low- and middle- income countries do not get the treatment they need.
• In many parts of the world, people with epilepsy and their families suffer from stigma and discrimination.

It is characterized by recurrent seizures, which are brief episodes of involuntary movement that may involve a part of the body (partial) or the entire body (generalized) and are sometimes accompanied by loss of consciousness and control of bowel and bladder function.

Anyone can develop epilepsy. Epilepsy affects both males and females of all races, ethnic backgrounds and ages.

Seizure symptoms can vary widely. Having a single seizure doesn't mean the person has epilepsy. At least two unprovoked seizures are generally required for an epilepsy diagnosis. On record
up to 10% of people worldwide have one seizure during their lifetime.

Seizure episodes are mainly caused by excessive electrical discharges in a group of brain cells. Different parts of the brain can be the site of such discharges.Seizures can vary from the briefest lapses of attention or muscle jerks to severe and prolonged convulsions. Seizures can also vary in frequency, from less than 1 per year to several per day.

Epilepsy is one of the world’s oldest recognized conditions, with written records dating back to 4000 BC. Fear, misunderstanding, discrimination and social stigma have surrounded epilepsy for centuries. This stigma continues in many countries today and can impact on the quality of life for people with the disease and their families.     

Symptoms

 Seizures are main symptom of epilepsy. Symptoms differ person to person.

An Introduction to Epilepsy [Internet]. American Epilepsy Society; 2006. Author Bromfield EB, Cavazos JE, Sirven JI, editors.

Epilepsy is caused by abnormal activity in the brain and seizures can affect any coordination of brain. The signs and symptoms may include

• Temporary Confusion
• A staring spell
• Involuntary jerking of the hands and legs
• Loss of consciousness 
• Psychic symptoms like fear, anxiety, deja vu 

Symptoms vary depending  on type of seizure. In most cases, a person with epilepsy pose same type of seizure each time. It may be classified as focal and generalized.

Focal (partial) Seizures

A simple partial seizure does not involve loss of consciousness. Signs include
  

• sense of taste, smell, sight, hearing, or touch alteration
• dizziness
• tingling and twitching of arms and legs

Complex partial seizure involve loss of awareness or consciousness with some of the following symptoms

• blank staring
• unresponsiveness
• performing repetitive movements

Generalized Seizures 

It involve full brain activities. There are six types of generalized seizures.

• Absence Seizure -it is often called as petit mal seizure, cause a blank stare with repetitive movement such as lip smacking and blinking and brief loss of awareness.

• Tonic Seizure causes muscle stiffness

• Atonic Seizure responsible for loss of muscle control which lead to sudden fall down.

• Clonic Seizure causes repeated jerk muscle movements of the face, neck and arms.

• Myoclonic Seizure causes spontaneous twitching of the limbs

• Tonic-Clonic Seizure often it is called grand mal seizure. The symptoms are  

• body stiffening
• shaking
• loss of bladder or bowel control
• biting of the tongue
• loss of consciousness

  A bite to the tip of the tongue due to a seizure  By James Heilman, MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=24076770

Persons with epilepsy most of the cases won't remember of the seizure but feel slight illness following few hours.

Characteristics of seizures vary and depend on where in the brain the disturbance first starts, and how far it spreads.
In a recent note WHO cautioned

People with seizures tend to have more physical problems (such as fractures and bruising from injuries related to seizures), as well as higher rates of psychological conditions, including anxiety and depression. Similarly, the risk of premature death in people with epilepsy is up to three times higher than in the general population, with the highest rates of premature mortality found in low- and middle-income countries and in rural versus urban areas.

A great proportion of the causes of death related to epilepsy especially in low- and middle-income countries are potentially preventable, such as falls, drowning, burns and prolonged seizures.

Factors and Causes 

It is now well observed and researched that following factors may increase the risk of seizures in people predisposed to seizures :

• Stress and Trauma
• Sleep deprivation or fatigue due to workload or any kind of mental pressure
• Inadequate food intake
• Alcohol use or drug abuse
• Failure to take prescribed anticonvulsant medications
• Exposure to unfamiliar atmosphere 
• Dementia - it can increase the risk in older adults.
• Brain infections-  Infections such as meningitis, which causes inflammation in brain or spinal cord, can increase risk.
• Seizures in childhood - High fevers in childhood can sometimes be associated with seizures. Children who have seizures due to high fevers generally won't develop epilepsy. The risk of epilepsy increases if a child has a long seizure, another nervous system condition or a family history of epilepsy.

A steel image of generalized seizure  By https://wellcomeimages.org/indexplus/obf_images/2b/0f/0a119c657a876dab0f1c6a9e8793.jpgGallery: https://wellcomeimages.org/indexplus/image/L0074938.htmlWellcome Collection gallery (2018-03-23): https://wellcomecollection.org/works/djraxds6 CC-BY-4.0, CC BY 4.0, https://commons.wikimedia.org/w/index.php?curid=36302736

Epilepsy is not contagious. The most common type is called idiopathic epilepsy which affects 60% of people with the disease has no identifiable cause.
Epilepsy with a known cause is called secondary epilepsy or sometimes symptomatic epilepsy. The causes thus include  :

• Injury (brain damage) at prenatal or perinatal stages (a loss of oxygen or trauma during birth, low birth weight);
• congenital abnormalities or genetic conditions with associated brain malformations;
• a severe head injury;
• a stroke that restricts the amount of oxygen to the brain;
• an infection of the brain such as meningitis, encephalitis, neurocysticercosis,
• certain genetic syndromes; and
• a brain tumor
• Genetic Influence : Some types of epilepsy, which are categorized by the type of seizure  or the part of the brain that is affected, run in families. In these cases, it's likely that there's a genetic influence. Researchers have linked some types of epilepsy to specific genes, but for most people, genes are only part of the cause of epilepsy. Certain genes may make a person more sensitive to environmental conditions that trigger seizures
•  Developmental disorders. Epilepsy can sometimes be associated with developmental disorders, such as autism and neurofibromatosis.

  

Socioeconomic, Physical, Psychological and other Impacts and Complications of Epilepsy

Epilepsy counts 0.6% of the global burden of disease, a time based measure that combines years of life lost due to premature mortality and time lived in less than full health and capability. Epilepsy has significant economic impact in terms of health care needs, premature death and lost work productivity.

Having a seizure at certain times can lead to circumstances that are dangerous to the person with epilepsy and others.

• Falling can be severe, breaking bones, head or brain injury, death.

• Drowning - it is estimated that there is a 15 to 19 times more chance than the normal person , a person with epilepsy likely to drawn while swimming or bathing.

• Driving a car or operating any equipment can be very dangerous for person with epilepsy.

• Pregnancy complications - Seizures during pregnancy pose dangers to both mother and baby, and certain anti-epileptic medications increase the risk of birth defects. If a person has epilepsy and she is considering becoming pregnant, she should talk to her doctor as she plans her pregnancy. Most women with epilepsy can become pregnant and have healthy babies. Only that will need to be carefully monitored throughout pregnancy, and medications may need to be adjusted. It's very important that working with doctor to plan pregnancy.

• Emotional health issues -. People with epilepsy are more likely to have psychological problems, especially depression, anxiety and suicidal thoughts and behaviors. Problems may be a result of difficulties dealing with the condition itself as well as medicinal side effects.

• Status Epilepticus - this condition happens when a state of seizure lasting more than five minutes or having frequent seizures without regaining full consciousness in between. It poses an increased risk of permanent brain damage and death.

• SUDEP - Sudden unexpected death in epilepsy - People with epilepsy also have a risk of sudden death. The cause is unknown but some research shows  it may be due to heart and respiratory conditions.Overall 1% of people with epilepsy die of SUDEP. 

Although the social effects vary from country to country, the stigma and discrimination that surround epilepsy worldwide are often more difficult to overcome than the seizures themselves. People living with epilepsy can be targets of prejudice. The stigma of the disease can discourage people from seeking treatment for symptoms, so as to avoid becoming identified with the disease.

Not only social, epilepsy can have adverse effects on psychological well-being. These effects may include social isolation, stigmatization, or disability They may result in lower educational achievement and worse employment outcomes. Learning disabilities are common in those with the condition, and especially among children with epilepsy The stigma of epilepsy can also affect the families of those with the disorder.

Certain disorders occur more often in people with epilepsy, depending partly on the epilepsy syndrome present. These include depression, anxiety, obsessive–compulsive disorder (OCD), Schizophrenia , PTSD and migraine Attention deficit hyperactivity disorder and Dyslexia affects three to five times more children with epilepsy than children without the condition. Dyslexia, ADHD and epilepsy have significant consequences on a child's behavioral, learning, and social development. Epilepsy is also more common in children with autism.
 

Human Rights

According to WHO's write up

People with epilepsy can experience reduced access to health and life insurance, a withholding of the opportunity to obtain a driving license or educational opportunities, and barriers to enter particular

Photo by rawpixel on Unsplash

occupations, among other limitations. In many countries legislation reflects centuries of misunderstanding about epilepsy. For example:

• In both China and India, epilepsy is commonly viewed as a reason for prohibiting or annulling marriages.
• In the United Kingdom, laws which permitted the annulment of a marriage on the grounds of epilepsy were not amended until 1971.
• In the United States of America, until the 1970s, it was legal to deny people with seizures access to restaurants, theaters, recreational centers and other public buildings.

Legislation based on internationally accepted human rights standards can prevent discrimination and rights violations, improve access to health-care services, and raise the quality of life for people with epilepsy.

How to Live with Epilepsy

People with epilepsy are at risk for two life-threatening conditions: tonic-clonic status epilepticus and sudden unexplained death in epilepsy (SUDEP). Tonic-clonic status epilepticus is a long-lasting seizure that's considered a medical emergency. If not stopped within about 30 minutes, it may cause permanent injury or death.

There are evidences that people with epilepsy die from inhaling vomit during or just after seizure.

Epilepsy is a chronic condition that affects people in different ways. Many people with epilepsy lead normal, active lives. About 70  percent of people with epilepsy can successfully control their seizures through medication or surgical techniques.

Photo by rawpixel on Unsplash

Some epileptic patients take their life very positively. They rarely think about epilepsy, except when taking their medications or going to see the doctor. No matter how epilepsy affects a person, it is important to remember that being well-informed about the condition and keeping a positive attitude are important. Working closely with a healthcare team and adhering to prescribed medications are essential to helping control seizures so that the patient can lead a full, balanced life.

How can a patient with epilepsy can prevent a seizure ? - here is some advises from Doctor

Support Organizations 

There are organizations that provide support for people and families affected by epilepsy. The Out of the Shadows campaign, a joint effort by the World Health Organization, the International League Against Epilepsy and the International Bureau for Epilepsy, provides help internationally.

Photo by Hans Eiskonen on Unsplash

The Joint Epilepsy Council serves the UK and Ireland. In the United States, the Epilepsy Foundation is a national organization that works to increase the acceptance of those with the disorder, their ability to function in society and to promote research for a cure. The Epilepsy Foundation, some hospitals, and some individuals also run support groups in the United States.

Epilepsy Treatment

There is currently no cure for most types of epilepsy. However, surgery can stop some kinds of seizure from occurring, and in many cases, the condition can be managed.

If an underlying correctable brain condition is causing the seizures, sometimes surgery can stop them.

If epilepsy is diagnosed, the doctor will prescribe seizure-preventing drugs or anti-epileptic drugs (AEDs).

If drugs do not work, the next option could be surgery, a special diet or VNS (vagus nerve stimulation).

The doctor's aim is to prevent further seizures from occurring, while at the same time avoiding side effects so that the patient can lead a normal, active, and productive life.

Yoga and Epilepsy

Is Yoga can be a help to fight Epilepsy?

Having a seizure at certain times and not being aware of the symptoms can lead to circumstances that are dangerous to the individual and others. People with epilepsy are also likely to have psychological problems, especially depression, anxiety and, in extreme cases, suicidal tendencies. Problems may be a result of difficulties dealing with the condition itself as well as side effects from medications.

Photo by Emily Sea on Unsplash

Olga Kabel argues

The vagus nerve can be thought of as a superhighway that connects your body and your brain- a connection we talk about a lot in yoga! It innervates most organs in the body; the messages zip along its five lanes of traffic with four lanes delivering information from the body to the brain and one lane moving information from the brain to the body. This is the most obvious physical representation of the mind-body connection. The vagus nerve both senses your internal environment (via its sensory neurons) and affects it (via its motor neurons). Since a lot of the nerve’s function depends on which way the information is going, from here on we will separate those into body-to-brain and brain-to-body pathways 

Ram Rao says in his write up  What is Epilepsy? How Can Yoga and Meditation Help?

People with low vagal tone are more sensitive to stress and can be vulnerable to epilepsy. “Vagal tone” defines the functional status of the vagus nerve, which is the 10th and largest cranial nerve. It relays information between the brain and other internal organs. It starts at the base of the skull and innervates the neck, chest, and abdomen, and provides information about the state of the body’s organs to the central nervous system. Thus, the vagus nerve is responsible for a myriad of tasks including heart rate, breathing, respiration and digestion, peristalsis of the gut, small intestine and colon, sweating, muscle movements in the mouth, speech, and hearing.

Optimal physiological functioning is a direct reflection of the functional status of the vagus nerve. A sub-population of epileptic patients receives an implant called a vagus nerve stimulator underneath the skin of their chest, similar to a heart pacemaker. Wires from the stimulator are connected to the vagus nerve in the neck. The battery-powered device sends bursts of electrical energy through the vagus nerve and to the brain that result in inhibiting seizures by 20 to 40 percent.

Of course, it would be ideal to find treatments that could control epilepsy and reduce the need for anti-seizure medications. So researchers have been exploring the effect of yoga asanas in treating epilepsy, with the rationale that yoga is relaxing, reduces stress, and may reduce the excessive brain wave activity.

There are several articles available in the internet like 7 Amazing Yoga Poses To Treat Epilepsy.
However it is always good to have a proper guidance to choose certain postures to start with.