Brain is made up of a specialised cells called Neurons with a capability to generate electrical activity. Through these electrical signals only Brain is able to communicate with the body. A sudden spark at times can disrupt the normal activity of brain leading to convulsions or Fits. If such fits occur again and again it is called Epilepsy So it is only an electrical disturbance and not contagious.

More than half the time, the cause is unknown. In those who has secondary epilepsy the causes could be: Head injury, infections of the brain, stroke, brain tumor, Brain malformations, or Genetic defects. Neurocysticercosis caused by tape worm infestation is particularly common in India.

A good description of the events and ideally by an eyewitness or a mobile video recording is key to determine weather it was a seizure and what kind. A medical history, physical and neurological examination, blood tests and other tests are important. These help diagnose epilepsy and look for other conditions or causes. An EEG is one of the most important tests. It records the brain’s electrical activity. Some patterns of activity are unique to certain types of seizures. Imaging tests (like a CT, MRI, or PET scan) look at the structure and function of the brain. An MRI is needed for anyone with new onset of seizures. PET scans or other advanced imaging may be done later. Sometimes look-alike seizure (pseudo-seizure due to conversion disorder) may be difficult to distinguish from true epilepsy and may require long-term video EEG monitoring for 2-3 days.

Usually people get get a premonition at times of likely hood of getting a seizure at times 24 to 48 hours before called prodrome. Just before the seizure many experience peculiar sensations called “ Aura” which is often a warning of an impending seizure. Aura is specific for each individual and repetitive. This will be followed by the actual attack with various forms, followed by sleep for varying periods. After that there can be post octal confusion, weakness, behaviour disturbance, and body pains depending upon the type of seizure.

Types of seizures

Seizures can take many different forms, not just the convulsive type that most people associate with epilepsy. Common types of seizures include:

• Generalized Onset - Tonic-Clonic(Grand Mal)– Convulsions, rigid muscles, jerking; typically lasts 1 to 3 minutes and followed by period of confusion
• Absence(Petit Mal) – Blank stare lasting only a few seconds; sometimes with blinking or chewing motions, often missed in children
• Focal Onset - Impaired Awareness(Complex Partial) – Staring and dazed facial expression; person is not aware of what is going on or will not remember; person may perform repetitive random movements and may not be able to talk normally; typically lasts 1 or 2 minutes and may be followed by confusion
• Focal Onset - Aware (Simple Partial) –Jerking in one or more parts of the body or sensory or perceptual changes that may or may not be obvious to onlookers; the person is aware of what occurs during the seizure
• Atonic (Drop Attacks) –Sudden collapse with recovery within a minute
• Myoclonic –Sudden, brief, massive jerks involving all or part of the body

Medications are used to treat epilepsy are called anti-epileptic drugs. About 30 anti-seizure medications are currently approved to treat epilepsy. About 6 in 10 people may control their seizures with the first or second medicine. Yet a survey of adults in the community found that 56% still have seizures. Neurologists are specialised doctors in treating Epilepsy. If the seizures are not controlled with 2 or more medications, one will be evaluated at an Epilepsy center where options beyond medications are possible. Epilepsy surgery, Vagus Nerve stimulations and ketogenic diet are other methods of treatment.

Seizure triggers: Some people find that certain situations, habits, health problems, or medications can affect their seizures. For example, not sleeping well or too much stress can make some people more likely to have a seizure. Missing doses of seizure medicine makes you likely to have more seizures and is a common cause of breakthrough seizures and emergencies. If you find things you think could affect seizures, keep track of them over time and see how often they happen. If they frequently happen before seizures, then it’s time to see if you can change or avoid the trigger.

Personal responsibility of Patients

Epilepsy is often “invisible” to doctors, since seizures don’t usually happen during an office visit. That means your doctor is relying on you to say what your seizures are like, how often they happen, and how they affect your life. Keep a seizure diary to track any seizures or other symptoms you have. Take it to your doctor. When you track your seizures and how you are feeling, you’re bringing in critical data that will make the right diagnosis and offer right choice of treatment. Make a list of all the medicines you take – including any vitamins or herbal remedies – and the amount you take. Be ready to talk about anything that has changed since your last visit, like a new job, school problems, or changes in how you feel. Tell them if you feel nervous, sad, depressed, or are having changes in sleep, appetite, or sex drive. This may make you uncomfortable, but your health care team is there to help. Regularity of medicines, proper diet and sleep are essential. Based upon the diary and information the medications, activity and life style can be titrated to suit their best. Everyone should carry the information about their medication in the pocket, that can help in case of emergency especially when the person is alone. Any information or details should not be hidden from the treating team.

When a person continues to get fits or convulsions despite adequate dosage of medicines over two years or the illness or medicines are interfering with the activities of life. Usually medicines in combinations in sufficient doses and for sufficient period of time will be used before such declaration of intractability.

All of them need to be investigated as soon as intractability is established. A series of tests will be conducted to identify underlying structural or electrical abnormality in the brain. In select individuals the abnormality can be removed or corrected through different specialised brain surgeries to remove the source. Once decided it is better to do early surgery in order to preserve the brain function and quality of life. After surgery the dose of medications can be reduced and that can also help the quality of life. Where ever definitive surgery is not possible certain corrective surgeries to controle the spread of seizure in the brain, Vagal nerve stimulation, DBS can be tried to minimise the disability.

Many false beliefs and myths are associated with epilepsy. Epilepsy is considered as a curse, possession, incurable and those who have are not fit for normal life etc. Hence every one will hide the illness and shun away from getting treated. Many goes to traditional treatments and to exorcists. Epilepsy is like any other disease of the brain. Most of them are controllable. When treated early they can lead a normal life. If well controlled it will not interfere with education, employment, marriage, childbirth, normal activities of life including driving. It is important to have clarity to avoid misunderstanding and misinterpretations that can lead to disharmony in life.

Most importantly disciplined life and regularity of medications are essential for proper control of epilepsy. Non compliance can lead to intractability by itself.