Epilepsy indicates a group of neurological diseases characterized by episodes of vigorous shaking that may vary from nearly undetectable or short to extremely long duration. These episodes known as epileptic seizures may be so severe, resulting in physical injuries such as broken bones. Epileptic seizures occur due to excessive & abnormal nerve cell activity in the brain's cortex.

Epileptic seizures tend to recur, and have may have no immediate underlying cause. Some isolated seizures, which are provoked by a specific cause such as poisoning or extremely high fever are not considered to represent epilepsy. In many regions of the world, including India, people with epilepsy experience stigma, and often remain untreated due to superstitious beliefs and practices.

While the underlying cause of many cases of epilepsy remain unknown, it is well documented that people acquire or develop epilepsy as the result of a brain injury or tumours, stroke, infections of the brain, and birth defects. Epilepsy can also be due to genetic causes, with acquired & genetic factors interacting in many cases.

Types of seizures

There are three types of diagnoses a doctor might make when treating a patient with epilepsy:

• Idiopathic - No apparent cause
• Cryptogenic - Your neurologist thinks there is a cause, but cannot pinpoint it
• Symptomatic - Your neurologist knows what the cause is

Risk Factors

• Genetic- Blood relatives of a person with epilepsy have a five times greater risk.
• Down Syndrome- 1% - 10%.
• Angelman Syndrome - 90%.
• Stress.
• Alcohol Abuse.
• Flickering lights or
• Lack of Sleep, etc.

The term seizure threshold specifies the amount of stimulus necessary to cause a seizure. This threshold is lowered in epilepsy patients.

Seizures that begin in one hemisphere of the brain are termed as Partial Seizures. Those that begin in both hemispheres of the brain are known as Generalized Seizures.

Some types of seizures may change brain structure, while others have little or no effect. Gliosis, neuronal loss, and atrophy of specific areas of the brain are linked to epilepsy but it is unclear if epilepsy causes these changes or if these changes result in epilepsy.

First Aid for Seizures

If you see someone having a seizure, take the following steps:

• Time how long the seizure lasts.
• Clear the area of anything hard or sharp.
• Don't crowd around the person
• Loosen anything at the neck that may affect breathing, i.e., necktie, chokers.
• Turn the person onto her side.
• Put something soft beneath the head.
• Don't place anything inside the mouth. No one can swallow their own tongue.
• Call an ambulance or take him/her to the hospital if a seizure lasts more than 5 minutes, happens again, or the person is pregnant, injured, or has diabetes.

In specific cases, Doctors consider Epilepsy to be resolved in individuals who had an age-dependent Epilepsy Syndrome but are now past that age or those who have remained seizure-free for a decade, with no seizure medicines in the last 5 years.

The World Health Organisation estimates there are approximately 50 million people with epilepsy worldwide, 80% reside in developing countries, with an estimated 10 million people living with epilepsy in India.

In India, an estimated 22% of urban, middle-income people with epilepsy to around 90% of people in rural areas do not receive appropriate treatment for their condition. The treatment gap, i. e., the number of people with active epilepsy who do not receive treatment (diagnostic & therapeutic) or receiving inadequate treatment, stated as a percentage of the total number with active epilepsy. The lack of access to or knowledge of Anti-Epileptic Drugs (AEDs), poverty, superstition/cultural beliefs, stigma, poor healthcare delivery mechanisms, coupled with shortage of trained professionals leads to the Treatment Gap. People with Epilepsy are influenced by superstitions and cultural beliefs to seek treatment from traditional healers instead of allopathic practitioners.

Treatment

The correct diagnosis of the type of epilepsy is critical in choosing the treatment that best fits a person with Epilepsy.

Other factors include:

• Frequency & severity of seizures.
• Age
• Overall health, and
• Medical History.

Epilepsy is best treated with anti- convulsant or Anti- Epileptic Drugs (AEDs) such as Carbamazepine, Valproate, Valproic Acid, Zonisamide, and many others.

People living with Epilepsy must never stop taking their medicine or switch to any other form of treatment without first consulting with their healthcare specialists. Epilepsy is unique to each individual and the healthcare provider will determine whether a patient can be taken off treatment after a few years or will require lifelong treatment, depending on the type of epilepsy.