【Major points】

1. Epilepsy is a disorder of the brain in which seizures occurred and caused by an abnormal electrical discharge.
2. Keep a seizure diary. After each seizure, note the details about the seizures including the types, frequency, and medication (drug name, dosage, usage).
3. If seizure attacks frequently or continue up to 30 minutes, then visit the emergency department immediately between two episodes, even when the patient’s consciousness is not clear.
4. Do not adjust the drug by yourself even though the seizures are well controlled. You should take the drug on time and in the amount to maintain the therapeutic level of the drug.

Epilepsy (convulsions) is a clinical symptom caused by abnormal discharge of brain cells. The real cause is unknown. Possible pathogenic factors include heredity, brain injury during childbirth, hypoxia, inflammation, abnormal blood vessels, etc., When the brain is disturbed and repeated seizures occur, it is epilepsy.

二、What are the common symptoms ?

1. Some patients have aura before seizure attack, such as: the visual area will see flashes, the olfactory area may feel strange odor, and the auditory area will hear music.
2. General seizure attack: The symptoms for general seizure attack are loss of consciousness, muscle convulsion, seizures, apnea, and cyanosis of the lips and skin. These may lead to falls or incontinence, biting of the tongue and lips are rare. Absence epilepsy causes a brief changed state of consciousness and staring. Atonic seizures are loss of consciousness and muscle strength all at a sudden.
3. Focal seizure attack: these seizures do not cause a loss of consciousness. Seizure symptoms are related to specific areas of the brain, in some cases, generalized seizures might occurred after focal seizures.

      If you have above symptoms, it is not necessarily a sign of epilepsy, please visit the neurology clinic for further evaluation.

三、Treatments for epilepsy

1. Medications: most anticonvulsants are effective for seizure control.
2. Surgical treatment: for patients with poor drug control, the doctor will provide suitable surgical advice after examination and evaluation. You can choose electro cautery the lesions with abnormal discharge, install vagus nerve stimulator or cortical stimulator to prevent seizure attack.
3. Diet: Ketogenic diet is suggested to children with intractable seizures. It is prescribed by physician and prepared by dietitian. 

四、Home care for epilepsy

1. Keep a seizure diary. After each seizure, note the details about the seizures including the types, frequency, and medication (drug name, dosage, usage).
2. Epilepsy patients should maintain a regular daily life, do not stay up late or fatigue, avoid emotional nervous, catching a cold , alcoholism or taking stimulating drugs or beverages, (cigarettes, betel nut, coffee, tea, etc.), and do not engage in hazardous work during seizure attack, such as driving, or swimming. When you swimming, you need someone to company with you.
3. Precautions of anticonvulsants 
   1. The patient and the caregiver should know the names, usages, dosages, side-effects, and contra-indications of each medication.
   2. Do not adjust the drug by yourself, even though the seizures are well controlled. You should take the drug on time and in the amount to maintain the therapeutic level of the drug.
   3. If any side-effects occur, see your doctor as soon as possible. Let your doctor decide if your medicine should be adjusted. The adjustment period for medication may cause a grand mal or continuous seizure. Thus, you should protect yourself in every day. Write down the changes in your seizure diary and let your doctor know.
   4. If you seek medical attention for other conditions such as a cold or pregnancy, you should inform the doctor about taking epilepsy medications and contact your epilepsy doctor to understand the effects of the medications.
4. Management during seizure attacks
   1. If there is any epilepsy aura noted, then find a safe place or bed to lie down to protect yourself from other injuries.
   2. Loosen the clothing around your neck and waist. Lying on one side.
   3. If the mouth is already open, you might place a tongue depressor or a long strip handkerchief in the mouth to prevent tongue-biting. DO NOT force open the mouth if it is close to avoid patients and yourself from injury.
   4. DO NOT let a patient stay alone during seizure attack. Clear dangerous objects in the surrounding area. Utilizing soft  linens or clothing to prevent injury from any dangerous objects  
   5. If seizure attacks frequently or continue up to 30 minutes, then visit the emergency department immediately between two episodes, even when the patient’s consciousness is not clear.
   6. Observe carefully after each attack and let the patient to have a good rest.

References

1. Bank, A. M., & Bazil, C. W. ( 2019). Emergency management of epilepsy and seizures, Seminars in Neurology, 39, 73–81. https://doi.org/10.1055/s-0038-1677008
2. Higgins, A., Downes, C., Varley, J., Doherty, C. P., Begley, C., & Elliott, N. (2019). Supporting and empowering people with epilepsy: contribution of the epilepsy specialist nurses (SENsE study), Seizure, 71, 42–49. https://doi.org/10.1016/j.seizure.2019.06.008
3. Thijs, R. D., Surges, R., O’Brien, T. J., & Sander, J. W. (2019). Epilepsy in adults. The Lancet, 393, 689-701. https://doi.org/10.1016/S0140-6736(18)32596-0