Definition:
Epilepsy is a disorder of the brain in which seizures occurred and caused by an abnormal electrical discharge. The causes of epilepsy are not well identified yet. The causes can be genetic abnormality hereditary epilepsy, brain damage from birth, or hypoxia, brain infection, head injury, or brain tumor, or blood vessels abnormalities. Anything that interrupts the normal connections between nerve cells in the brain can cause a seizure. When a person has recurrent seizures, this is diagnosed as epilepsy.
 
Symptoms of epilepsy:
  1. Generalized seizures: The symptoms of generalized epileasy includes loss of consciousness, muscle convulsion, seizures, apnea, and cyanosis of the lips and skin. These may lead to falls, biting of the tongue and lips, or incontinence. Absence epilepsy causes a brief changed state of consciousness and staring. With an atonic seizure, you have a sudden loss of muscle tone and unresponsive.
  2. Focal seizures: These seizures do not cause a loss of consciousness. The symptoms of seizure depends on which area of the brain is affected. For example, the person may see a flashing lights if the visual cortex involved, smell peculiar odors, or hear musical sounds if the olfactory cortex and auditory cortex are involved. In some cases, generalized seizures might appear after focal seizures. 
People with the above symptoms may not be as epilepsy only. Please visit a neurologist for further evaluation.

Treatments for epilepsy:
  1. Medications: Most anti-seizure medications are effective for epilepsy control.
  2. Surgery: Epilepsy surgery is performed only antiepileptic drugs fail to control seizures. A patient should have a pre-surgical evaluation. Lobectomy can be performed to control seizures by removing the area of the brain causing abnormal electrical discharge. In addition, vagal nerve stimulator or a responsive cortical neuro-stimulation device can be implanted to prevent epileptic seizures.
  3. Diet: Ketogenic diet is usually used in children with difficult-to-control seizures. It is prescribed by a physician and prepared by a dietitian. 
 
Home care for epilepsy:
  1. Keep a seizure diary. After each seizure, note the details about the seizures including the types, numbers and medication (drug name, dosage, usage).
  2. Keep a daily routine. A patient should avoid trigger factors such as staying up late, fatigue, emotional instability, stress or cold. Stop using more alcohol, stimulant drugs or drinks such as cigarettes, betel nut, coffee and tea. Having a seizure at certain times can lead to circumstances that are dangerous to yourself or others, such as driving or swim. You should always swim with someone. 
  3. Precautions of anti-seizure medications: 
    1. The patient and the caregiver should know the names, usages, dosages, side-effects, and contra-indications of each medicine taken.
    2. DO NOT voluntarily adjust the medicines even when no attacks have happened. The medicine works only if you take the right amount on the schedule your doctor sets up. Following this schedule keeps the right level of medicine in your body.
    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 everyday life. 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 a seizure attack. Clear the surrounding area of dangerous objects. Prevent injury from any dangerous objects by applying linens or clothing. 
    5. If seizure attacks occur frequently or continue up to half an hour, then see a doctor immediately between two episodes, even when the patient’s consciousness is not totally clear yet.
    6. Observe carefully after each attack and allow the patient to have an enough rest.
 
References
  1. Bank, A. M., & Bazil, C. W. (2019). Emergency management of epilepsy and seizures, Seminars in Neurology, 39, 73–81. doi: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. doi: 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. doi:10.1016/S0140-6736(18)32596-0
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