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Job Osazuwa
A tall fair man in his early 30s caused a stir at the busy Agege Bus Stop in Lagos recently. As he joined the crowd, heading towards the police station axis, he fell flat and started shaking, forming in the mouth.
The young man suffered epileptic seizure. He lay unconscious for about 15 minutes.
When he finally regained consciousness, he rose and dusted his rumpled dress. Embarrassed, he walked away without saying a word.
The mere mention of epilepsy evokes fear, confusion, pity, social stigma and oftentimes misconceptions among sufferers, relatives and the society. Some persons simply are of the misinformed opinion that the ailment is contagious and spiritual. Others simply do not understand it.
Epilepsy is a serious health issue. It is defined as a chronic disorder that causes unprovoked, recurrent seizures – a sudden rush of electrical activity in the brain. There are two main types of seizures: Generaliased and focal. Generalised seizures affect the whole brain, while focal or partial seizures affect just one part of the brain.
Experts say a mild seizure may be difficult to recognise. It can last a few seconds during which the patient lacks awareness. Stronger seizures can cause spasms and uncontrollable muscle twitches, and can last a few seconds to several minutes.
Though there is no accurate statistics, epilepsy is a fairly common neurological disorder that affects 65 million people around the world. The cause remains largely unknown despite the advancement in medical sciences. Anyone can develop epilepsy at any age, but it is more common in young children and older adults. It occurs slightly more in males than in females. For most people, the risk of developing epilepsy before age 20 is about one per cent, but having a parent with genetically linked epilepsy raises that risk to two to five per cent.
Epilepsy sometimes runs in families. Still, the risk of inheriting the condition is fairly low. Most parents with epilepsy don’t have children with epilepsy.
It has been revealed that one of the reasons preventing patients and relatives from seeking early help at the hospital is to avoid social stigma, especially seeing epilepsy as a communicable disease. The consequence of delayed treatment is grievous, especially for children.
While warning against the use of herbal medication, experts raised the alarm that herbal mixtures, which are not subjected to thorough or clinical analysis often compound the patient’s woes.
There is no cure for epilepsy, but the disorder can be managed with medications and other strategies and the patient can lead a normal and healthy life. Early treatment is said to make a big difference. The right treatment can result in dramatic improvement in patient’s condition and his quality of life.
Children with epilepsy may experience uncertainty in their lives. The prospect of a sudden seizure in front of their friends and classmates could be stressful. These feelings can cause a child to act out or withdraw from social situations. If a child is having epilepsy and it is not controlled, it can affect his learning capacity and self-esteem. Most children learn to adjust over time. For others, social dysfunction can continue into adulthood.
Between 30 and 70 per cent of people with epilepsy also have depression, anxiety or both.
A Chief Consultant Psychiatrist, Neuro-Psychiatric Hospital, Aro, Abeokuta, Ogun State, Dr. AK Oyekanmi, said epilepsy was one of the most misunderstood disorders of the brain.
Said he: “The brain is made up of cells called neurons or nerve cells. Each nerve communicates to the other through small electrical signals and chemicals called neurotransmitters. What happens in epilepsy is that there is an abnormal discharge of electrical current, which disrupts the normal functioning of the brain. When that abnormal discharge becomes recurrent, we call it an epileptic seizure.
“The only type of epilepsy our people know is the one that affects the whole of the brain, whereby the patient falls down and experiences a vigorous involuntary movement of the limbs and the trunk with the stiffness of the muscles. Sometimes, the patient might urinate on himself or herself. The patient may be foaming at the mouth because there is a contraction of the muscles of the throat. This one is called grandmal epilepsy. Apart from this, there are several other types of epilepsy, depending on that part of the brain where that problem is. And they could manifest at any time of the day, even in sleep.
“If you have a child or a friend, who, you notice, sometimes manifests some abnormal behaviour for just a few seconds or minutes, and then he/she is back to normal, maybe you should suspect epilepsy and seek medical evaluation. Again, if you are talking to someone, and the person stares absentmindedly, it may be an epileptic symptom,” she said.
Symptoms of epilepsy
Seizures are the main symptom of epilepsy. Symptoms differ from person to person and according to the type of seizure.
A simple partial seizure doesn’t involve loss of consciousness. Symptoms include: alterations to sense of taste, smell, sight, hearing, or touch; dizziness; tingling and twitching of limbs.
Complex partial seizures involve loss of awareness or consciousness. Other symptoms include: staring blankly; unresponsiveness; performing repetitive movements; generalised seizure involving the whole brain. There are six types in this category, which include: Absence, tonic, atonic, clonic, myoclonic and tonic-clonic seizures. Following a seizure, the patient may not remember having one, or you might feel slightly ill for a few hours.
Triggers of epileptic seizure
Identifying triggers is not always easy. A single incident doesn’t always mean something is a trigger. It’s often a combination of factors that trigger a seizure.
Though it varies from one individual to another, some people are able to identify things or situations that can trigger seizures, and a few of the most commonly reported triggers are: Lack of sleep; illness or fever; stress; bright lights, flashing lights, or patterns.
Others are caffeine, alcohol, medicines, or drugs, skipping meals, overeating or specific food ingredients.
Diagnosis
If you suspect you have had a seizure, see your doctor as soon as possible. Epilepsy is usually diagnosed if you have seizures for no apparent or reversible reason.
Your medical history and symptoms will help your doctor decide which tests will be helpful. You’ll probably have a neurological examination to test your motor abilities and mental functioning.
In order to diagnose epilepsy, other conditions that cause seizures should be ruled out. Your doctor will probably order a complete blood count and chemistry of the blood.
Blood tests may be used to look for: signs of infectious diseases, liver and kidney function and blood glucose levels.
Electroencephalogram (EEG) is the most common test used in diagnosing epilepsy. It shows the pattern of electrical waves in the brain. First, electrodes are attached to your scalp with a paste. It’s a non-invasive, painless test. You may be asked to perform a specific task. In some cases, the test is performed during sleep. The electrodes will record the electrical activity of your brain. Whether you’re having a seizure or not, changes in normal brain wave patterns are common in epilepsy.
Imaging tests can reveal tumours and other abnormalities that can cause seizures. These other tests might include: CT scan, MRI, positron emission tomography (PET) and single-photon emission computerized tomography.
Epilepsy treatment
Most people can manage epilepsy. Patient’s treatment plan will be based on severity of symptoms, his or her health, and how well he or she responds to therapy. Medications are generally available in tablet, liquid, or injectable forms and are taken once or twice a day. These medications must be taken consistently and as prescribed by the doctor.
Some treatment options include: Anti-epileptic (anticonvulsant, anti-seizure) drugs: These medications can reduce the number of seizures the patient has. In some people, they eliminate seizures. To be effective, the medication must be taken exactly as prescribed.
Vagus nerve stimulator: It is a device that is surgically placed under the skin on the chest and electrically stimulates the nerve that runs through your neck. This can help prevent seizures.
Brain surgery: The area of the brain that causes seizure activity can be removed or altered. This is said to be a highly technical medical procedure.
Ketogenic diet: More than half of people who don’t respond to medication benefit from this high fat, low carbohydrate diet.
On slow pace of improvement during treatment, specialists insist that epileptic seizure would be effectively controlled if the sufferers strictly adhere to their drug prescription, adding that the seizure occurrence may continue until a patient’s prescription reaches his or her effective dose.
Just as there is no drug without side effects, according to experts, some potential side effects during treatment may include: fatigue, dizziness, skin rash, poor coordination and memory problems. Though rare, serious side effects include depression and inflammation of the liver or other organs.
However, worries over the possible side effects of prolonged use of drugs have been allayed at different platform. It was said that the side effects of these drugs were often exaggerated. The medical personnel agreed that the minor side effects of orthodox medication were much more tolerable than the consequences of badly managed epilepsy.
Dietary recommendations for epileptic patients
The ketogenic diet is often recommended for children with epilepsy. This diet is low in carbohydrates and high in fats. The diet forces the body to use fat for energy instead of glucose, a process called ketosis.
The diet requires a strict balance between fats, carbohydrates, and protein. That’s why it’s best to work with a nutritionist or dietician. Doctors must carefully monitor children on this diet.
The ketogenic diet doesn’t benefit everybody. But when followed properly, it is often successful in reducing the frequency of seizures. It works better for some types of epilepsy than others.
For adolescents and adults with epilepsy, a modified Atkins diet may be recommended. This diet is also high in fat and involves a controlled carb intake.
Quick tips to prevent and overcome episode
It is advised that when one sees somebody having the convulsive type of epileptic seizure, the patient should be assisted to ensure there is nothing around that could injure him or her. The person is to be carefully held down and turned to the left side so that the patient will not aspirate. A quick medical intervention is recommended to abort the episode.
Also, keep a seizure diary to help identify possible triggers, so you can avoid them. Wear a medical alert bracelet, though not common in Nigeria, so people know what to do if you have a seizure and can’t speak. Teach the people closest to you about seizures and what to do in an emergency.
