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Articles on Epilepsy

Articles on Epilepsy

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Surgical help for epileptic patients
Epileptic seizures not only affect your body but also make drastic changes in your psychological and emotional life. While most people benefit from medications, there are same for whom there is no respite from “Fits”.

Says Dr. Nusli Ichaporia of Jehangir Hospital and Medical Center, “Every year there are 15,000 people in Pune who develop epilepsy. Of these there are 10 to 20per cent who have medically intractable epilepsy”.

For these people, medication provides no relief. In these truly resistant type of epilepsy, despite proper choice of the standard drug, addition of new drugs and monitoring of blood levels, the seizures will continue without much change in their pattern of occurrence. While the scenario may seem pretty bleak for such persons, surgery now provides hope. At the Epilepsy Center at Jehangir hospital, patients can undergo surgery for correction of their condition. In the Epilepsy Surgery program, 13 patients with resistant epilepsy underwent surgery.

The types of seizures that are surgically remediable are Mesial temporal sclerosis, tumors presenting with seizures as a pre dominant symptom, structural defects in the brain mostly from birth, and post brain injury gliosis. Of the 13 patients, 5 had Mesial temporal sclerosis, and were between 25 to 35 years of age and had resistant epilepsy for 15 to 25 years. Clinically there was no focal neurological defect in most patients and neuro–psychology tests had to be done to show impaired function of the temporal lobe on the side of the sclerosis. Neuropsychological tests are necessary because MTS cannot be detected on CT or routine MRI.

4 patients had tumors, but these are without the usual symptoms of headaches, vomiting or focal neurological deficit typical of tumors. Yet another group of persons had brain injuries that resulted in seizures.

Says Ichaporia, “With surgery, after a six month period, 85 percent of the patients had a good seizure control, and 90 percent showed an improvement in the quality of life”.

The surgery costs INR 30 to 45,000 a compared to USD 30,000 to 45,000 abroad but for the people suffering from epilepsy, this is more than just an issue about money.

Epilepsy and Contraception

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Some anti–epilepsy medicines have a side–effect of increasing the speed in which some contraceptive pills and injections are processed by the liver. (These medicines are known as liver enzyme inducers as they speed up certain processes in the liver cells.) For example, the following anti–epilepsy medicines are liver enzyme inducers: carbamazepine, oxcarbazepine, phenobarbital, phenytoin, primidone, and topiramate. Other anti–epilepsy medicines such as sodium valproate, lamotrigine (but see below), and ethosuximide are not liver enzyme inducers.

In general, women with epilepsy who require contraception are usually treated with medicines that are not liver enzyme inducers. Contraceptive choices, doses, etc, are then usually the same as for any other women (but see below about lamotrigine). See leaflet called ‘Contraceptive Choices’ for details of the options. However, in some situations, an anti–epilepsy medicine that is a liver enzyme inducer is required for treatment. If you take an anti–epilepsy medicine that is a liver enzyme inducer, then:

If you take the combined oral contraceptive pill – the dose of the oestrogen part needs to be at least 50 micrograms. This is more than the usual dose. Also, many doctors recommend that
  • You should take three packs together (tricycling). This means taking one pack after each other without a break between the three packs. Then have a ‘Pill free break’ after the third pack.
  • When you do have a ‘Pill free break’, only have four days break rather than the usual seven.
  • If you get breakthrough bleeding whilst taking the pill, the dose of oestrogen should be increased to 75–100 micrograms per day.
Even with these extra precautions, the reliabilty of the pill is reduced compared to women who do not take medicines that are liver enzyme inducers. Therefore, some doctors advise that you use condoms in addtion to the pill for extra contraceptive protection.
  • If you use the progestogen injection called Depo–provera for contraception – then you need an injection every 10 weeks. (This is more often than usual which is every 12 weeks.)
  • The progestogen–only pill is not recommended.
  • Progestogen implants are not recommended.
  • The combined transdermal contraceptive patch is not recommended.
  • If you use emergency contraception tablets – the initial dose of levonorgestrel should be increased to 1.5 mg followed by 750 micrograms 12 hours later.
Special consideration – lamotrigine and the pill
There is some evidence that the combined oral contraceptive pill may interact with lamotrigine (Lamictal) in some women. Lamotrigine is an anti–epilepsy medicine. It is not a liver enzyme inducer but may interact with the pill in another way. The interaction may work ‘Both ways’. That is, the lamatrigine may make the pill less efective. But also, the pill may make the lamotrigine less effective and increase your risk of seizures. Therefore, the doses of both may need to be adjusted.

The ‘Take home message’
For reliable contraception, it is best to seek advice from a doctor or nurse. They will be able to tell you if your epilepsy treatment affects a method of contraception.

Facts about Epilepsy

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Facts about Epilepsy
  • Up to 5% of the world’s population may have a single seizure at some time in their lives.
  • It is likely that around 60 million people in the world have epilepsy at any one time.
  • Children and adolescents are more likely to have epilepsy of unknown or genetic origin than adults.
  • Epilepsy can start at any age.
  • Recent studies show that seizures in up to 70% of children and adults with newly diagnosed epilepsy can be controlled with medications; however, many of these people experience treatment–related side effects.
  • Seizures in up to 30% of people with epilepsy do not respond to available medications.
  • There is a fine balance in the brain between factors that begin electrical activity and factors that restrict it, and there are also systems that limit the spread of electrical activity. During a seizure, these limits break down, and abnormal electrical discharges can occur and spread to whole groups of neighboring cells at once. This linkage of electrical discharges creates a “Storm” of electrical activity in the brain. This is a seizure. When a person has had at least two of these seizures, that’s called epilepsy.
How does epilepsy begin?
  • The reasons why epilepsy begins are different for people of different ages. But what’s true for every age is that the cause is unknown for about half of everyone with epilepsy.
  • Children may be born with a defect in the structure of their brain, or they may suffer a head injury or infection that causes their epilepsy. Severe head injury is the most common known cause in young adults. In middle age, strokes, tumors, and injuries are more frequent. In people over 65, stroke is the most common known cause, followed by degenerative conditions such as Alzheimer’s disease.

Why does it sometimes take years before someone with a brain injury experiences a seizure?
Often seizures do not begin immediately after a person has an injury to the brain. Instead, a seizure may happen many months later. We do not have a good explanation for this common observation, but scientists are actively researching this subject.

Mild head injuries, such as a concussion with just a very brief loss of consciousness, do not cause epilepsy. Even though you may not know the cause of your epilepsy, you can help yourself by looking for factors (often called “Triggers”) that seem to make your seizures more frequent or more severe and then avoid them altogether or atleast reduce their effects.

Famous People with Epilepsy

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Biographers and historians have tried for centuries to explore the link between Epilepsy and Uniqueness of prominent personalities. While the research continues, we would like to encourage People with Epilepsy with stories of such famous personalities.

Here is a list of a few such famous people who were known to have this medical condition.

Socrates Greek philosopher
Fyodor Dostoyevsky Russian novelist
Joan of Arc French saint and national heroine
Alexander the great King of macedonia
Charles Dickens English novelist
Napoleon Bonaparte French emperor
Julius Caesar Roman general and statesman
Vincent Van Gogh Dutch painter
Lewis Carroll English author and mathematician
Sir Isaac Newton English scientist and mathematician
Alfred Lord Tennyson English poet
Jonty Rhodes South african cricketer

Epilepsy in Senior Citizens

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Though most of the epilepsies occur in infancy or childhood, some seizures begin late in life and the incidence of seizures which ids low in the 20-50 gage groups again starts increasing after 60 yrs.

Epilepsies in the elderly may be primary (i.e. without any cause being found), or secondary to lack of blood supply, or trauma, or tumors, to name a few common causes. In view of these, all seizures beginning late in life need to be thoroughly investigated.

One needs to be careful in treating elderly patients. They often have multiple other illnesses, e.g. high BP, diabetes, heart disease, stroke, arthritis etc. The medicines we give should not worsen any of these conditions. More importantly they should not interfere with the medicines which the patient is already taking. Hence it is important that the patient reveal his medicines in detail during the initial visit to a specialist. Often patients are taking medicines for sleep, chakkar, acidity, weakness or other common ailments which they fail to inform the neurologist and this may sometimes lead to drug interactions which may reduce the effects of medicines for seizures.

Secondly, elderly people tolerate drugs very poorly and are more prone to "Side effects" (these are in fact over effects and can be easily remedied). The dose needed by these people is often only ½ or 2/3 the usual dose. Hence we often start with very small doses and increase these gradually, depending on how the patient tolerates the medicine. The choice of drug is often dictated by how safe it is rather than how effective it is.

one needs to watch carefully for the side effects especially chakkar, imbalance, sleep disturbances, as falls in the elderly often lead to fractures and can be quite disabling.

Also close watch on medicines and side effects has to be kept during other illnesses which may be unrelated to the epilepsy, especially during fevers, or during any operations the patient may be undergoing.

Once epilepsy develops in late life, it most often needs lifelong medication, and patients need to be counseled regarding this and should be mentally prepared. In our society, patients are reluctant to take long term medicines, and this is especially true in case of the elderly, and more so for allopathic medicines and hence more counseling and reinforcement id as well as encouragement is needed at every follow up.

Thus epilepsy in the elderly needs a different approach as compared to the children. These patients need to actively participate in their treatment and psychological handling is needed as much as medical management.

Contributed by
Dr. Hemant Sant
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