In A Fit Over Your Seizures?

Living with epilepsy is not easy! The thought of spontaneously experiencing a seizure is both overwhelming and challenging, and for many, traumatic as well.

Yet, those with this neurological condition will attest that they are able to manage their condition and live an active and productive life with the medical guidance and advice of their physician, by adhering to suitable treatment and by adopting a healthier lifestyle which includes exercise, a right diet plan, coupled with the love and support of family and friends.

Epilepsy is the most common chronic brain disease which affects people of all ages and has no geographic, social or racial boundaries. It is characterised by recurrent seizures due to a disruption of electrical activity in the brain which temporarily disturbs the messaging systems between brain cells.

According to the World Health Organisation[1], more than 50 million people worldwide have epilepsy and nearly 80% of them live in low- and middle-income countries. A 2021 survey in Malaysia reports that the lifetime prevalence of epilepsy (risk of having an epileptic seizure at some point in an average lifetime) stands at 7.8 in 1,000 population, and the prevalence for active epilepsy (continuing seizures or with the need for treatment) was 4.2 in 1,000 population.[2]

According to Dr Ahmad Rithauddin bin Mohamed, Head of Paediatric Neurology Unit at the Hospital Tunku Azizah Kuala Lumpur, “Epileptic seizures affect people in very different ways depending on the brain area that is affected. Generalised seizures begin with sudden abnormal electrical activity throughout the entire brain at once while focal seizures are due to abnormal electrical activity which start in one part of the brain but can spread to other areas as well.

“Depending on the type of seizure, the signs and symptoms of seizures may typically be characterised by staring into space, muscle spasms, mental confusion, loss of consciousness, repeated or rhythmic, jerking muscle movements, impaired awareness and body stiffening. Generally, seizures can last between seconds to minutes, and then will stop on their own. Some will have no recollection of their seizures once they regain consciousness.”

Epilepsy can affect a variety of mental and physical functions of the patient and can lead to depression, anxiety, cognitive and memory impairment, seizure related injuries, impaired social relations as well as increased healthcare costs.

Dr Ahmad explained that there are many causes of epilepsy; the causes vary with age. In childhood, abnormalities of brain structure and genetic causes are more common. In adults, epilepsy following acquired brain conditions such as stroke or multiple sclerosis is more prevalent.[3] Other causes include brain tumours and sequalae of head trauma or brain infection. In many cases, no clear cause of the seizure can be determined, but recent advances in genetic testing and brain imaging are now revealing the causes in some of these undiagnosed cases[4].

However, having a single seizure does not necessarily mean a person has epilepsy. High fever, low blood sugar, severe head injury, lack of oxygen, or a number of other medical conditions can provoke a seizure. It is advisable to consult your doctor upon having a seizure and, if required, you can be referred to a neurologist for further assessment.

Your neurologist will review your medical history and your account of the seizures, conduct a thorough neurological examination and may recommend a series of basic tests to better understand your condition. These include, among others, an EEG (electroencephalogram), a magnetic resonance imaging (MRI) of the brain and possibly some blood tests.
An estimated 70% of people with epilepsy could be seizure free if properly diagnosed and treated. However, about three quarters of people with epilepsy especially in low-income countries do not get the treatment they need, and this rises to 90% in some countries.[5]

For decades, epilepsy therapy remains anti-seizure medications (ASMs) which are effective for the majority of patients with epilepsy, but not all. Studies have shown that more than one third of patients fail to achieve seizure freedom with ASMs.[6,7] Of greater concern is the fact that mortality is high in drug resistant epilepsy. Uncontrolled seizures increase the risk of premature death up to 10 times.[8]

In such cases of drug resistant epilepsy, surgical procedures are the recommended first line treatment for patients with brain lesions. While these have proven successful for some patients, there are those who are deemed unsuitable to undergo surgery. Alternative therapies, such as the ketogenic diet, a diet high in fat, and depending of type, varying degrees of protein and carbohydrate, can be explored in consultation with your neurologist.

Neurostimulation-based treatments have gained considerable interest in the last decade. Among them is the Vagus Nerve Stimulation (VNS) therapy, often referred to as the pacemaker for the brain, which reduces the frequency of and can prevent seizures by sending regular, mild pulses of electrical energy to the brain via the vagus nerve. VNS therapy is known to be able to reduce the severity and frequency of these seizures and offer patients an improved quality of life.

“A comprehensive approach is equally critical in effectively managing epilepsy. All epileptic patients should ensure a balanced lifestyle, minus any stressors and surround yourself with the love and support of friends and family to help you get through this challenging condition.

“Having a positive mindset is crucial. The end goal is to manage the seizures and lead a normal life as much as you can,” advised Dr Ahmad.

References :
1 www.who.int/news-room/fact-sheets/detail/epilepsy
2 pubmed.ncbi.nlm.nih.gov/33440303
3 https://www.epilepsy.com/learn/about-epilepsy-basics/what-causes-epilepsy-and-seizures
4 https://www.epilepsy.com/learn/epilepsy-due-specific-causes/genetic-causes-epilepsy
5 https://www.who.int/health-topics/epilepsy#tab=tab_1
6 Kwan P, et al. Epilepsia. 2010;51:1069-77
7 Mohanraj R, et al. Eur J Neurol. 2006;13:277-282
8 Alexopoulos, Andreas. (2013) Pharmacoresistant Epilepsy : Definition and explanation. Epileptology. 1.38-42.
https://doi.org/10.1016/j.epilep.2013.01.001