Management of seizures, epilepsy

CHENNAI: A seizure is a condition that develops due to abnormal and uncontrolled electrical activity in the brain leading to neurological symptoms. Contrary to traditional beliefs, seizures can assume different types of presentations.

The classical picture of seizure involves jolting movement of all 4 limbs along with tongue bite and up rolling of eyeballs. Other seizure types include but are not limited, to behaviour changes, continuous jerking of only one side of body with preserved consciousness, episodes of vacant stare or recurrent blinking (commonly seen in children and referred to as absence seizures), lip-smacking/ fidgeting behaviour, and the rare hyper-motor seizure with actions mimicking a complex motor movement like a drum beating.

It is crucial to understand that seizure is not a disease but a symptom (like fever). Seizures can be due to changes in blood sugar levels, blood sodium levels, bleeding inside the brain, tumors in the brain, or can be a consequence of infection. In these scenarios treatment of the underlying disorder is sufficient to prevent future seizures. On other hand, in some cases no obvious cause for seizure is identifiable and patient keeps getting recurrent episodes which are then referred to as epilepsy. The two terms are not interchangeable.

As a part of the routine assessment for patients with seizures, a set of tests are done which include basic blood tests and sophisticated neurological tests. The mainstay of treatment for epilepsy is the administration of medications that directly act on brain and modulate the effects of the chemicals and ultimately prevent future seizure recurrences. More than a dozen drugs are available at present for epilepsy. However, the requirement for each patient varies. Some drugs have niche indications (specific seizure types) and tend to be useless or even potentially harmful in some scenarios.