Epilepsy (Seizure) - Causes, Symptoms, Surgery & Treatment

Overview

Epilepsy is a chronic neurological disorder that disrupts normal brain activity and causes unprovoked recurrent seizures. These seizures can vary in time, frequency, and severity and can cause loss of consciousness.

Seizures are episodes of disturbed brain function, caused by abnormally excited electrical signals in the brain. Epilepsy is a term used for recurrent seizures caused by increased firing in the brain cells resulting in short-circuiting of the brain circuits. Epilepsy is not a psychological illness.

Epileptic seizures can be of different types with some being mild while the others causing spasms and uncontrollable muscle twitches. About 1% of people worldwide (70 million) have epilepsy, and nearly 80% of cases occur in developing countries. In India, it’s prevalent in between 6 to 10 per 1000 people.

Anyone can develop epilepsy at any stage of life. It can be caused by damage or malformation to a part of the brain. The most common causes include:

Traumatic head/brain injury
Infections, including brain abscess, meningitis, encephalitis, and AIDS
Abnormal blood vessels in the brain
Brain tumour
Viral illness
Metabolism disorders present at birth
Changes to the brain as part of the aging process
Alcohol misuse/abuse

There are also genetic causes for some epilepsies.

With advancements in the medical field, it has become possible to control epilepsy and further reduce its symptoms. To cope with epilepsy, it is also important to recognise its signs early and treat it as fast as possible. Symptoms vary from person to person, depending on the functioning of the brain where excessive neuronal discharge is excessively produced. The most common signs are:

Staring spells
Loss of alertness
Strange sensation

Max Institute of Neurosciences (MINS) provides comprehensive and compassionate care to adults and children with seizure disorders. Our team of highly experienced doctors and surgeons strive to ensure the best results that eventually bring good quality life to people. We provide super speciality tertiary care for all kinds of neurological disorders. Apart from an array of services like Advanced Brain Tumour Centre, Minimally Invasive Spine Surgery Centre and Stroke Centre, it has India's first BrainSUITE - the most advanced Neuro Operation Theatre. We have highly-skilled neurosurgeons, neurologists, interventional neurologists, neuro anaesthetists, experts in critical care and specialised nurses who work together to deliver world-class services. They are supported by next-gen facilities such as a dedicated high-end Neuro ICU and HDU with 24x7 neurosurgery and neuro anaesthetist backup. Each member of the team brings expertise from years of experience and skills, all directed towards providing the highest standards of patient care.

The institute provides round-the-clock, comprehensive diagnostic and therapeutic neurology services, according to evidence-based protocols set as per internationally accepted guidelines. Our casualty services are available round-the-clock for diagnosis and early management of a wide range of neurological emergencies, including Status Epilepticus.

At Max Institute of Neurosciences, patients can receive a comprehensive evaluation and neurodiagnostic treatment services such as counselling, education, customised treatment plans, medication, physical evaluations, and psychological reports. It also provides elaborate presurgical evaluation and surgical treatment to those epilepsy patients whose condition cannot be controlled with medical treatment.

Early diagnosis and treatment can save patients from severe complications of epilepsy. To help you fight epilepsy, Max Institute of Neurosciences provides holistic and integrated care by consolidating opinions of highly-qualified doctors. The Epilepsy Programme at Max Institute of Neurosciences is led by an epileptologist.

There is no definitive test for epilepsy. The doctor will reach a diagnosis based on the patient's account or that of eyewitnesses. Max Institute of Neurosciences offers the following diagnostic tests for epilepsy:

Electroencephalogram (EEG): Repeated EEG may be helpful when the diagnosis of epilepsy or the syndrome is unclear. However, if the diagnosis has been established, repeated EEGs are not likely to be helpful. When a routine EEG has not contributed to diagnosis or classification, a sleep-deprived EEG is performed. Long term Video EEG is used for the assessment when there are diagnostic difficulties after clinical evaluations and standard EEG. It is also used as a part of the pre-surgical assessment in patients who are not responding to medical treatment.
Neuroimaging: It is used to identify structural abnormalities that cause certain epilepsies. MRI is the imaging investigation of choice. It is particularly important in those patients who have any indication of a focal onset on history, examination or EEG or who have continued seizures in spite of first-line medication. Neuroimaging is not routinely requested when a diagnosis of Idiopathic Generalised Epilepsy (IGE) has been made. CT Scans are used to identify underlying pathology if MRI is not available or is contraindicated.
Other Tests: Appropriate blood tests (glucose, electrolytes, calcium, renal function, liver function and urine biochemistry) to identify potential causes and/or to identify any significant comorbidity are considered.
Electrocardiogram (ECG): A 12 lead ECG is performed in adults with suspected Epilepsy. In the case of diagnostics uncertainty, a referral to a cardiologist is considered.

Based on the medical evaluation, our doctors can make a treatment plan to treat the type of seizure that the patient has experienced.

There are several options for treating epilepsy, with the most common being anti-epileptic drugs, or AEDs. Up to 70% of people with epilepsy could have their seizures completely controlled with the right treatment.

Max Institute of Neurosciences offers the following options to get the best treatment for epilepsy.

A) Anti-Epileptic Drugs: This is usually the first treatment that the doctor will try to start to control the seizures. The aim is to control seizures as fully as possible, whilst minimising the side effects of the drugs.

B) The Ketogenic Diet: It is usually considered for children when AEDs have not had a good effect on controlling seizures. It involves strict control of fat, protein and carbohydrate levels, and should always be done with the supervision of a specialist dietitian.

C) Vagal Nerve Stimulation (VNS): This involves implanting devices to attempt to suppress the abnormal electrical activity that causes seizures. They can be considered for people when anti- epileptic drugs have failed to give control.

D) Surgery: This option is recommended for people with uncontrolled seizures. About 20 to 30% of people have poorly controlled epilepsy despite trying multiple medications. Surgery can practically cure epilepsy in such patients. The origin of seizures can be located by Video-EEG Monitoring and MRI. The small area of the brain responsible for seizures can be removed easily by surgery. Surgery has been very successful in such cases.