UNDERSTANDING EPILEPSY.

Epilepsy is a diagnosis made by a doctor after examining a person experiencing recurrent unprovoked seizures.A seizure is an abnormal electrical activity within the brain that results in abnormal body functions.

It’s important to note that not all people who have ever experienced a seizure are said to have epilepsy. Up to 10% of people worldwide experience a seizure or two during their lifetime. There is a criterion that doctors use for the diagnosis of epilepsy hence the importance of having a person experiencing seizures examined by a qualified medical doctor. Good thing is  that most of those who are identified to have epilepsy can live a normal life with the current medication and other treatment options that are available.

The history of epilepsy has been 4000 years of ignorance, superstition and stigma. This was then followed by 100 years of knowledge, superstition and stigma. Over the years, there has been a lot of advancement in terms of understanding epilepsy. However, some questions about epilepsy still remain unanswered. This has enabled the stigma and superstition associated with epilepsy to continue.

We hope  this read will shed some more light on this condition and hence alleviate some misconceptions about epilepsy.

What is Epilepsy

Epilepsy is a tendency to experience recurrent unprovoked seizures. Seizures are abnormal signalling and electrical discharges in the brain. Normally brain cells send signals that control who we are, how we move, our consciousness, our behaviour, our daily thoughts and even our memory. When there is excessive electrical discharge or signalling, it manifests as abnormal body functions. This can manifest as convulsions, absent mindedness and sometimes changes in behaviour, memory and function.

It’s approximated that there are about 50 million people living with epilepsy globally. Most of this people living with epilepsy are from low and middle income countries. This makes it one of the most common disorders affecting the brain. There are some illnesses that can mimic epilepsy. It is hence important to involve a doctor when dealing with someone experiencing symptoms that point towards epilepsy.

What causes Epilepsy

Some cases of epilepsy have no identifiable cause, even after all the relevant checks and tests have been done. However, most cases have an identifiable cause. We have discussed some of the identified causes of Epilepsy below. This is not a comprehensive list but it does cover the most common causes here in Africa.

Genetics play a role in development of epilepsy. People with a family history of epilepsy are at a greater risk of developing the disease. It is important then to mention to the doctor about any relative, especially a first degree relative, who has epilepsy or experiences recurrent seizures.Charting a family tree however sometimes proves difficult due to stigma as not many people want to acknowledge the presence of a family history of epilepsy.Some gene abnormalities and mutations have also been shown to cause Epilepsy.

Trauma to the head that leads to brain injury can result to epileptic seizures as a complication. Injury can be a onetime thing as seen in road traffic accidents or can be due to repetitive trauma as sometimes happens in child abuse or self-injurious behaviours in mental handicap. Taking precautions to protect from head injury, especially for children is essential.

Brain injury related to pregnancy and birth; some infections that occur during pregnancy can affect the development and function of the brain. Complications during birth that leads to decreased oxygen supply to the baby or decreased glucose can also cause epilepsy as a complication.

Some Infections; especially those that directly affect the brainhave shown to result in epilepsy as a consequence.

Stoke; a stroke occurs when there is sudden session of blood supply to a particular part of the brain. If blood supply is not restored in time, then there is death of some brain cells and this can lead to epilepsy, depending on the part of the brain that is affected.

Brain tumour; this is an abnormal growth within the brain mainly due to an infection or abnormal brain cell growth or a cancer. A tumour in the brain compresses on the other normal brain cells and hence causes their abnormal function.

Who is at risk of developing Epilepsy

It’s possible for anyone to develop epilepsy if they are exposed to any of the factors discussed above. People with a family history of epilepsy have a genetic predisposition hence have a higher risk of acquiring epilepsy.

How does epilepsy present

As mentioned before, all people at any age group can be diagnosed with epilepsy. There is evidence however of peak age groups when epilepsy occurs. The first peak is during childhood and adolescence and the second peak is in older adults who are more than 65 years of age. Epilepsy in the earlier years is mainly attributed to genetic causes or birth related complications while in the later years, occurs mainly due to an underlying disorder of the brain.

There are many ways a seizure can present. This depends on the part of the brain that is affected. Some people experience seizures without losing their consciousness while others loss their consciousness. Some seizures involve a part of the body while others involve the whole body. Sometimes one may experience an episode of absent mindedness with no other presentation or a twitch of the hand, a change in smell or taste, a problem with movement, loss of some memory and so on.  

The frequency and intensity of presentation depends on which part of the brain is affected and for how long. Sometimes young people with epilepsy can grow out of it in their late teens and early twenties.

What treatment options are available.

Its estimated that 70% of people living with epilepsy could live seizure free if the proper diagnosis and management is done. There are people who after proper medical follow up live a seizure free life and are able to resume activities they were restricted from. There are some cases however that are quite complex and do not show much improvement even with medication.

There are various medications available for Epilepsy. Almost 2/3 of patients with epilepsy suppress the attacks with one drug when taken well and in adequate doses. Once one is started on medication, consistency is key to achieving improvement.

Different antiepileptic drugs work for different people hence drug sharing is not advised. All people living with epilepsy need to get their prescriptions from a certified doctor.

Surgery in some cases has shown benefit. Surgery is reserved for cases where the benefit outweighs the risk.

There are many other therapies that have shown to help alleviate the symptoms of epilepsy all of which are best taken under a doctors advisement.

How to take care of a person with Epilepsy

Daily medication for years is not an easy task for anyone and hence the importance for support from those around people living with epilepsy. Encouragement to take the drugs consistently goes a long way.

Checking on them frequently to ensure they are safe. Epileptic convulsions, especially before medication are very unpredictable. Also Ensure they go for their frequent check-ups as advised by the doctor.

Exempting them from tasks that can easily cause them harm is recommended. Due to the unpredictable nature of the disease, people living with epilepsy shouldn’t cook without supervision, they should avoid high unrestricted areas or driving unobserved.

Remind them that after a period of medication and with good compliance, they could actually resume activities that they were restricted from previously and live a seizure free life

What activities can pose danger to someone with Epilepsy

Epileptic seizures are difficult and almost impossible to predict. Few people are able to tell when they are about to experience a seizure but majority are usually caught unaware. People  living with epilepsy therefore are at a higher risk of accidents that can be life threatening. Some activities that we do on a daily bases are quite dangerous for people with epilepsy. WHO estimates that people with epilepsy have a three times higher risk of early death as compared to the general population.

Here are some of the activities that can prove dangerous to someone living with epilepsy and the recommendations put forward to avoid harm.

People living with epilepsy should not cook when they are alone. They should always have a companion when cooking, handing open flames or when they are dealing with hot substances.

 Fishing, boating, swimming should be avoided until one is seizure free for a while or under a doctor’s recommendation. Heights should be avoided as much as possible.

Some activities like driving and operating machinery are not recommended and are legally prohibited in some countries. This means that some jobs are off limits to those with uncontrolled epilepsy. These restrictions are always reviewed by a doctor and if one is seizure free for a certain period of time, these restrictions can be lifted.

People living with epilepsy are safest when they are with other people. Having someone to keep them company most times is the best way to reduce harm.

Preventing Epilepsy

Washing hands and observing proper hygiene. This will ensure a reduction in infections especially in children. Also the Early diagnosis and treatment of  conditions that predispose to Epilepsy

Protecting against head injury by using protective gear during play and work goes a long way. Ensure use of seat belts and careful riding and driving.

Proper follow up during pregnancy and ensuring birth assisted by a qualified professional.

People living with epilepsy should be aware of the effect of some activities on seizures as. Fatigue, sleep deprivation, alcohol, infections and flashing lights can all act as triggers and hence one should be cautious.

Reporting a family history of epilepsy to the doctor is important. This might not prevent the development of epilepsy but it might ensure proper advice and follow-up to minimize the effects of the illness.

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