In ancient history, epilepsy was attributed to spiritual or demonic possession. Hippocrates shunned the notion that it was a supernatural phenomenon and believed that it was derived from the brain, had hereditary aspects, and that how it presented itself in childhood also determined how it affected the rest of the individual’s life. However, Hippocrates wasn’t believed until well into the 17th century. Even today the stigma associated with it continues. Epilepsy is a chronic non-communicable disease of the brain that affects around 70 million individuals all over the globe. It is the second leading problem affecting the rural and urban population, which has made the disorder a public health issue despite being clinically benign in most cases. Diagnosis of epilepsy leads to a considerable amount of negative psychological effects especially on school-going children as they have to face a lot of discrimination in the school environment from their teachers and peers. Developing countries are somewhat lagging behind in clearing the misconceptions about epilepsy that makes it all the more challenging to live with the disorder more than the disorder itself. A study in South India showed that although 88% of people had heard about epilepsy, lack of proper knowledge has created a negative attitude toward the disorder; 23% thought that it is hereditary and 23% thought it to be a type of lunacy. Due to the lack of proper knowledge, it has been noted that few people do not really know what to do when a person is having an episode of seizure. This facilitates the feeling of impotence that strengthens the belief that epilepsy cannot be treated. However, the following points can help increase awareness and that, in turn, will prevent morbidity.
What to do in case of a seizure?
- Stay calm
- Protect the child from injury
- Lay the child on the ground and turn on one side
- Stay with him/her until recovery is complete (5-20 minutes)
- Try to time the seizure
- Use Midazolam spray if a seizure lasts more than 3 minutes
What not to do?
- Do not panic or walk away
- Do not hold down or restrain the child’s movements.
- Do not put anything in the child’s mouth. Smelling an onion or shoe will not help.
- Do not try to move the child unless they are in danger
- Do not give the child anything to eat or drink until fully recovered
Treatment options for Epilepsy:
- Medication – The majority of epilepsies can be managed with medications. Irrespective of the cause, 25-30 % of children with epilepsies will be medically refractory ie. poor seizure control on 2 or more medications.
- Ketogenic diet (KD) – a high-fat, low carbohydrate diet that has gained popularity for weight loss. However, it has been used for almost 100 years for control of refractory epilepsy. Approximately two-thirds of children have achieved a 50 per cent reduction in seizures, and up to 25 per cent can become seizure-free.
- Vagus Nerve Stimulation (VNS Therapy) – is a small generator (like a pacemaker), which is placed under the skin. It has a thin wire which sends regular, mild pulses of electrical energy to the brain via the left vagus nerve. This reduces and/or shortens seizures and has a positive effect on neurobehavioral issues – like mood, memory and learning. VNS is a good option for children who are not candidates for epilepsy surgery or cannot tolerate KD.
- Epilepsy surgery- Epilepsy surgery is a procedure that removes or alters an area of your brain where seizures originate. The type of surgery depends largely on the location of the neurons that trigger the seizure and the age of the patient. It is usually done for patients with medically refractory seizures, for those who have intolerable side-effects of medications, patients with brain lesions, certain types of seizures. It involves a multidisciplinary role of Neurologist, Neurosurgeon, Neuroradiologist and Neurophysiologist.
Dr. Anaita Hegde | Senior Consultant – Neurology – Paediatric | SRCC Children’s Hospital, Mumbai