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Health Matters Sandisiwe Mahlangu
Epilepsy is a chronic neurological condition characterised by recurrent seizures. A seizure happens when abnormal electrical activity in the brain causes an involuntary change in body movement or function, sensation, awareness or behaviour. Seizures can vary from momentary disruption of the senses, to short periods of unconsciousness or staring spells to convulsions. Some people have only one type of seizure. Others have more than one type. The term epilepsy can be used interchangeably with the term seizure disorder. Epilepsy is a chronic condition and cannot be transmitted from person to person.

Epilepsy is remarkably uniformly distributed around the world. There are no racial, geographical or social class boundaries. It occurs in both sexes, at all ages, especially in childhood, adolescence and increasingly in aging populations.

The periodic clinical features of seizures are often dramatic and alarming, and frequently elicit fear and misunderstanding. This in turn has led to profound social consequences for sufferers, which has greatly added to the burden of this disease. In ancient times, epileptic attacks were thought to be a result of the invasion and possession of the body by supernatural forces, usually malign or evil influences requiring exorcism, incantations or other religious or social approaches. Even to this day, some still think that way.

Delayed recognition of seizures and inadequate treatment which may result from lack of specialty care, greatly increases a person’s risk for subsequent seizures, brain damage, disability and death from injuries incurred during a seizure.

Epilepsy is a widely recognised health condition, but one that is poorly understood by the public, even among people who know someone with the disorder. Lack of knowledge about the causes of epilepsy has been associated with negative attitudes, beliefs and stigma. Lack of understanding about epilepsy is a leading cause of discrimination in the workplace and in schools.

Epilepsy can be caused by many different conditions that affect a person’s brain. Examples of these conditions include:

1) Interruptions of blood flow to the brain caused by stroke, tumour or certain cardiovascular diseases.

2) Head trauma that causes scarring of the brain tissue complications during childbirth.

3) Infections (such as meningitis, encephalitis, or brain abscess) and genetic disorders.

Often, no definite cause can be found.

There are precipitating factors which may trigger a seizure. These factors may be different for each individual patient. Some patients learn which factors are important for them and so they can modify their behaviour or activities to try to avoid seizures.

The most common factors are:

• Flashing lights resulting in reflex epilepsy
• Lack of sufficient sleep
• Emotion –being angry or excited
• Physical stress
• Hormonal changes, for example, during menses

Types Of Seizures
Partial seizures with elementary symptomology are often referred to as a simple partial. During this type of seizure the patient can experience a range of strange or unusual sensations including sudden, jerky movements of one body part, distortions in hearing or seeing, stomach discomfort, or a sudden sense of fear. Consciousness is not impaired. If another seizure type follows, these sensations may be referred to as an “aura”.

Complex partial seizures are characterised by a complicated motor act involving impaired consciousness. During the seizure the patient appears dazed and confused. Purposeless behaviours such as random walking, mumbling, head turning, or pulling at clothing may be observed. Usually, the patient cannot recall these so called “automatisms”.

In children this seizure may consist of staring or lip smacking, and therefore may be confused with the absence seizures.

Generalised absence seizures are characterised by 5 to 15 second lapses in consciousness. During this time the patient appears to be staring into space and the eyes may roll upwards. Absences are not preceded by an aura and activity can be resumed immediately afterwards. Typically, they occur in children and disappear by adolescence. The child is unresponsive when spoken to.

These typical absences occur many times a day. During an absence seizure the child of school going age does not hear what the teacher is saying and as they occur so often, the child cannot follow the lessons any more. Unless the teacher is aware of this condition, the child would be scolded for daydreaming and inattentiveness.

These absence seizures, however, evolve into other seizure types, such as complex partial or tonic clonic. The occurrences of absences in adulthood are rare.

The tonic clonic seizure is a generalised convulsion involving two phases. In the tonic phase, the individual loses consciousness and falls, and the body becomes rigid. In the clonic period, the body extremities jerk and twitch. After the seizure, consciousness is regained slowly. If the tonic clonic seizure begins locally (with a partial seizure) it may be preceded by an “aura”. These seizures are said to be secondarily generalised.

While the tonic clonic seizure is the most visible, obvious type of Epilepsy, it is not the most common. Partial seizures are more frequently encountered and occur in 62 percent of all Epilepsy patients. Complex partial seizures account for approximately 30 percent of all cases.

First Aid for Seizures

The appropriate behaviour for helping someone who has a seizure depends on the type of seizure it is. While a person experiencing a tonic clonic seizure may require some first aid, in most cases there is little that can be done. Tonic Clonic (Grand Mal): This type of seizure is often the most dramatic and frightening, but it is important to realise that a person undergoing an epileptic seizure is usually unconscious and feels no pain. The seizure usually lasts only a few minutes, and the person does not need medical care. These simple procedures should be followed:

• Keep calm. You cannot stop a seizure once it has started. Let the seizure run its course. Do not try to revive the person.
• Ease the person to the floor and loosen clothing.
• Try to remove any hard, sharp, or hot objects that might injure the person. It may be necessary to place a cushion or soft item under their head.
• Turn the person on his or her side, so that the saliva can flow from the mouth. Do NOT put anything in the person’s mouth.
• After the seizure the person should be allowed to rest or to sleep if necessary.
• After resting most people carry on as before. If the person is not at home and still seems groggy, weak, or confused, it may be better to accompany them home.
• If the person undergoes a series of convulsions, with each successive one occurring before he or she has fully recovered consciousness, or a single seizure lasting longer than 10 minutes, you should immediately seek medical assistance.

Thorough history taking and some tests like the electroencephalogram (EEG) do help in diagnosing epilepsy. The aim of medical treatment is to control the seizures, so that life can get on with as little disruption from epilepsy as possible. Anti-epileptic drugs are usually prescribed to help control the seizures. Therefore it is crucial to visit the nearest health facility if there is suspicion that one could be having a seizure disorder.