Epilepsy

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Description of the disease
Useful tips

What is epilepsy?

Epilepsy is not one specific disease, but rather a group of neurological disorders characterized by epileptic seizures. That’s why it is often referred to as not epilepsy but epilepsies. Epilepsies are characterized by recurrent epileptic seizures. An epileptic seizure is developed due to abnormal and excessive synchronous neuronal activity in the brain.

What can be the course of the disease and how is it manifested?

Epileptics seizures have various manifestations. They vary from generalized tonic-clonic seizures (a patient loses consciousness and falls with subsequent tonic seizures of the whole body and clonus of the extremities) to hardly noticeable twitching of hands and legs (myoclonus). Besides, there are attacks with disturbed consciousness when a patient does not fall but still fails reacting to what is going around him (or her) during the attack. The attack can have distinct motor constituents such as hand or leg twitching with no loss of unconsciousness, asymmetric tonic tension in the muscles of the body and extremities. The attacks can be manifested by auditory, visual and olfactory hallucinations and other distorted perceptions of the world.

Epileptic syndromes (diseases) are diverse as well. They are very diverse in childhood. Epilepsies can be age-dependent (begin and resolve at a certain age even without treatment). They can be long-lasting. They can last for decades. They can produce either a negative or no effect on a patient’s intelligence. Rate of attacks in different epileptic syndromes varies from one per year to dozens (or even hundreds) per day. In general, epilepsy is a serious disease. It requires a responsible attitude both from a patient, and a doctor. A patient with epilepsy needs additional examinations such as short 20 minute electroencephalogram (EEG) recording and long-term video-EEG monitoring of sleep and wake (records EEG and captures attacks on video), if needed. Almost all patients have magnetic resonance imaging of the brain. Children with epilepsy often require additional genetic and metabolic examinations.

What is the treatment?

Treatment of epilepsy is long-term. The majority of patients obtain constant and continuous individually tailored treatment with an antiepileptic drug. Regular doctor’s visits and monitoring of drug tolerability are necessary. Success of treatment mainly depends on a patient’s (or parents’ of a pediatric patient) adherence to a doctor’s recommendations.

K. R. Badalyan

Department of Neurology, Faculty of Additional Professional Education

of Pirogov Russian National Research Medical University

All patients with epilepsy, their relatives, caregivers and doctors need to have a normal life of a healthy person. Epilepsy can produce a negative effect on a patient’s way of life but reasonable optimism will decrease the negative effect to a certain extent.

Emotional and mental support is extremely important for patients. The same goes for the patient’s family, school/college/institute he attends and place of work. Everyone around needs to treat patients with epilepsy as normal people who, though, have certain problems. Patients and their relatives can also gain support from multiple special social organizations (associations) which are currently available. Some patients and their families need help of a psychologist and psychotherapist.

As a rule, patients with epilepsy need no special diet. However, patients with severe epilepsy require ketogenic diet.

General physical loads do not provoke attacks. Sports is recommended to patients with epilepsy. It produces a favorable effect on the mood and makes the patient feel less isolated from the society. However, in every case the question is solved on the individual basis. The type of attacks is important: if a patient loses consciousness during the attacks, certain restrictions can be introduced.

Having epilepsy can stop people from doing the job they want. One can’t be a pilot, driver, professional soldier, policeman and fire guard if he/she suffers from epilepsy. Working with moving machinery and chemical agents can be dangerous for a patient with persistent attacks. If attacks are developed due to sleep loss, working at night is unacceptable.

Many patients suffering from epilepsy have normal sexual life with no complaints. Some antiepileptic drugs can decrease the effectiveness of peroral contraception. It is necessary to consult a doctor regarding this issue. If a patient with epilepsy is planning to get pregnant, the pregnancy should be scheduled. A pregnant women with epilepsy must be consulted by both epileptologist and gynecologist who determine the tactics of pregnancy and labor.

Having enough amount of an antiepileptic drug during a trip is sufficient. It is better to take a prescription form where the international name of the drug is stated. Having a short record from your treating physician containing recommendations as well is even better.

Alcohol taken in large amounts decreases the effectiveness of antiepileptic treatment (recurrent seizure is possible). The majority of patients with epilepsy can have some wine (100 ml) or beer (285–300 ml) or distilled spirits (30 ml) occasionally.

In our country, the motor-vehicle law is very strict. If a person suffers from epilepsy, he/she can’t drive a car.

Patients without photosensitivity can work on the computer or watch TV programs without limitations.

It is recommended that all photosensitive patients avoid provoking factors. To achieve that, sunglasses or polarized sunglasses should be worn. There is no need to tell patients with epilepsy not to watch TV. However, certain rules have to be followed: a remote control is used and TV is watched in a properly lighted room to decrease the contrast.

If you have become a witness of an epileptic seizure, don’t panic. Even the most severe seizure (generalized tonic seizure) is short-term. It lasts no longer than 1–2 minutes. There is no need in resuscitation procedures or placing something in a patients’ mouth. The respiration will restore on its own, skin will regain its normal color and the patient will return to consciousness. You can hold the patient’s head to prevent the back of his head hitting the floor or ground or place something under the head. When the attack is about to be over, let the patient lie on his side. When the attack is over, it is sometimes accompanied by a large amount of saliva and mucus. So, do this to prevent him/her from choking. Remember that such a person is disoriented and needs your help (do not leave him/her alone). Take the person home or ask his/her relatives to do so. In case of persistent seizures call the ambulance.

K. R. Badalyan

Department of Neurology, Faculty of Additional Professional Education

of Pirogov Russian National Research Medical University

Epilepsy

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