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Epilepsy Topics

People with epilepsy can live normal lives. Many athletes, authors, politicians, entrepreneurs, doctors, parents, and artists have epilepsy. Epilepsy can put a strain on families. So each member of the family needs to understand what epilepsy is, how it’s treated, and what to expect. Families can be a great source of support for someone with epilepsy–but it might take some work. Encourage all members of your family to learn as much as they can.

If you have epilepsy, you can still become involved in extracurricular activities.Your doctor will give you instructions about taking precautions to protect yourself in various situations. For example, teens with epilepsy can enjoy swimming, but should always swim with other people to be safe. Aside from some minor safety precautions, though, you can enjoy all the stuff your friends and classmates do. As long as epilepsy is under medical control, people with epilepsy are able to drive.

Tell the people close to you, your friends, relatives, teachers about your epilepsy and teach them what to do in case you have a seizure when they’re with you.

Since seizures are unpredictability in terms of their nature, timing, severity and the situations in which they can occur, can cause social difficulties. Taking an active role in managing your own epilepsy is an important part of coping successfully.

Driving
Epilepsy does not automatically disqualify you from being legally permitted to drive. In fact, many people with epilepsy do drive. Generally people with epilepsy must not drive unless they have been free from seizures for atleast 6 months and the medication does not cause drowsiness or poor co–ordination. If you have not had a seizure for over two, you may be considering quitting medication. However, if you stop medication and a seizure recurs, you will have to stop driving again for at least a further year. For many this is a very difficult decision.

Work
Companies do not single out people with epilepsy. But there are many jobs which are not possible for example commercial driving, airline pilot, armed forces. At times employers worry about productivity, absenteeism, liability, reaction of customers or co–workers and workplace safety.

School
Most children with epilepsy go to normal schools. Children with epilepsy do not have any other disability, and the seizures are well controlled. You should inform the principal and teachers about the problem, most teachers will understand the correct use of medication and will not hesitate to do their best if the child has an attack.

Sport and leisure
Epilepsy is not a disease that has limitations for active and normal life. Patients can and should participate in most sports, but with informed and qualified supervision and, relevant safety measures where required.

Travel
As long as you have medication with you during your travels it is fine. Try to keep journeys short, break it up and do not tire yourself as that may make more prone to a seizure. Also when flying, ‘Jet–lag’ may make you tired. But this should not stop you from travelling. Ideally you should travel with someone or that someone on the trip is aware of your situation.

Sex and the contraceptive pill
People with epilepsy do come across sexual difficulties. Epilepsy can have effect on sex, and sex has effect on epilepsy. One of the commonest sexual effects of epilepsy is the decrease or loss of desire. This can be due to many reasons, the medication to reactions of partners or epilepsy itself. Some medicines used to treat epilepsy interfere with ‘The pill’, and a higher dose pill may be needed for effective contraception. Your doctor will give you the right advise.

Pregnancy
During pregnancy you must make sure that seizures are minimal. However, epilepsy and the medications to treat it can have many effects on the mother, the pregnancy, and the fetus and newborn. Though most women are able to have a healthy pregnancy and baby, there are risks these include stillbirths, slightly smaller babies and perhaps high blood pressure. Before becoming pregnant it is best to seek advice from a doctor, Anticonvulsant drugs interfere with folic acid therefore you should take extra folic acid before and throughout the pregnancy. This reduces the chance of certain abnormalities occurring. If you have an unplanned pregnancy, do not stop medication but see a doctor as soon as possible.

Tips for living with epilepsy
  • Make sure you get at least 8 hours of sleep everyday. Lack of sleep is known to trigger epilepsy.
  • Take your antiepileptic medicines at a regular time everyday as specified by your doctor.
  • Fasting is OUT! Eat proper, balanced meals and drink at least 6–8 glasses of water per day to maintain hydration.
  • Infections are often associated with worsening of seizures, especially if associated with fever.
  • Do not work on the computer for too long at a stretch. Take adequate breaks.
  • Too much television viewing is dangerous too. Certain patterns and colors are known to trigger epilepsy. In fact just last year, a Japanese Children’s TV program was discontinued when it triggered epilepsy in 9 children.
  • Do not take over the counter medicines for cold as they may contain ephedrine & pseudoephedrine, Known to be triggers.
  • Certain drugs are known to aggravate seizures – It is best to avoid chlorpromazine, quinolone group of antibiotics (ciprofloxacin), stimulants, etc. Your doctor will be able to guide you if you have any doubts about your medicines, food, etc.
Epilepsy is a neurological condition, which affects the nervous system, and is also known as a seizure disorder. The seizures in epilepsy may be related to a brain injury or a family tendency, but most of the time the cause is unknown. The word “Epilepsy” does not indicate anything about the cause of the person’s seizures, what type they are, or how severe they are.

A seizure is a sudden surge of electrical activity in the brain that usually affects how a person feels or acts for a short time.

About half of the people who have one seizure without a clear cause will have another one, usually within 6 months. You are twice as likely to have another seizure if you have a known brain injury or other type of brain abnormality. If you do have two seizures, there’s about an 80% chance that you’ll have more. If your first seizure occurred at the time of an injury or infection in the brain, you are more likely to develop epilepsy.More seizures are also likely if your doctor finds abnormalities on a neurological examination; a set of tests of the functioning of your nervous system that is performed in the doctor’s office.

Another thing that can help your doctor predict whether you will have more seizures is an EEG, electroencephalogram (e–LEK–tro–en–SEF–uh–LOG–ram), a test in which wires attached to your scalp record your brain waves. Certain patterns on the EEG are typical of epilepsy. If your brain waves show patterns of that type, you are about twice as likely to develop epilepsy as someone who does not have those patterns.

When an individual is aware of the beginning, it may be thought of as a warning or aura. On the other hand, an individual may not be aware of the beginning and therefore have no warning. Sometimes, the warning or aura is not followed by any other symptoms. It may be considered a simple partial seizure by the doctor.

The middle of the seizure may take several different forms. For people who have warnings, the aura may simply continue or it may turn into a complex partial seizure or a convulsion. For those who do not have a warning, the seizure may continue as a complex partial seizure or it may evolve into a convulsion.

The end to a seizure represents a transition from the seizure back to the individual’s normal state. This period is referred to as the “Post–ictal period” (an ictus is a seizure) and signifies the recovery period for the brain. It may last from seconds to minutes to hours, depending on several factors including which part(s) of the brain were affected by the seizure and whether the individual was on anti–seizure medication. If a person has a complex partial seizure or a convulsion, their level of awareness gradually improves during the post–ictal period, much like a person waking up from anesthesia after an operation.

Epilepsy can develop in any person at any age. 0.5% to 2% of people will develop epilepsy during their lifetime. People with certain conditions may be at greater risk. More men than women have epilepsy.
Facts about Epilepsy
  • Up to 5% of the world’s population may have a single seizure at some time in their lives.
  • It is likely that around 60 million people in the world have epilepsy at any one time.
  • Children and adolescents are more likely to have epilepsy of unknown or genetic origin than adults.
  • Epilepsy can start at any age.
  • Recent studies show that seizures in up to 70% of children and adults with newly diagnosed epilepsy can be controlled with medications; however, many of these people experience treatment–related side effects.
  • Seizures in up to 30% of people with epilepsy do not respond to available medications.
  • There is a fine balance in the brain between factors that begin electrical activity and factors that restrict it, and there are also systems that limit the spread of electrical activity. During a seizure, these limits break down, and abnormal electrical discharges can occur and spread to whole groups of neighboring cells at once. This linkage of electrical discharges creates a “Storm” of electrical activity in the brain. This is a seizure. When a person has had at least two of these seizures, that’s called epilepsy.
How does epilepsy begin?
  • The reasons why epilepsy begins are different for people of different ages. But what’s true for every age is that the cause is unknown for about half of everyone with epilepsy.
  • Children may be born with a defect in the structure of their brain, or they may suffer a head injury or infection that causes their epilepsy. Severe head injury is the most common known cause in young adults. In middle age, strokes, tumors, and injuries are more frequent. In people over 65, stroke is the most common known cause, followed by degenerative conditions such as Alzheimer’s disease.
Why does it sometimes take years before someone with a brain injury experiences a seizure?
Often seizures do not begin immediately after a person has an injury to the brain. Instead, a seizure may happen many months later. We do not have a good explanation for this common observation, but scientists are actively researching this subject.
Mild head injuries, such as a concussion with just a very brief loss of consciousness, do not cause epilepsy. Even though you may not know the cause of your epilepsy, you can help yourself by looking for factors (often called “Triggers”) that seem to make your seizures more frequent or more severe and then avoid them altogether or atleast reduce their effects.

Risk factors are factors that increase the possibility of getting a condition. The risk factors for epilepsy are:
(It is possible to develop epilepsy with or without these factors but these factors increase the possibility)

  • Injury to the brain
  • Head injury (trauma) / birth injury
  • Cerebral malformation
  • Stroke
  • Vasculitis – e.g. Systemic Lupus erythmetosis
  • Tumour (Primary or metastatic)
  • Conditions that might deprive the brain of oxygen – for example near drowning.
  • Infective causes: e.g. – meningitis, encephalitis, febrile convulsions etc.
  • Metabolic conditions like hypoxia, low blood sugar, low or high salt, low magnesium or calcium etc.

Other factors:

  • Exposure to lead, carbon mono oxide or other environmental toxins
  • Overdose or withdrawal or certain medications
  • Alcoholism

Different risk factors are common in specific age groups.

Seizure–Provoking Factors
  • Irregular eating and sleeping habits particularly when associated with severe mental stress and anxiety.
  • Physical exhaustion
  • Emotional upsets, more so for persons emotionally very sensitive.
  • Fever, particularly in children
  • Pregnancy
  • Epilepsy has been known throughout history. It observes no cultural, geographical, racial or economical boundaries. It can occur to anybody at any age. Approximately 1 in every 100 suffers from it. 70-75% have their first attack in childhood. If not treated properly and at the right time, epileptic attacks recur and can hamper growth and development. Epilepsy thus poses a widespread major problem.
  • Missed medication.
  • Lack of sleep.
  • Illness (both with and without fever).
  • Severe psychological stress.
  • Use of cocaine and other recreational drugs such as Ecstasy.
  • Over–the–counter or prescription medications or supplements that decrease the effectiveness of seizure medicines.
  • Alcohol over intake and alcohol withdrawal state.
  • Nutritional deficiencies: vitamins and minerals.
  • Premenstrual tension.
  • It may seem obvious that heredity (genetics) plays an important role in many cases of epilepsy in very young children, but it can be a factor for people of any age. For instance, not everyone who has a serious head injury (a clear cause of seizures) will develop epilepsy. Those who do develop epilepsy are more likely to have a history of seizures in their family. This family history suggests that it is easier for them to develop epilepsy than for others with no genetic predisposition.
  • Epilepsy in which the seizures begin from both sides of the brain at the same time is called primary generalized epilepsy. Primary generalized epilepsy is more likely to involve genetic factors than partial epilepsy, in which the seizures arise from a limited area of the brain.
Are the brothers and sisters of children with epilepsy more likely to develop it?
Their risk is slightly higher than usual, not because they will “Catch” it (that can’t happen) but because there may be a genetic tendency in the family that makes seizures and epilepsy more likely. Even so, most of them will not develop epilepsy. Epilepsy is more likely to occur in a brother or sister if the child with epilepsy has primary generalized seizures. Depending on the type of epilepsy and the number of family members who are affected, only about 4% to 10% of the other children in the family will have epilepsy.
If I have epilepsy, will my children also have it?
  • Less than 2 people out of every 100 (2%) develop epilepsy at some point during their lifetime. The risk for children whose father has epilepsy is only slightly higher. If the mother has epilepsy and the father does not, the risk is still less than 5%. If both parents have epilepsy, the risk is a bit higher. Most children will not inherit epilepsy from a parent, but the chance of inheriting epilepsy is higher for some types.
  • If you have epilepsy, it is normal for you to be afraid that your children will have epilepsy too. However, a fear that your children will have epilepsy is not enough reason to decide against having any. The risk is low, most children outgrow epilepsy, and most people who have it are able to control their seizures by taking one medicine.
  • About 80% of people with epilepsy treated with seizure medicines remain free of seizures for at least 2 years. Many never have any more seizures. The chances of becoming completely seizure–free are best if there is no known brain injury or abnormality, and if the person has a normal neurological examination and EEG.
  • Of adults, 50–60% will be seizure–free after using their first seizure medicine. Another 11–20% will gain seizure control using the second medication, leaving 20–30% who are still having seizures.
  • Among those who are young when their epilepsy is diagnosed, 20% start on medication and never have another seizure after medication is stopped, even when they reach adulthood. About 50–60% of children become seizure–free with the first medication used, but 30% never stop taking seizure medicines. About 10% have a really difficult time with “Intractable seizures.”
  • The more time that passes without seizures, the greater is the chance of staying seizure–free. Over 50% of children outgrow their epilepsy. Twenty years after the diagnosis, three–quarters of people will have been seizure–free for at least 5 years, although some may still need to take daily medication.
Will I have to take seizure medicines for the rest of my life?
  • Many people who are seizure–free for 2 to 4 years can stop taking their medications, under their doctor’s supervision, without having further seizures. However, about 30% of children and 30% to 65% of adults will have seizures again. You need to discuss this with your neurologist and, if the decision is made to go off medication, agree on a plan for stopping gradually over weeks or months, not all at once. Currently, most neurologists in the United States and Canada consider withdrawing seizure medicines after someone has been seizure–free for 1 to 2 years.
  • Whether it will be safe for you to stop taking your seizure medicine depends partly on whether you drive a car or engage in other activities that would be dangerous if you had another seizure. If your answer is “yes,” you will need to be more cautious.
I’ve been taking seizure medicine but I’m still having seizures. Will I always have them?
  • Some people with seizures that cannot be controlled with tolerable doses of seizure medicine (who have what doctors call “Intractable epilepsy”) do eventually become seizure–free. The longer that you continue to have seizures after the diagnosis of epilepsy is made, however, the lower the chance that your seizures will stop.
  • Your doctor will want you to try different medications or combinations of them. The more medicines that are unable to control your seizures, however, the less likely it is that another medication regimen will fully succeed. Other kinds of treatments, such as vagus nerve stimulation or epilepsy surgery, may be very helpful for some people who continue to have seizures while taking seizure medicines.
The overall life expectancy of people who have epilepsy is the same as for anybody else if they are otherwise pretty healthy. Some people whose epilepsy is caused by things like a stroke or a brain tumor may die sooner from those conditions, of course.
A long–lasting convulsive seizure (called “Tonic–clonic status epilepticus”) is a medical emergency. If not stopped within about 30 minutes, it may cause permanent injury or death. In addition, people with epilepsy can also die from inhaling vomit during or just after a seizure. This can be prevented if someone will turn the person onto one side when the seizure begins and ensures that the vomit completely comes out of the mouth. In general, seizures are hardly ever fatal, even if the person loses consciousness.
People who are not seizure–free need to be careful about possible accidents during a seizure. Death from drowning is more common among people with epilepsy. It can even occur in a tub with only a few inches of water, so people who have seizures probably should stick to showers instead of baths. If you have epilepsy, your doctor–and the agency in your state or province responsible for licensing drivers–will help you decide whether it is safe and legal for you to drive. You should also be careful on train or subway platforms and when walking near busy streets. However,with some planning, you should be able to lead a life that is both active and safe.
Some anti–epilepsy medicines have a side–effect of increasing the speed in which some contraceptive pills and injections are processed by the liver. (These medicines are known as liver enzyme inducers as they speed up certain processes in the liver cells.) For example, the following anti–epilepsy medicines are liver enzyme inducers: carbamazepine, oxcarbazepine, phenobarbital, phenytoin, primidone, and topiramate. Other anti–epilepsy medicines such as sodium valproate, lamotrigine (but see below), and ethosuximide are not liver enzyme inducers.

In general, women with epilepsy who require contraception are usually treated with medicines that are not liver enzyme inducers. Contraceptive choices, doses, etc, are then usually the same as for any other women (but see below about lamotrigine). See leaflet called ‘Contraceptive Choices’ for details of the options. However, in some situations, an anti–epilepsy medicine that is a liver enzyme inducer is required for treatment. If you take an anti–epilepsy medicine that is a liver enzyme inducer, then:
If you take the combined oral contraceptive pill – the dose of the oestrogen part needs to be at least 50 micrograms. This is more than the usual dose. Also, many doctors recommend that
  • You should take three packs together (tricycling). This means taking one pack after each other without a break between the three packs. Then have a ‘Pill free break’ after the third pack.
  • When you do have a ‘Pill free break’, only have four days break rather than the usual seven.
  • If you get breakthrough bleeding whilst taking the pill, the dose of oestrogen should be increased to 75–100 micrograms per day.
Even with these extra precautions, the reliabilty of the pill is reduced compared to women who do not take medicines that are liver enzyme inducers. Therefore, some doctors advise that you use condoms in addtion to the pill for extra contraceptive protection.
  • If you use the progestogen injection called Depo–provera for contraception – then you need an injection every 10 weeks. (This is more often than usual which is every 12 weeks.)
  • The progestogen–only pill is not recommended.
  • Progestogen implants are not recommended.
  • The combined transdermal contraceptive patch is not recommended.
  • If you use emergency contraception tablets – the initial dose of levonorgestrel should be increased to 1.5 mg followed by 750 micrograms 12 hours later.
Special consideration – lamotrigine and the pill
There is some evidence that the combined oral contraceptive pill may interact with lamotrigine (Lamictal) in some women. Lamotrigine is an anti–epilepsy medicine. It is not a liver enzyme inducer but may interact with the pill in another way. The interaction may work ‘Both ways’. That is, the lamatrigine may make the pill less efective. But also, the pill may make the lamotrigine less effective and increase your risk of seizures. Therefore, the doses of both may need to be adjusted.

The ‘Take home message’
For reliable contraception, it is best to seek advice from a doctor or nurse. They will be able to tell you if your epilepsy treatment affects a method of contraception.
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