What is Epilepsy

At Buddhi Clinic we are able to bring together a
unique skill set in managing What is Epilepsy

PRELUDE

About Epilepsy

Epilepsy is a chronic disorder that causes unprovoked, recurrent seizures. A seizure is a sudden rush of electrical activity in the brain.

There are two main types of seizures. Generalized seizures affect the whole brain. Focal, or partial seizures, affect just one part of the brain. A mild seizure may be difficult to recognize. It can last a few seconds during which you lack awareness.

Stronger seizures can cause spasms and uncontrollable muscle twitches, and can last a few seconds to several minutes. During a stronger seizure, some people become confused or lose consciousness. Afterward you may have no memory of it happening.

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Chapter 1

What is Epilepsy

Chapter 2

Children & Epilepsy

Chapter 3

Seizure Vs Epilepsy

Chapter 4

Diagnosing Epilepsy

Chapter 5

Therapy & Treatment

Chapter 6

Non-Pharmacological Management

Chapter 7

Living With Epilepsy

CHAPTER 1

What is Epilepsy

Epilepsy is a disorder in which a person has two or more unprovoked seizures. Unprovoked means that the seizures are not brought on by a clear cause such as alcohol withdrawal, heart problems, or extremely low blood sugar. In other words, epilepsy is a condition of recurrent, unprovoked seizures. A person with epilepsy has had two or more unprovoked seizures, regardless of seizure type. The seizures may result from a hereditary tendency or a brain injury, but often the cause is unknown. Many use the term “seizure disorder” instead because “epilepsy” seems more serious or stigmatized. However, almost all seizure disorders are epilepsy.

How many people have epilepsy?

Epilepsy is the most common serious neurological disorder affecting people of all ages. A prelevance rate of 0.5% (1 in 200) is usually quoted as a minimum prevalence.
Anyone can develop epilepsy; it occurs in all ages, races and social classes. Seizures tend to start in infancy or by late adolescence, but the incidence rises again after 65.

Are there different types of epilepsy ?

Epilepsy may take many forms and just knowing that a person has `epilepsy’ gives very little useful information about that individual. Epilepsy can broadly be divided into two categories, both producing a number of types of seizure.

Idiopathic Epilepsy
In this type, there is no clear environmental cause for the epilepsy and it is presumed that genetic factors predominate. There are usually no other handicaps and the EEG is often normal between seizures. The response to drug treatment is usually good.

Symptomatic Epilepsy
This usually develops as a result of some structural abnormality in the brain either present at birth or occurring later in life. Other disabilities may be caused by this same abnormality (physical, intellectual or psychiatric). EEG investigations may reveal the abnormality and the response to drug treatment is variable in different individuals. Some individuals have cryptogenic epilepsy, which is epilepsy in which no cause can be found, but a cause is suspected. A number of investigations may provide additional information, although these tests do no make the diagnosis of epilepsy.

Can Epilepsy Be Treated ?

Yes. But the success depends on many factors; type of epilepsy, accuracy of diagnosis, accuracy of treatment, compliance, associated handicaps and social problems. With appropriate drug treatment, seizures can be completely controlled in the majority of people. In some, the tendency to have seizures diminishes with time, but maximum control should still be sought as early as possible. It may be necessary to take anti-epileptic drugs for a period of years even if seizures have stopped. Some people, however, continue to have seizures despite appropriate treatment. A small portion of such people may benefit from neurosurgery, but this is only usually recommended in people whose seizures can be shown to arise from activity in one discrete area of the brain. Even if seizures continue, it should be possible to adjust the drug regime so that the condition remains stable, to allow the person to function at an optimal level.

Many people are able to keep their seizures to a minimum by avoiding situations which they know may bring on a seizure. These may include lack of sleep, too much alcohol, emotional upsets or not taking tablets as directed. Practising such “self care” is a vital part of overall management of Epilepsy.

Is Epilepsy a Disability ?

If seizures can be completely controlled, and if the person can achieve a high level of confidence and self-esteem, then epilepsy should present no real obstacles to a full life. However, having seizures for the first time, and being told that the diagnosis is “epilepsy” (about which there may be many misconceptions in the individual’s mind) can be very upsetting. Careful counseling and health education can do much to alleviate anxiety for the individual and the family.

If the person continues to have seizures, then there may be difficulties in many aspects of daily living. But even in this situation, good psychological health can help minimize physical problems which only occur from time to time. Individuals should be helped not to blame everything on their epilepsy, and there should be an emphasis on abilities rather than the extent of the disability.

Merely labeling people as “epileptics” on the basis of a medical diagnosis of epilepsy ignores the rest of their attributes and characteristics both good and bad and must be avoided.

CHAPTER 2

Children & Epilepsy

What are Febrile Seizures?

5% of children in the age group of 3 months – 5 years have febrile seizures. They may be non-specific manifestations of fever; but, occasionally may occur due to CNS infection like meningitis or encephalitis. They occur when body temperature is usually above 38 Celsius. What are Infantile Spasms? Most occur before 12 months of age. Spasms occur which last for 1-2 seconds. Abrupt flexion of head, trunk and limbs occur and in clusters over a period of minutes. Consciousness is lost briefly with the spasm which is rarely noticeable.

What is Lennox –Gastaut Syndrome?

It is characterized by tonic seizures. The neck and body are suddenly flexed and the child falls which could be associated with tremors of the whole body. Impairment rather than loss of consciousness may occur. Massive myoclonus and status epilepticus may also affect these children.

What is Landau-Kleffner Syndrome?

Landau-Kleffner Syndrome also known as Acquired Epileptic Aphasia. Usually occurs between ages of 5 & 7 years. Boys are affected twice as often as girls. Speech and understanding are affected and the child may become mute. Seizures occur occasionally.

What is Benign Focal Epilepsies of Childhood?

Seizures start with an odd sensation on one side of the mouth followed by drooling and twitching of the side of the mouth. Speech is affected. Jerks may then spread down one side of the body and consciousness is most often retained, though some may have jerky movements of all limbs followed by loss of consciousness.

CHAPTER 3

Seizure Vs Epilepsy

What is a Seizure?

A seizure is an event during which a person experiences alteration or loss of consciousness, has some abnormal involuntary movements involving his/her face, arm, let etc., and may fall to the ground, pass urine without their knowledge, bite their tongue or cause other injury. A seizure (often called fit, attack, turn or blackout) is an isolated episode which could happen to anyone if circumstances are appropriate.

Why do Seizures occur?

Seizures occur when ordinary highly complex brain activity is suddenly disrupted. Recurrent seizures (Epilepsy) occur due to intrinsic disturbance of neuronal function within the brain. Any person’s brain has the capacity to produce a seizure if the circumstances are appropriate. Most brains are not likely to do this spontaneously and can therefore, be said to have a high “seizure threshold” or high resistance to seizures. Individuals vary as to their threshold and it is probably due to their genetic characteristics. A person with a low threshold might develop epilepsy spontaneously without other factors being involved. Sometimes a predisposition to seizures can be seen in some families where several members are affected. But the genetics of epilepsy are not straightforward. In some individuals the existing seizure threshold may be lowered if the brain is subjected to unusual stimulation (such as certain frequencies of flickering light and some drugs) or is injured. If the injury is severe e.g. due to road traffic accident, infection, birth trauma, stroke or tumour, then epilepsy may develop as a consequence. Many individuals attribute the onset of their seizures to some relatively minor event such as a blow to the head or an emotional upset. Although these cannot be completely discounted, in such cases it is likely that family predisposition to seizures plays a more important role.

What is Epilepsy?

Epilepsy means having a tendency to experience repeated spontaneous seizures. Epilepsy is not just one condition and it is not always easy to give an explanation in each individual case of why seizures begin or why they continue to occur. There are many misconceptions about this condition. However, it may be noted that it is not an illness or a disease.

How Can Seizures be Described?

Not all seizures involve convulsions and many different terms are used. It is important to use terms which describe what is happening during the seizure. A person with epilepsy can experience more than one type of seizure, but the pattern of seizures tends to remain fairly constant in an individual. Although epilepsy can be classified in different ways, the International Classification of Seizures (published by the International League Against Epilepsy) is the most commonly used.

The Buddhi Clinic Management Approach to ASD:

The consultant (Behavioural Neurologist, Neuropsychiatrist, Child Psychiatrist) conducts a triage consultation. A comprehensive assessment is carried out by the Buddhi Clinic team and a “therapeutic program” prescribed.

Med Lab
Behavioural Management, Caregiver Training & Family Therapy

Mind Lab
Neurodevelopmental therapy for fine motor skills and sensory integration

Nerve Lab
Neuromodulation Treatments: rTMS, tDCS or other cognitive enhancement therapies as appropriate

Rehab Lab
Speech & Language Training

CAM Lab
Shiroabhyangam, Acupressure, Reflexology, Mud Therapy & Yoga- other treatments as appropriate

CHAPTER 4

Diagnosing Epilepsy

How is a Diagnosis of Epilepsy Made?

Unlike most neurological disorders, there may be no physical signs. The diagnosis is, therefore, made on the basis of a history of more than one epileptic seizure. An accurate eye-witness account is crucial to making a correct diagnosis, as the person experiencing the seizure usually has no recollection of what has happened. It is always good for the doctor to have a written eye-witness account. A number of investigations may provide additional information, although these tests do no make the diagnosis of epilepsy. EEG can aid in the diagnosis.

How is Epilepsy Classified and What are the types of seizures?

Epilepsy is classified according to a combination of characteristics including clinical seizure type, EEG, and aetiology. A simple classification of epilepsy is:

A) Generalised epilepsy.
– Generalised tonic clonic seizures
– Absences
– Myoclonic epilepsy

B) Partial epilepsy.
– Simple partial seizure
– Complex partial seizure

C) Partial becoming generalized.

What are Generalized Seizures?

In this type, the whole of the brain is involved and consciousness is lost. The seizure may then take one of the following forms: Generalized Tonic Clonic Convulsive Seizure (GTCS): The most dramatic form is the GTCS (still sometimes called a `grand mal’ seizure) in which the person becomes rigid, and may fall if standing. The muscles then relax and tighten rhythmically causing the person to convulse. Breathing is laboured and they may be incontinent. Other types of generalized seizures include: Tonic in which there is general stiffening of muscles without rhythmical jerking. The person may fall to the ground if standing with consequent risk injury. Atonic (also known as drop attacks) in which there is a sudden loss of muscle tone, again causing the person to fall if standing. Myoclonic in which abrupt jerking of the limbs occurs. These often happen within a short time of waking up, either on their own or in company with other forms of generalized seizure. Absences in which there is a brief interruption of consciousness without any other signs, except perhaps for a fluttering of the eyelids. These occur most commonly in children and are still sometimes known as “petit mal”.

What are Partial Seizures?

During a partial seizure the disturbance in brain activity begins in or involves a distinct area of the brain. The nature of these seizures is usually determined by the function of the part of the brain that is involved. Partial seizures are sometimes known as “focal”. There are basically three types of partial seizures – Simple Partial Seizures; Complex Partial Seizures; and Secondarily Generalized Seizures In simple partial seizures, consciousness is not impaired and the seizure is confirmed to either rhythmical twitching of one limb, or part of a limb, or to unusual tastes or sensations such as pins and needles in a distinct part of the body. Simple partial seizures sometimes develop into other sorts of seizures and they are often referred to as a “warning” or “aura”. Complex partial seizures differ from partial seizures in that consciousness is affected. The seizures may then be characterized by a change in awareness as well as “semi- purposive” movements such as fiddling with clothes or nearby objects, wandering about and general confusion. Complex partial seizures usually involve the temporal lobes of the brain, however they can also affect the frontal and parietal lobes. In some people either of these seizures may spread to involve the whole of the brain and if this happens it is called a secondarily generalized seizure.

CHAPTER 5

Therapy & Treatment

What are the Treatment for Seizures Emergencies?

Emergency treatment usually involves IV medication such as lorazepam, phenytoin, fosphenytoin, sodium valproate, levetiracetam etc. A nasal spray (midazlolam) and in some instances oral medication (clobazam or clonazepam) are used apart from usual AED’s. While most seizures are self terminating, treatment must begin soon as continual seizures lasting 20-30 min. may result in damage to the brain. Once seizures are controlled, the underlying cause is sought. Additional medications depend on the underlying causes and the recommendations from a neurologist.

What is the Medication for Epilepsy?

Epilepsy cannot be cured with medication. However, with the right type and strength of medication, the majority of people with epilepsy can achieve complete or at least partial (50% reduction in episodes) seizure control. The medicines work by stabilising the electrical activity of the brain. You need to take medication every day to prevent seizures. Medicines used to treat epilepsy include: (alphabetise please) Carbamazepine sodium valproate lamotrigine phenytoin oxcarbazepine ethosuximide* gabapentin levetiracetam tiagabine* topiramate vigabatrin* phenobarbital primidone* clonazepam Clobazam Lacosamide Bivaracetam Perampenel Midazolam (spray) *infrequent and rarely used drugs today The drugs have international brand names and those that are manufactured by generic manufacturers come in different brand names.

How Effective is Medication Used for Epilepsy?

The success in controlling seizures by medication varies depending on the type of epilepsy. For example, if no underlying cause can be found for your seizures (idiopathic epilepsy), you have a very good chance that medication can fully control your seizures. Seizures caused by some underlying brain problems may be more difficult to control. The overall outlook is better than many people realise. The following figures are based on studies of people with epilepsy, which looked back over a five-year period. These figures are based on grouping people with all types of epilepsy together which gives an overall picture: • About 5 in 10 people with epilepsy will have no seizures at all over a five-year period. Many of these people will be taking medication to control seizures. Some will have stopped treatment having had two or more years without a seizure whilst taking medication. • About 3 in 10 people with epilepsy will have some seizures in this five-year period, but far fewer than if they had not taken medication. • So, in total, with medication about 8 in 10 people with epilepsy are well controlled with either no, or few, seizures. • The remaining 2 in 10 people experience seizures, despite medication.

What is the Medication for Epilepsy?

Epilepsy cannot be cured with medication. However, with the right type and strength of medication, the majority of people with epilepsy can achieve complete or at least partial (50% reduction in episodes) seizure control. The medicines work by stabilising the electrical activity of the brain. You need to take medication every day to prevent seizures. Medicines used to treat epilepsy include: (alphabetise please) Carbamazepine sodium valproate lamotrigine phenytoin oxcarbazepine ethosuximide* gabapentin levetiracetam tiagabine* topiramate vigabatrin* phenobarbital primidone* clonazepam Clobazam Lacosamide Bivaracetam Perampenel Midazolam (spray) *infrequent and rarely used drugs today The drugs have international brand names and those that are manufactured by generic manufacturers come in different brand names.

CHAPTER 6

Non-Pharmacological Management

What is Vagal Nerve Stimulation?

Vagal nerve stimulation is a treatment for epilepsy where a small generator is implanted under the skin below the left collar bone. The vagus nerve is stimulated to reduce the frequency and intensity of seizures. This can be suitable for some people with seizures that are difficult to control with medication. Trans-Auricular Vagus Nerve Stimulation (TA-VNS) (Vivek to input)
Repetitive Transcranial Magnetic Stimulation (rTMS) (Vivek to input)

How does the Ketogenic Diet Work?

The ketogenic diet is a high fat, low protein and low carbohydrate diet used as a treatment for epilepsy. The ketogenic diet may be ordered by the doctor for children who have severe forms of epilepsy that have not responded well to various drug treatments.
The diet is very high in fat, in the form of fatty foods such as butter, margarine, oil and cream. The diet contains enough protein for your child to grow and develop normally and very small amounts of carbohydrate foods. No one is certain exactly how the diet works. Normally, your body breaks down the carbohydrates in the food you eat to glucose, the fuel for the brain. When you do not have enough carbohydrate (such as during starvation) your body starts to break down your fat reserves. When fat is broken down it produces a by-product called ketones. Your brain then starts to burn ketones for energy.
The ketogenic diet provides your child with enough energy to grow, but mimics the effects of starvation. The high fat content makes the body produce ketones in larger than normal quantities, and these are used by the brain for energy instead of glucose. It is the change in fuel for the brain that is thought to make the diet work. Not all children respond to the diet, but those that do may have fewer seizures of decreased intensity, and may even remain free from seizures for extended periods.

What is the Modified Atkins Diet?

The Modified Atkins diet is a special high-fat diet that is used for difficult to treat seizures. Heavy cream, butter and vegetable oils provide the necessary fat. The diet allows all protein rich foods such as meat, chicken, eggs and fish. It completely eliminates sweets such as lollies, biscuits and desserts. Other carbohydrate rich foods such as bread, potatoes, rice, pasta and cereals are not allowed in the first month on the diet then may be introduced later.

What is the Difference Between the Ketogenic Diet and the Modified Atkins Diet?

The Modified Atkins Diet is less restrictive than the Ketogenic Diet. It allows unlimited amounts of protein foods and fats are encouraged. Food does not need to be weighed and recipes do not need to be precise. Carbohydrate foods are counted and spread throughout meals with the aim to keep within the daily limit. Studies that have followed children on the diet for long periods reveal that around 50% of children treated with the Modified Atkins Diet have greater than 50% seizure reduction. Greater rates of seizure reduction are seen in some children with specific epilepsy syndromes.

Highlights:

At Buddhi Clinic we see parents and families as key stakeholders in the journey of the child, adolescent and adult with ASD.

We involve the parents and family actively in our therapeutic program through transparent sharing of knowledge and information, education about the condition and enablement with tools.

We create for each client and family an active home program toolkit, one that they can use to schedule, deliver, track and manage the progress of their family member.

Our approach has cultural consonance - weaving together, seamlessly, the rigour of Western medicine and the mindfulness of the East.

CHAPTER 7

Living With Epilepsy

Epilepsy and Mental Health

What is the Relationship Between Epilepsy and Depression?

There may be a number of causes for depression in people with epilepsy including biological reasons. The potential relationship between epilepsy, depressive feelings and depressive illness may be classified as follows:

Depressive reaction to acquiring the label of epilepsy
Depressive reaction to social/family problems of epilepsy.
Prodromal depressive feelings before a seizure.
Depressive feelings as an aura
Depressive feelings as an ictal experience
Post-ictal depressive feelings
Depressive twilight state
Epileptic Depressive delirium
Endogenous depression unrelated directly to seizures, but possibly due to their increase in frequency.
Depressive symptoms occurring in association with other mental illnesses
Social consequences of being a person with epilepsy in relation to their ability to function effectively in the work place as well as a family supporter.

What is the Relationship Between Epilepsy and Aggression?

There is no evidence to show that aggression may occur due to epilepsy or consequence of seizures. If violence has been witnessed, it could be as a response to constraint by others during the recovery stage of a seizure.

What is the Relationship Between Epilepsy and Psychosis?

The relationship between epilepsy and psychosis is unclear. A small number of people with epilepsy may present with psychoses and there is a suggestion that their symptoms may well be as a result of an underlying epileptic process linked with lesions in the brain.

What is the Relationship Between Epilepsy and Anxiety?

Many people with Epilepsy experience anxiety as a result of the diagnosis of epilepsy and the ensuing adjustment. Anxiety may also occur as part of the pre-ictal, ictal and post-ictal aspect of a seizure. Some people with epilepsy have attacks that are associated with or precipitated by anxiety. Potential sources of anxiety in people with epilepsy: • fear of having a seizure and the belief that seizures may lead to death.• Stigmatizing condition of epilepsy• Determination to conceal the condition – epilepsy. It has been suggested that a reciprocal relationship exists between anxiety and epilepsy in that the more anxious the person with epilepsy is the more likely they are to have a seizure and the more seizures they have the more anxious they become.

Epilepsy and Employment

What jobs are not suitable for persons with epilepsy?

When deciding to work, the decision should be realistic based on the nature of seizure one has. A few occupations are barred basically to avoid accidents if epilepsy occurs like

Could working in night/day shifts cause a problem?
Working in nights shifts per se may not cause a problem. But, sleep deprivation/change in sleep pattern can aggravate seizures.

Laws and Policies Epilepsy and Marriage / Divorce

Old Law:
As per the Marriage Laws Amendment Act 1976, a person subjected to recurrent attacks of insanity or epilepsy cannot have a legally valid marriage and such a marriage shall be voidable, resulting in divorce.
The New Law:
However, after the public interest litigation filed by Indian Epilepsy Association, vide the Rajyasabha Bill dated Nov. 30, 1999 and Loksabha Bill dated Dec. 20, 1999, the provisions have been changed. The current rule is that a person with epilepsy can have a legally valid marriage and is no longer a condition to claim for divorce.

Epilepsy and Driving

Years ago, people with epilepsy were not allowed to hold a driving license all over the world. With the availability of effective Anti Epileptic drugs, many developed countries have relaxed the rules for issuing driving license. But, this has not been done in India. In India, the Motor Vehicle Act is uniform all over the country and is formulated by the Central Government. The State Government is authorized to make required amendments with a view to implement the laws. Current status on issuing of Driving License is that all applicants irrespective of age, have to fill up Form – 1 (Application cum declaration to the physical fitness) and if declared as having epilepsy, then has to undergo a medical examination. Inspite of medical recommendations, there is no provision to issue a driving license if the person has epilepsy. Thus, according to current Indian Law, a person with epilepsy cannot drive. Medical examination is compulsory irrespective of age for all applicants for transport vehicle driving license. For non-transport vehicle driving license, medical examination is required only if they are above the age of 40 years. There have been modifications to this legislation in some states and one should therefore check in the relevant state one wishes to drive in.

Is there any law in India to protect the rights and interests of person with epilepsy?

It is well known that people with epilepsy are discriminated at every stage -school admission, employment, marriage, insurance, sports etc ,. In USA – Americans with Disability Act (ADA) and in UK the Disability Discrimination Act (DDA) prohibits discrimination in various spheres of life. Unfortunately in India there is no such Law. At the moment one has to fight under the Fundamental Rights Act. http://www.epilepsyindia.org/documents/EpilepsyLawIndia_Book.pdf

Epilepsy and Insurance

In India, Life Insurance Corporation of India does issue policies at a slightly increased premium rate of 10-15% as do some private insurers. Even this is decided on a case to case basis. However, personal accident, health insurance and travel insurance are available with a proviso that the insurance does not cover illness/accident related to epilepsy. Motor insurance and home insurance are issued without any restrictions. Information/guidelines available with private insurance companies is limited.

Epilepsy and Income Tax Laws

There are certain Income Tax benefits under section 80 DD of the Income Tax Act provided a certificate is obtained from an authorized Medical Practitioner as prescribed under the Income Tax Act that such disability reduce considerably the affected person’s capacity to normal work or engaging in a gainful employment. If such person incurred any expenditure for the medical treatment, training and rehabilitation of a dependent for a person with such disability, he/she shall be allowed a deduction. Deduction under section 80DD of the income tax act is allowed to Resident Individuals or HUFs for a dependant-who is differently-abled and– is wholly dependent on the individual (or HUF) for support & maintenance. Below are the conditions you must meet to avail this deduction – Deduction is allowed for a dependant of the taxpayer and not the taxpayer himself. The taxpayer is not allowed this deduction if the dependant has claimed a deduction under section 80U for himself/herself. Dependant in case of an individual taxpayer means spouse, children, parents, brothers & sisters of the taxpayer. In case of a HUF means a member of the HUF. The taxpayer has incurred expenses for medical treatment (including nursing), training & rehabilitation of the differently-abled dependant or the taxpayer may have deposited in a scheme of LIC or another insurer for maintenance of the dependant. Disability of the dependant is not less than 40%. Disability is defined under section 2(i) of the Persons of Disabilities Act, 1995. When the above conditions are met, amount of deduction allowed is – Rs 75,000 (Starting from the financial year 2015-16) where disability is more than 40% and less than 80%. Rs 1,25,000 (Starting from the financial year 2015-16) where disability is more than 80%. These deductions are allowed irrespective of your actual expenditure.

conclusion:

In conclusion, we wish to impress upon the reader that treating and managing ASD is possible, going beyond the levels of basic care and therapy.

When you merge modern Medicine and the tools of technology advancement with ancient wisdom, the benefits of treatment increases multifold. This is what we offer as a team at Buddhi Clinic, our level of expertise in integrated brain and mind care, having been honed over several years.

From Tasmanian Devil to Mathematical Whiz

Attention Deficit and Hyperactivity Disorder (ADHD)

From Tasmanian Devil to Mathematical Whiz

We must admit that S’s remarkable progress was made possible by the wonderful therapeutic relationship our team had with his family. From S and his family we have learnt the importance of looking beyond terminology and the diagnostic label.

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