Do you have unanswered questions regarding the impact of epilepsy on your life? If so, you are not alone. Below are questions frequently asked by persons with epilepsy, their family, and friends.
Q: What is the difference between “Fits” and “Epilepsy”?
A: Epilepsy is simply defined as a condition in which the patient is prone to get epileptic “seizures” or “fits”. Anyone having two or more unprovoked fits or seizures can be said to have Epilepsy. Epilepsy clearly is not a homogenous entity, but may vary widely in its forms, causation and severity.
An epileptic fit or seizure is caused by brief, excessive and abnormal discharge of nerve cells in the brain. It is something like a small “electrical storm” or ‘short circuiting” in the brain. The abnormal discharge of electrical activity may involve a small part of the brain or even the whole brain itself. The symptoms of an epileptic fit depend upon the part of the brain that is activated by abnormal electrical discharges and it results in an abnormal movement, sensation, thought process and even unconsciousness. This explains the variation in the clinical types of seizures that can occur in different individuals.
Q: Does a person who gets only a single fit have epilepsy?
A: No. Epilepsy means that the person has recurrent (more than one) fits. A single fit in a person does not mean that he/she has epilepsy. It is estimated that majority of people who have had an isolated, single fit will never have another one. On the other hand, persons who are destined to develop epilepsy will have the second fit after a variable interval, usually within one year of the first fit.
Q: What is the best way to diagnose epilepsy?
A: The diagnosis of epilepsy is essentially made on clinical grounds. A clear eyewitness account of the fit is the most important factor in the diagnosis of epilepsy. Investigations like electroencephalogram (EEG) are helpful but the diagnosis is largely based on the clinical history. Even in the most experienced hands, many cases of epilepsy are incorrectly diagnosed while some cases of epilepsy are often missed. Other investigations like CT and MRI scan are helpful in finding the possible cause for epilepsy in many cases. Some other investigations like SPECT, Long-term Video-EEG, and neuro-psychological testing are helpful in selected cases only.
Q: How can you diagnose pseudo-seizures?
A: The description of these seizures in association with peculiar circumstances most often is helpful in the diagnosis. Many times the diagnosis can be extremely difficult but with modern technology it is now possible to diagnose pseudo-seizure in almost all the cases. We now utilize the technique VIDEO – EEG in which the manifestations of the fit are recorded with a video camera and EEG is also recorded simultaneously. Such patients do not exhibit any EEG abnormality during the fit. Once a correct diagnosis is arrived at, these patients with pseudo-seizures can then be managed accordingly.
Q: Can persons with epilepsy drive?
A: Laws with regards to epilepsy and driving vary from country to country. In general, it is not advisable for persons with epilepsy to drive during the first two years of treatment. Some countries allow driving after an individual has been seizure free for two or more years. Those persons whose fits are not controlled should not drive any vehicle. Similarly, stricter precautions have to be followed for driving heavy goods vehicles or public transport vehicles. In any case, the driving of a vehicle by person with epilepsy should not be a source of danger to the public.
Q: Are persons with epilepsy employable?
A: Most often it is difficult for epileptic persons to find suitable employment after disclosing their epilepsy. On one hand, a person whose seizures are completely controlled without any disabilities should be considered on equal terms as anyone else for most of the jobs. On the other hand, someone who has poorly controlled seizures with some handicaps will not be able to find any job in the public or private sector.
As with other activities, the decision about job suitability should also be individualized keeping in mind the type and frequency of seizures and the associated handicaps. However, some jobs are not recommended for persons with epilepsy. These include defense services, fire services, working with unguarded machinery, working at heights, driving a motorized vehicle, railway engine driver etc. Persons with epilepsy whose seizures are well controlled should be acceptable for most of the other jobs. In case a person develops epilepsy while in service, than the employer should help finding a suitable alternate job for that person.
Q: How common is epilepsy in the general population?
A: It is estimated that the overall “incidence” of epilepsy (number of new cases observed over a fixed period of time) lies between 20 – 50 cases per year per 100,000 persons in a general population. The usual “prevalence” rate (number of persons with epilepsy during a specified time) is 500-1000 cases per 100,000 persons in the population. Going by these statistics, there will be about 2,600 – 6,500 new cases of epilepsy every year in Delhi and New Delhi alone (estimated population of 1.3 crores) and 200,000 to 500,000 new cases in the whole of India (estimated population about 100 crores). Similarly at the present time there may be approximately 65,000-130,000 persons with epilepsy in Delhi/New Delhi and about 50-100 lakhs in whole of India respectively.
The following practical points need to be remembered:
1. One in 20 people will have an epileptic seizure at some point in their lives.
2. One in 100-200 people in a general population has epilepsy at any given time.
3. About 50–70% patients will develop epilepsy (have their first seizure) before the age of 18 years.
EPILEPSY IS CLEARLY, THEREFORE, A MAJOR PUBLIC HEALTH PROBLEM.
Q: What is the role of different investigations like EEG, CT scan, and MRI scan in the diagnosis of epilepsy?
A: The electroencephalograph (EEG) which records the electrical activity of the barn cells has its own limitations. It is helpful, when it is clearly abnormal but 40-50% of patients with epilepsy have a normal single inter-ictal EEG. On the other hand, about 5% of non-epileptic patients may have non-specific EEG abnormalities. Despite its limitations, the EEG is a simple non-invasive and relatively inexpensive test that gives useful information if used judiciously and correlated with the clinical description of seizures. When abnormal, it is helpful in making a correct diagnosis of epilepsy and may even help in the choice of anti-epileptic drug therapy in a given case. The availability of CT scanning in larger cities of our country has been of a great help in the management of some cases of epilepsy, especially where an underlying pathology is suspected as the cause of seizures. Magnetic resonance imaging (MRI) is now established to be a better and safer diagnostic modality than CT scanning for the detection of an epileptogenic focus or the suspected abnormality in the brain of patients with seizures.