Thursday, February 2, 2012

WHAT IS EPILEPSY?

Child health specialist pediatrician Mumbai presents epilepsy FAQs:
Following is not a medical prescription, but just for information. No medicines should be taken or changed without direct clinical consultation and prescription issued by your doctor.
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WHAT IS EPILEPSY?
A repetitive seizure disorder due to abnormal cortical excitation, manifesting as local or generalized paroxysmal stereotypical movements with or without loss of consciousness, with or without frothing at mouth, with or without passage of urine and stools , with or without visible, tonic/clonic manifestations of a seizure.

WHAT IS NOT EPILEPSY?
Single seizure with normal EEG is not an epilepsy. Movement disorders like tremors, chorea may be confused as epilepsy. Epilepsy may mimick syncope, migraine or vertigo

. WHAT ARE THE DIFFERENT PATTERNS OF EPILEPSY?
Epilepsy can be presenting as focal or generalized seizures without any aetiology as idiopathic epilepsy. When some reason is there, it may be called as pathological or syndromic epilepsy. Clinical patterns may vary from just twitching to tonic clonic movements and from syncope like events to unconsciousness.

HOW DO WE DIAGNOSE THEM
Diagnosis is often clinical. Investigations help in understanding prognosis and aetiology. EEG and MRI brain is often asked for in most epileptics.


DO’S AND DONTS WHEN A PATIENT GETS A SEIZURE
When a patient gets a seizure, let the seizure pass, turn the patient on one side to prevent aspiration of secretions. If available you may give oxygen and nasal midazolam or injectable or per rectal diazepam. Even if seizure is settled, giving medicine will delay next seizure. Discourage the myths about pouring water and applying strong smells or onion to nose , as it will harm the patient.

WHAT ARE THE EMERGENCY DRUGS FOR SEIZURE CONTROL?
Emergency seizure control can be achieved by any of the following drugs depending on availability: Intranasal midazolam spray, per rectal diazepam, intramuscular diazepam,intravenous diazepam or lorazepam or phenytoin or phenobarbitone. These drugs may have life threatening side effects if proper precautions not taken by the doctor.

WHATS ANTICONVULSTANTS TO BE USED FOR WHAT TYPE OF SEIZURES?
This is better left to the experts as type and pattern of seizure and availability of drugs and knowledge of dosages and side effects does matter.The drugs used in past for generalized and focal epilepsies in past that is phenobarbitone and phenytoin respectively, may not be recommendable in view of their side effects, as better drugs are available. Focal and temporal lobe seizures, complex partial seizures, respond better with carbamazepine and oxycarbazepine. Most generalized seizures are well controlled with valproic acid which is a relatively safe drug as the dosages with it can be easily titrated to double without side effects.Newer anticonvulsants shouldnot be used without specialists consultations.

WHAT ARE THE DOSAGES OF SEIZURE CONTROLLING MEDICINES?
Most common drugs like phenytoin, phenobarbitone have narrow therapeutic window and are used in dosages of 5mg/kg body weight per day. Valproic acid having a wider therapeutic window is used in doses of 15 to 40 mg/kg/day. Carbamazepine is used in doses of 10-20mg/kg/day. Should always be started by and confirmed with treating doctor.

HOW LONG THE SEIZURE THERAPY SHOULD BE CONTINUED?
Single seizures with normal EEG and also febrile seizures, often do not need long term seizure therapy. Once started for valid reasons, seizure therapy is usually continued to observe at least 2 years seizure free. Then afterwards there may be a chance of tapering and stopping the therapy, though not in all patients.

WHAT ARE THE SIDE EFFECTS OF SEIZURE THERAPY?
They differ with different drugs, from intellectual dysfunction to anemia, rickets, gynecomastia , obesity etc. Overdoses may cause sleepiness, ataxia, diplopia, headaches and convulsions with different drugs.

WHEN WILL IT GET CURED?
Once the patient is seizure free fro more than 2 years, and there is no other reason to continue the same medicines and on with drawl of medicines if seizures donot recur in 6 months, the disease may be taken as cured for that time.

CAN THE PATIENT SWIM OR DRIVE?
Should preferably be avoided till medicines are on, though many countries promote these activities once 2 years seizure free.

IS THERE ANY SURGERY?
Selective refractory cases with focal manifestations on clinical evaluation or EEG or MRI may be subjected to surgery.


CAN THEY GO TO SCHOOL?
Schooling and office work can be permitted as long as it is stress free and doesn’t involve being on empty stomach for longer hours.

ARE ALL OF THESE ARE MENTALLY RETARDED?
Some seizure patients have mental retardation as comorbidity or may be associated with developmental delay, more so in pediatric patients say of birth asphyxia. In fact, some of the epileptics are superintellectuals.




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