It is estimated that four in every 100 people will be diagnosed with epilepsy, says Dr Prashant Makhija, neurologist consultant, Wockhardt Hospital, South Bombay. In recognition of November as Epilepsy Awareness Month, here’s a basic guide from Dr Makhija to understand and know the difference between fits and epilepsy.
What is a fit?
*A fit/convulsion occurs when there is abnormal or excessive electrical discharge from nerve cells of the brain. Depending on how much of the brain is affected by this abnormal/excessive electrical discharge, a fit is of two types:
# Focal: when it occurs in a localised area
# Generalised: when there is widespread involvement of both halves of the brain
What are the symptoms of a fit?
*Depending on the area of the brain involved, a patient may have varied symptomatology. Some of the common symptoms include blank stare, transient confusion, transient abnormal behaviour, deviation of head and eyes to one side, posturing or jerking of one limb which may sometimes be accompanied with twitching of the face, violent jerking of all four limbs during which patient may produce abnormal sound, he/she may bite his/her tongue and there may also be an involuntary passage of urine/stools in clothes
What is the difference between having fits and suffering from epilepsy?
*Fit/convulsion is a one-time event and having a single episode of fit/convulsion does not necessarily mean the patient is suffering from epilepsy
*Epilepsy is a neurological disorder wherein patient has a tendency to have recurrent seizures
*A single episode of fit/convulsion may occur because of rapidly correctable/reversible problem such a low blood sugars (hypoglycaemia), low sodium levels (hyponatremia), consumption of alcohol etc. In such cases correction of the underlying cause will prevent the patient from developing further episodes of fits/convulsions and patient may not necessarily require anti-seizure medications. Around 1 in 10 persons will have fit/convulsion once in a lifetime.
*A person is diagnosed as having epilepsy when he/she shows an enduring predisposition to have recurrent seizures due to genetic/acquired causes. Epilepsy occurs either due to genetic (familial) causes or when there is damage to the brain which may occur following a head injury, infection of the brain, stroke, brain tumour etc. Around 1 in 26 persons will have a lifetime risk of developing epilepsy
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How is epilepsy diagnosed?
*For a correct diagnosis, it is important that the patient seeks consultation from a neurologist.
*A neurologist makes a diagnosis of epilepsy based on clinical evaluation of the patient (symptoms/signs), EEG(Electroencephalogram) which detects brain waves and MRI scan patient’s brain.
What should one do when a person sees someone having fit/convulsion?
*When a person is having fit (particularly generalised), there is often pooling of saliva in the mouth and a chance that patient may aspirate, therefore it is important that patient is made to lie down laterally (that is either to the left or right)
*Make sure not to give water to the patient or insert anything in the mouth which may do more harm
*A soft pillow may be placed below the neck
*If the patient is wearing tight clothes, his/her clothes may be loosened
*If there is posturing or jerking of limbs, they should not be held tightly but if there’s a chance that patient may injure himself/herself from nearby objects, these may be pushed away from him/her
*Take note of the time, most fits stop in 2-3 minutes following which patient goes to sleep but if the episode is lasting for five minutes or more, the patient should be rushed to a nearby hospital.
What are the treatment options for epilepsy?
*It is important to understand that epilepsy is treatable and, in many cases, the treatment is curative
*A majority of the cases (around 70 per cent) can be managed with appropriate anti-seizure medications
*About 30 per cent patients remain refractory to medicines and require evaluation if they are candidates for epilepsy surgery which in many cases is curative
*There are certain advanced modalities of treatment (Neuromodulation- Vagus nerve stimulation, Responsive nerve stimulation) which can also be offered in selective cases.