Epilepsy is a treatable condition in the majority of patients, say experts. Epilepsy is amongst the most common neurological conditions.
The term is derived from a Greek term ‘Epilambanei’ with means ‘to take hold of.’ Ibn Sina identified it as a brain disease. Epilepsy, particularly the generalized type, is easy to identify with the patient having jerking of limbs before losing consciousness with biting of tongue and injuries during the episode.
Others like focal epilepsy may manifest as jerking or numbness of a limb. The psychomotor type manifests with altered consciousness with unresponsiveness along with motor manifestations like lip smacking or grimacing.
Some types like absence manifest in children and may manifest as falling grades. With such varied manifestations it is important to diagnose the condition early for meaningful interventions to improve the quality of life.
This is particularly important in children who might have epilepsy as manifestations of a syndrome or due to brain malformation that occur during its development.
Epilepsy is an electro-clinical syndrome and the two simple investigations help in diagnosis are a 32 channel scalp electroencephalography and neuroimaging using CT/ MRI with epilepsy protocol.
Neuroimaging is particularly in ruling out brain conditions such as tumors, trauma or infections. It is essential that all patients with epilepsy should have at least one brain scan to rule out a treatable cause and predict the possibility of a cure.
Comprehensive assessment helps in providing comprehensive care of patients with the condition and avoidance of an incorrect label of epilepsy which carries serious social stigma and impacts employability.
Most of the epilepsies are curable or can be controlled symptomatically with affordable medications. The primary aim does remain to keep the patient on single automated external defibrillator or AED.
Drug-resistant epilepsy is defined as a failure of two or more appropriately selected and adequately tried anticonvulsant medications to achieve seizure freedom for a sustained period of time.
The reasons for an incorrect label of drug-resistant epilepsy include a wrong diagnosis, prescription of wrong drug used of wrong dose, or poor compliance on part of patient. Patients with epilepsy who are drug-resistant should be referred to an epilepsy centre for a surgical evaluation or more specialized care.
Additional investigations are required in cases of refractory epilepsy to localize the focus of epilepsy include video EEG and detailed neuropsychological evaluation. The best results are achieved if surgery for epilepsy is performed in the initial two years of the onset of symptoms.
Surgery benefits vary from helping reduce falls from seizure, decreased number of epileptic attack, halt progressive neurological deficit and in some cases may make patient seizure and drug free for life.