Mastering Epilepsy Care: A Guide to Understanding and Managing Seizures

What is Epilepsy?

Epilepsy, as defined by the World Health Organization (WHO), is a non-communicable neurological disorder that affects millions of people worldwide. It is marked by recurrent seizures, which are sudden, uncontrolled electrical disturbances in the brain.

These seizures can vary widely in intensity and duration, ranging from mild and barely noticeable to severe and debilitating. They can manifest as brief episodes of involuntary movement, such as jerking or convulsions, and may also include alterations in consciousness, sensory perception, or behaviour.

Recording seizures is an invaluable practice for both patients and healthcare providers, offering crucial insights for optimizing epilepsy management. Effective seizure recording involves several key components:

1. Detailed Description: Encourage family members to provide a thorough description of the seizure event, including its duration.
2. Seizure Type: Different types of seizures present with varying symptoms. Documenting the type of seizure is essential for accurate diagnosis and treatment.
3. Time and Date: Recording the date and time of the seizure helps healthcare providers track the frequency and pattern of seizures, aiding in treatment planning.
4. Duration: Documenting the duration of the seizure is crucial for assessing its severity and determining appropriate interventions.
5. Triggers and Factors: Identifying potential triggers or factors that may have contributed to the seizure can help patients and healthcare providers develop strategies to minimize future episodes.
6. Video Documentation: If possible, consider recording the seizure using a video camera or smartphone. Video documentation provides valuable insights into the nature of the seizure and aids in accurate assessment by healthcare providers.

In cases where a seizure occurs in water, specific steps must be taken to ensure the individual’s safety:

• Support the Person’s Head: Ensure the person’s head is supported so that their face remains out of the water, minimizing the risk of drowning.
• Tilt the Head Back: Tilt the person’s head back to maintain a clear airway, facilitating breathing.
• Remove from Water:  If the person is in a pool, remove them from the water when the jerking stops. (Note: If, in a highly unlikely scenario, the jerking does not stop, you should remove the individual from the water at the shallowest end of the pool and try to get assistance from others). Take them out of the water right away if they are in the waves.
• Use Flotation Devices: Consider using flotation devices to assist in removing the person from the water safely.
• Seek Help: If available, seek assistance from others to ensure the person’s safety.

After removing the individual from the water, additional steps should be taken:

• Position on Side: Place the person on their side to maintain an open airway and prevent aspiration.
• Check Breathing: Determine whether the subject is breathing regularly. If not, reposition onto their back and initiate appropriate CPR.

Differentiating Epilepsy from Other Conditions:

Diagnosing epilepsy can be challenging due to the similarity of symptoms with other conditions such as fainting, migraines, and panic attacks. Confirmation typically requires more than one seizure occurrence.

Tests for Epilepsy:

Various tests, including electroencephalogram (EEG), brain scans (CT, MRI), and positron emission tomography (PET), are used to diagnose epilepsy by detecting abnormal brain activity or structural abnormalities.

Photosensitive Epilepsy:

Photosensitive epilepsy, triggered by flashing lights or contrasting light and dark patterns, can be diagnosed using EEG and specific light exposure tests.

Managing Photosensitive Epilepsy:

Treatment typically involves anti-seizure medication to lower seizure risk, along with precautions to avoid triggering stimuli.

Psychological assessment plays a vital role in understanding and managing the emotional and cognitive impact of epilepsy:

• Emotional Impact: Seizures can lead to anxiety, depression, or PTSD. Assessments identify emotional challenges, enabling timely intervention and support.
• Cognitive Impact: Understanding how epilepsy affects memory, attention, and cognitive functions guides treatment plans and interventions.
• Psychosocial Impact: Stigma, social isolation, and concerns about medication side effects affect quality of life. Identifying these factors enables tailored counselling and support services.
• Multifaceted Approach: Psychological assessment empowers healthcare providers to deliver holistic care, enhancing the overall well-being of individuals with epilepsy.

Electroencephalogram (EEG) is essential for diagnosing and monitoring epilepsy:

• Recording Brain Activity: EEG records brain activity using sensors attached to the scalp, aiding in seizure diagnosis and classification.
• Seizure Classification: Different epilepsy syndromes exhibit unique EEG patterns, guiding treatment decisions.
• Monitoring Treatment: Regular EEGs assess the effectiveness of antiepileptic drugs (AEDs) and guide treatment adjustments.

Seizure First Aid:

• Lower to the Ground: Lower the person to the ground to prevent falls and injuries.
• Clear the Area: Remove objects that could cause harm during the seizure.
• Support the Head: Place something soft under the person’s head to reduce the risk of head injuries.
• Stay Clear: Avoid restraining the person and stay clear once they are safe.

Calling Emergency Services:

• First-Time Seizure: If it’s the person’s first seizure, call emergency services for immediate medical care.
• Prolonged Seizure: If the seizure lasts more than 5 minutes, or if the person has a history of prolonged seizures, seek medical assistance.
• Stay with the Person: Monitor the person closely and provide assistance until help arrives.

Lack of good sleep can increase the likelihood and severity of seizures:

• Sleep Quality: Inadequate sleep quality or quantity can lower the seizure threshold and intensify seizures.
• Seizures During Sleep: Some individuals experience seizures exclusively during sleep or upon waking.
• Managing Sleep: Maintaining a regular sleep schedule and addressing sleep disorders are essential for seizure management.

Addressing these aspects holistically ensures optimal epilepsy care, promoting well-being and minimizing seizure-related risks. Collaboration between patients, healthcare providers, and support networks is paramount in achieving this goal.

By Dr Shivananda Pai, Consultant Neurology, KMC Hospital, Dr B R Ambedkar Circle, Mangaluru

Disclaimer: The opinions and assertions expressed in this article are solely those of the author/authors and do not necessarily reflect the views of Udayavani. The publication holds no legal responsibility for the content presented.