THE THREE PILLARS OF EPILEPSY - DIAGNOSIS, TREATMENT AND SUPPORT

Posted on Feb 09, 2025

Epilepsy is a chronic disease of the human brain in which the affected person suffers from recurrent seizures or “fits”. These are short periods of abnormal brain electrical activity in the patient’s brain with raised clinical manifestations ranging from mild to severe impairment of consciousness, abnormal limb movements, forceful turning of head, visual, psychological, sensory experiences, etc. In some instances, the seizures get abnormally prolonged even for hours together. This is a very serious medical condition called status epilepticus which requires emergency hospitalization and treatment. 

Three pillars of diagnosis

History taking: An eyewitness account of the episode will help the clinician make a diagnosis of epileptic seizure and differentiate it from conditions that mimic seizures. It also helps to understand the category of seizure and the part of the brain from which it originates. The patient’s history, starting from the antenatal period and a family history are also highly relevant to make a diagnosis.

EEG (Electroencephalogram): This is the single most important investigation in epilepsy. A carefully performed awake and sleep record (total 45 minutes) EEG will detect abnormalities in majority of the cases. However, in some cases a longer recording (8hrs to few days) may be required especially in patients who do not respond to medications. A combination of clinical seizure recording through a camera along with EEG changes (Video EEG) is the best possible method to classify and localize epilepsies.

Neuroimaging:  A special protocol MRI Brain and other forms of neuroimaging are useful to find any structural brain abnormalities which could result in epilepsy. Investigative modalities like PET (Positron emission Tomography) are useful when planning epilepsy surgery.

Three pillars of management (treatment)

Medical management: The most important and commonly used form of treatment for epilepsy is medication, which has been scientifically proven to be effective with a very good safety profile. Adverse effects may occur in a minority of cases. Fear of adverse effects and reluctance to take long term medication is a big hurdle in achieving good clinical outcomes. The patient and family require constant reassurance from the treating doctor during each visit to ensure compliance to medications. It is also important to ensure a healthy lifestyle and daily routine (especially good sleep and reduced screentime) to avoid recurrence of seizures while on medications.

Epilepsy surgery:  Surgery is reserved for patients who do not respond to anti-epileptic medications. Surgery can be potentially curative in about 70 percent of patients. Surgery is also performed to reduce the number and severity of seizures. Epilepsy surgery is a life-changing treatment option which must be performed only in a centre with a comprehensive epilepsy surgery program and an epilepsy team.

Neurostimulation

Stimulation of the vagus nerve in the neck (VNS) or deep brain structures (Deep Brain Stimulation -DBS) are two procedures that are now available to reduce the seizure burden in patients who cannot be considered for epilepsy surgery. 

Three Pillars of support:

Epilepsy is a disease which throws many questions. The fundamental question is whether we have the right answers to these questions. Overcoming challenges, limitations and perceptions is not an easy job. But then if we have family, friends and a caring empathetic doctor and a medical team, we will, emerge victorious.

Dr Sachin Sureshbabu 

HOD & Senior Consultant - Neurology, Director - Research and Innovations

Centre of Neurosciences, Meitra  Hospital, Kozhikode.