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Epilepsy is the most common chronic brain disorder in every country in the world. More than 50 million people in the whole world suffer from epilepsy. In the Philippines, an estimated 750,000 people are affected with this condition, and majority of them are children or adults in the most productive years of their life. About 1 out of 3 people with epilepsy develop the condition by age 18. More than half of all people with epilepsy develop symptoms before the age 25.
Epilepsy comes from a Greek word that means, "to be seized by forces from without". This condition occurs suddenly, without warning. Very often it presents as a convulsion with powerful contractions of the parts of the body. But it can also manifest as a sudden brief change in thinking, attention, sensation or behavior.
To the person with epilepsy and the people surrounding him, this condition can be very disturbing and frightening. Much of the anxiety over the disorder will be avoided with adequate and correct information about epilepsy. Let us learn some basic facts about it.
Epilepsy should be everyone's concern because anyone can have epilepsy.
Even you. It affects young and old persons alike, in any country, of any profession, social class, or background. It should be everyone's concern. Epilepsy is the most common chronic brain disorder in the whole world. It is not rare or exotic. Many people suffer from it.
Epilepsy comes from a temporary electrical disturbance inside the brain.
There is nothing mysterious or mystical about it. It is not contagious. It is not due to witchcraft, demonic possession, or mental illness. It is a medical condition caused by sudden, brief changes in how the brain works. When this change occurs in the brain, a person's movements, behavior or consciousness may be altered for a short time, after which he goes back to his former condition. This is also called a seizure.
The word epilepsy is used when seizures happen repeatedly. The brain is the control center for the body. It controls functions such as walking, talking, hearing, seeing, etc. The brain does this by transmitting and receiving electrical signals along wires of the brain called nerves. Sometimes the wires and the signals become short-circuited or "grounded". This disturbs the way nerve cells work and causes change in the way a person moves, talks, thinks or behaves. After a few minutes, it ends spontaneously, and the cells go back to their normal function. These disturbances in the "wires" of the brain can happen to anybody, even normal people; but it happens more often in those people with diseases or injury of the brain.
Epilepsy can result from many different conditions.
Epilepsy is very often but not always the result of underlying brain disease. Some of the common causes of epilepsy are:
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Head Injury
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Brain Infections
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Strokes
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Brain Tumors
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Drugs, Alcohol
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Chemical Imbalances in the Body
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Genetic/Hereditary predisposition
However, several community studies (USA, Italy, Ecuador) show that in about 60-75% of persons with epilepsy, no known cause can be found.
Some kinds of epilepsy can be prevented.
Some kinds of epilepsy arise because of acquired injury or scars in the brain. Scarring in the brain can happen after head injury, brain infections, stroke and after brain operations. These scars are called gliotic tissues and can cause unusual brain excitation leading to seizures. If scarring in the brain can be avoided, the risk for developing epilepsy can be minimized.
Safety in vehicles should be practiced. Seat belts, motorcycle helmets, and infant car seats protect against epilepsy resulting from car accidents.
Proper vaccines and hygiene prevent infections to the brain. In the Philippines, preventable brain infections such as meningitis, encephalitis and parasitic infections like cerebral schstosomiasis continue to be common causes of epilepsy.
There are many kinds of epilepsy. (Not just convulsions!)
There are many different manifestations of epilepsy, as many as there are different functions of the brain.
The manifestations depend on what part of the brain is disturbed. If it is the center in the brain for movement, then unusual movements are seen in the person briefly. If it is the center for memory, then the person can have unusual memories or thoughts. If it is the center for sensation, then a person can have brief numbness or electric like sensations in some parts of the body.
Some seizures are focal/partial or limited only to a certain part of the body and are not associated with a loss of consciousness. Some seizures are generalized, where the person can lose consciousness or collapse and have convulsions of the whole body.
Majority of the patients have infrequent seizures; some can have very frequent (daily) and severe seizures (20%).
Common Types of Seizures |
Partial Motor Seizures:
Brief twitching, jerking of one arm, leg or half of the face |
Partial Sensory Seizures:
Brief unusual sensations or numbness on one arm, leg or half of face, transient visual disturbances |
Partial Complex Seizures:
Brief and sudden changes in their behavior or mental state; appears to be in a trance, stares blankly, unresponsive when spoken to. |
Absence Seizures:
Frequent repeated spells of day dreaming or brief staring or blinking spells in children |
Drop attacks:
Sudden falls or collapse, head drops |
Myoclonic Seizures:
Massive muscle jerks |
Epilepsy can be treated.
Majority of the seizures can be treated (80-85%) as long as medications are taken regularly.
Persons with seizures can go to neurologists, pediatric neurologists, pediatricians, internists and family physicians who provide treatment for epilepsy. Those patients whose seizures are difficult to control should go to large medical centers where Neurology/Seizure clinics are located. They can also consult neurology specialists and epileptologists for expert epilepsy management. The following is a short list of medical centers (government and private) in Metro Manila where Neurology/Seizure clinics are available:
Jose Reyes Memorial Hospital
Makati Medical Center
Philippine Children's Medical Center Seizure Clinic
St. Luke's Medical Center: Comprehensive Epilepsy Program
UERM Seizure Clinic
UP-PGH Seizure Clinic
UST Hospital Seizure Clinic
For further referrals or information regarding specialists and Epilepsy Clinics in other regions, please visit our website or call the Epilepsy hotline given below. The Philippine Neurological Association also has a listing of neurologists all over the country.
Medications are available that control seizures. Different types of seizures require different types of anti-epileptic medications. As in any drug, anti-epilepsy medications have some undesirable side effects. Most of them are encountered when the doses are very high. Some of them appear only at the beginning of the treatment, even at low dosages. Most of them have potential for producing allergic rash. Discriminate prescribing, careful dosaging and close monitoring by your doctor minimize the side effects making them very manageable.
In cases where there is no definitive cause for the seizure, the patient usually has to take his medications only for about 2-5 years. With the recommendation of the physician the drug is eventually withdrawn slowly.
Medication | Common Side Effects |
Phenobarbital |
Sedation/sleepiness, hyperactivity, weakness |
Dilantin
(Phenylhydantoin, Phenytoin) |
Dizziness, poor balance, weakness, thickening of the gums, excessive hair growth, allergic rash |
Tegretol
(Carbamazepine) |
Dizziness, sleepiness, weakness, headache, gastric discomfort, allergic rash |
Epival, Depakene
(Valproic Acid) |
Loss of appetite, nausea, vomiting, gastric discomfort, tremors |
Rivotril
(Clonazepam) |
Sleepiness, weakness |
Trileptal
(Oxcarbazepine) |
Headache, dizziness, sleepiness, nausea |
Neurontin
Gabapentin |
Sleepiness, fatigue, dizziness, weakness |
Lamictal
(Lamotrigine) |
Allergic rash |
Topamax
(Topiramate) |
Weight loss, mood changes, sleepiness, dizziness |
There is something you can do to help someone who is having a seizure.
Most of us who see patients who are actively in seizures panic and feel totally helpless. Most seizures last for 1-3 minutes and are self-limiting. The seizures will eventually stop n a few minutes whether or not you do something. However, if you want to be of help during an acute seizure you may do the following:
- Stay calm. Most seizures last only for 1-3 minutes or shorter and will stop spontaneously whether or not you do anything.
- Loosen clothing around the neck.
- Turn the patient's head on his side to avoid choking or aspiration.
- Don't try to stop the seizure by holding the patient down. Do not shake his body, bite his finger/toe, slap his face, or pour water on his face in an attempt to rouse him. You might injure the patient unnecessarily.
- Do not try to put anything inside his mouth.
- Calmly assure the patient once he recovers consciousness.
- Call a doctor when the seizure happens for the first time, or when the seizure happens repeatedly or when it is prolonged (longer than 5 minutes).
Most patients with epilepsy can live normal lives.
Let us give them the chance.
Most patients with epilepsy have normal intelligence and are not mentally or behaviorally impaired. They can be good scientists, writers, politicians, sportsmen, musicians and artists. Patients with epilepsy can be productive and talented citizens. In fact some of the well-remembered figures in history, arts, music and literature are persons who suffered from epilepsy.
If diagnosed early and given early treatment, majority of persons with epilepsy can live normal lives: they can study, work, engage in certain sports, go out with friends, and raise a family like anyone of us.
This, however, does not always happen. Ignorance and misconceptions about the condition has lead to social stigma. The patients live in fear, shame and secrecy. They refuse to divulge their condition to their neighbors, friends, classmates, or co-workers/employers because of fear of ridicule, discrimination or ostracism. Some patients with epilepsy are refused admission to schools and places of employment. They are often overprotected and sheltered by their families and forbidden to pursue careers, sports and leisurely pursuits no matter how able and talented they are. The think twice before going to school, applying for a job or getting married. This is sad, because patients with epilepsy should have the right to equal opportunities to live a full life as anyone of us. It is a big waste of human potential.
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