following is not a medical prescription, but just for information. No
medicines should be taken or changed without direct clinical consultation and
prescription issued by your doctor.
WHAT IS EPILEPSY?
A repetitive seizure disorder due to abnormal cortical excitation,
manifesting as local or generalized paroxysmal stereotypical movements with or
without loss of consciousness, with or without frothing at mouth, with or
without passage of urine and stools , with or without visible, tonic/clonic
manifestations of a seizure.
WHAT IS NOT EPILEPSY?
Single seizure with normal EEG is not an epilepsy. Movement disorders like
tremors, chorea may be confused as epilepsy. Epilepsy may mimick syncope,
migraine or vertigo
WHAT ARE THE DIFFERENT PATTERNS OF EPILEPSY?
Epilepsy can be presenting as focal or generalized seizures without any
aetiology as idiopathic epilepsy. When some reason is there, it may be called as
pathological or syndromic epilepsy. Clinical patterns may vary from just
twitching to tonic clonic movements and from syncope like events to
HOW DO WE DIAGNOSE THEM
Diagnosis is often clinical. Investigations help in understanding prognosis
and aetiology. EEG and MRI brain is often asked for in most epileptics.
DO’S AND DONTS WHEN A PATIENT GETS A SEIZURE
When a patient gets a seizure, let the seizure pass, turn the patient on one
side to prevent aspiration of secretions. If available you may give oxygen and
nasal midazolam or injectable or per rectal diazepam. Even if seizure is
settled, giving medicine will delay next seizure. Discourage the myths about
pouring water and applying strong smells or onion to nose , as it will harm the
WHAT ARE THE EMERGENCY DRUGS FOR SEIZURE CONTROL?
Emergency seizure control can be achieved by any of the following drugs
depending on availability: Intranasal midazolam spray, per rectal diazepam,
intramuscular diazepam,intravenous diazepam or lorazepam or phenytoin or
phenobarbitone. These drugs may have life threatening side effects if proper
precautions not taken by the doctor.
WHATS ANTICONVULSTANTS TO BE USED FOR WHAT TYPE OF SEIZURES?
This is better left to the experts as type and pattern of seizure and
availability of drugs and knowledge of dosages and side effects does matter.The
drugs used in past for generalized and focal epilepsies in past that is
phenobarbitone and phenytoin respectively, may not be recommendable in view of
their side effects, as better drugs are available. Focal and temporal lobe
seizures, complex partial seizures, respond better with carbamazepine and
oxycarbazepine. Most generalized seizures are well controlled with valproic acid
which is a relatively safe drug as the dosages with it can be easily titrated to
double without side effects.Newer anticonvulsants shouldnot be used without
WHAT ARE THE DOSAGES OF SEIZURE CONTROLLING MEDICINES?
Most common drugs like phenytoin, phenobarbitone have narrow therapeutic
window and are used in dosages of 5mg/kg body weight per day. Valproic acid
having a wider therapeutic window is used in doses of 15 to 40 mg/kg/day.
Carbamazepine is used in doses of 10-20mg/kg/day. Should always be started by
and confirmed with treating doctor.
HOW LONG THE SEIZURE THERAPY SHOULD BE CONTINUED?
Single seizures with normal EEG and also febrile seizures, often do not need
long term seizure therapy. Once started for valid reasons, seizure therapy is
usually continued to observe at least 2 years seizure free. Then afterwards
there may be a chance of tapering and stopping the therapy, though not in all
WHAT ARE THE SIDE EFFECTS OF SEIZURE THERAPY?
They differ with different drugs, from intellectual dysfunction to anemia,
rickets, gynecomastia , obesity etc. Overdoses may cause sleepiness, ataxia,
diplopia, headaches and convulsions with different drugs.
WHEN WILL IT GET CURED?
Once the patient is seizure free fro more than 2 years, and there is no other
reason to continue the same medicines and on with drawl of medicines if seizures
donot recur in 6 months, the disease may be taken as cured for that time.
CAN THE PATIENT SWIM OR DRIVE?
Should preferably be avoided till medicines are on, though many countries
promote these activities once 2 years seizure free.
IS THERE ANY SURGERY?
Selective refractory cases with focal manifestations on clinical evaluation
or EEG or MRI may be subjected to surgery.
CAN THEY GO TO SCHOOL?
Schooling and office work can be permitted as long as it is stress free and
doesn’t involve being on empty stomach for longer hours.
ARE ALL OF THESE ARE MENTALLY RETARDED?
Some seizure patients have mental retardation as comorbidity or may be
associated with developmental delay, more so in pediatric patients say of birth
asphyxia. In fact, some of the epileptics are superintellectuals.
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