Epilepsy Treatment in Noida, Delhi Ncr, India

Overview

Epilepsy is a chronic neurological condition characterized by recurring seizures caused by abnormal electrical activity in the brain. It affects approximately 50 million individuals worldwide, with 90% of these patients residing in developing countries. Epilepsy can impact individuals of all ages, from infants to the elderly.

The causes of epilepsy are diverse, including genetic factors, brain infections, strokes, tumors, and high fever. Each year, about 125,000 new cases of epilepsy are reported, with 30% of these cases diagnosed in individuals under the age of 18. In India, the prevalence of epilepsy ranges from 3 to 11 cases per 1000 individuals, with an incidence rate of 0.2 to 0.6 cases per 1000 individuals.

Seizure generation is marked by hyperexcitability of neurons and hypersynchrony of neural networks, often due to an imbalance between excitatory and inhibitory neurotransmitters. Symptoms of epileptic seizures vary depending on the brain areas involved and may include loss of awareness, tremors, confusion, difficulty responding, and various sensory disturbances.

Types of Seizures

The International League Against Epilepsy (ILAE) classifies epileptic seizures into three main categories: generalized, focal (previously called partial), and epileptic spasms.

1. Focal Seizures

Focal seizures originate in neuronal networks confined to one cerebral hemisphere.

Focal Seizures Without Loss of Consciousness

Also known as simple partial seizures, these episodes do not involve a loss of consciousness. Symptoms can include alterations in emotions or sensory perceptions, déjà vu, involuntary jerks, or sensory disturbances like tingling or dizziness.

Focal Seizures With Altered Awareness

Also known as complex partial seizures, these involve a change or loss of consciousness. Patients may experience dream-like states, stare blankly, and perform repetitive movements like hand rubbing, chewing, or walking in circles.

2. Generalized Seizures

Generalized seizures involve bilateral distributed neuronal networks, affecting both hemispheres of the brain from the onset.

Absence Seizures

Previously called petit mal seizures, absence seizures commonly affect children. They involve brief periods of staring into space, sometimes accompanied by subtle movements like eye blinking or lip smacking, typically lasting five to ten seconds and occurring in clusters.

Tonic Seizures

Tonic seizures are characterized by muscle stiffness and loss of consciousness, affecting muscle groups in the arms, legs, and back, potentially leading to falls.

Atonic Seizures

Also known as drop seizures, atonic seizures cause a sudden loss of muscle control, often resulting in sudden collapses.

Clonic Seizures

Clonic seizures involve repeated or rhythmic muscle movements or jerks, typically affecting the neck, face, and arms.

Myoclonic Seizures

Myoclonic seizures are brief, sudden jerks or twitches that usually affect the upper body, arms, and legs.

Tonic-Clonic Seizures

Previously known as grand mal seizures, tonic-clonic seizures are dramatic, involving abrupt loss of consciousness, body stiffening, twitching, and shaking. They can also affect visceral organs, causing loss of bladder control or tongue biting.

Causes of Epilepsy

In many instances, the precise cause of epilepsy remains unknown. However, several factors may contribute, including:

• Genetic Influence: Certain types of epilepsy may run in families due to specific genetic factors.
• Head Trauma: Injuries from accidents can cause epilepsy.
• Brain Abnormalities: Tumors, arteriovenous malformations (AVMs), and other brain abnormalities can lead to epilepsy.
• Infections: Conditions like meningitis, HIV, and viral encephalitis are known causes.
• Prenatal Injury: Brain damage from prenatal infections, oxygen deficiency, or poor nutrition can result in epilepsy.
• Developmental Disorders: Conditions such as autism can also be contributing factors.

Risk Factors

Several risk factors increase the likelihood of developing epilepsy:

• Age: Children & older adults are more susceptible.
• Family History: A family history of epilepsy increases risk.
• Lifestyle Choices: Alcohol consumption and smoking can lead to vascular disorders, increasing the risk of epilepsy.
• Dementia: Common in older adults, dementia is linked with a higher risk of seizures.
• Brain Infections: Inflammation from infections like meningitis can trigger seizures.
• Childhood Seizures: High fever-related seizures in children can sometimes lead to epilepsy.

Symptoms of Epilepsy

Seizure symptoms vary based on the part of the brain affected. For example:

• Occipital Lobe: Vision changes
• Precentral Gyrus: Rhythmic muscle movements (clonic or tonic activity)
• Postcentral Gyrus: Abnormal sensory sensations like tingling

Diagnosis

Diagnosis of epilepsy involves a combination of medical history, symptoms, and various tests, including:

• Electroencephalogram (EEG): Records electrical activity in the brain using scalp electrodes.
• High-Density EEG: Provides more precise evaluation with closely placed electrodes.
• CT Scan: Detects structural abnormalities like tumors or cysts.
• MRI: Offers detailed imaging of brain abnormalities.
• Neuropsychological Tests: Assess thinking, memory, and speech skills to identify affected brain areas.

Treatment Options

Treatment for epilepsy typically starts with medication, aiming to control seizures while minimizing side effects. If medication is ineffective, surgery may be considered, particularly if:

• Seizures originate in a small, well-defined brain area.
• The area to be operated on does not interfere with vital functions like speech, motor skills, or vision.

Metro Institute of Neurosciences: Comprehensive Care

Metro Institute of Neurosciences offers several treatment options for epilepsy:

• Anti-Epileptic Drugs (AEDs): The first line of treatment to control seizures.
• Ketogenic Diet: Often used for children when AEDs are ineffective, involving strict control of fat, protein, and carbohydrates.
• Vagal Nerve Stimulation (VNS): Involves implanting devices to suppress abnormal electrical activity.
• Surgery: Recommended for individuals with uncontrolled seizures. Video-EEG monitoring and MRI help locate seizure origins for precise surgical intervention.

Complications of Epilepsy

Seizures can lead to various complications, some potentially fatal:

• Falling: Seizures can cause falls, leading to injuries.
• Drowning: Increased risk of drowning during swimming or bathing.
• Car Accidents: Seizures while driving can result in accidents.
• Pregnancy Complications: Seizures pose risks to both mother and baby, requiring careful monitoring and treatment adjustments.
• Emotional Health Issues: Depression, anxiety, and suicidal thoughts are common among epilepsy patients.

Life-Threatening Complications

• Status Epilepticus: Continuous seizure activity lasting over five minutes or frequent seizures without regaining consciousness, risking brain damage or death.
• Sudden Unexpected Death in Epilepsy (SUDEP): Some seizures impact heart or respiratory functions, leading to sudden death.

Expertise at Metro Institute of Neurosciences

Metro Institute of Neurosciences provides specialized care for epilepsy with a team of highly skilled neurosurgeons, neurologists, interventional neurologists, neuro anesthetists, and specialized nurses. They offer round-the-clock services, advanced diagnostic and therapeutic options, and comprehensive care, including presurgical evaluation and surgical treatment for patients with drug-resistant epilepsy.

Patients receive personalized care plans, including counseling, medication, physical evaluations, and psychological support. The institute is equipped with state-of-the-art facilities, including a high-end Neuro ICU and HDU, ensuring the highest standards of patient care.

Prognosis

With proper treatment, 60%–70% of epilepsy patients can achieve seizure control. Patients without identified causes of epilepsy generally have better outcomes than those with structural, metabolic, or genetic factors.

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Reviewed & Updated on 03-July-2024 by Dr. Sonia Lal Gupta, Director – Metro Group of Hospitals, Managing Director – Metro College of Health Sciences and Research, Sr. Consultant – Neurology.