Is it possible to prevent fits? Follow these essential measures to ensure that potential risk factors & associated conditions are kept under control.
What is epileptic fit? Epilepsy is a long-term condition, wherein there is a sudden surge of electrical activity in the brain, causing seizures or fits. These seizures can affect the whole brain (generalized) or part of the brain (focal or partial). Epilepsy, or fits, as it is commonly known as affects approximately 70 million people globally. In India itself, about 12 million persons are suffering from the condition. Over the years, various medications have been used to keep the seizures under control, which have been efficient to a considerable extent. However, in recent years, the number of drug-resistant epilepsy (DRE) has increased and is rapidly becoming a global public health problem. DRE is responsible for severe disability and at times, lifetime dependency on caregivers. Unfortunately, although over 20 new anti-epileptic drugs have been introduced, there has been minimal change in the number of DRE cases.
Signs and symptoms of an epileptic fit
We typically have known seizures/fits as uncontrollable shaking, jerky movements, spasms, collapsing on the ground, drooling, loss of consciousness, tongue biting, and bladder/bowel control loss. While these are true of some fits, in other cases, the patient may have a blank look (daydreaming appearance). Such fits, commonly called absence attacks, usually go unnoticed because the observers may assume that the person is merely gazing into space or is being inattentive.
Causes of an epileptic fit
In several cases, the cause of the attacks is unknown. There could be a hereditary component or an acquired reason. Traumatic brain injuries/head injuries are common causes of fits (sometimes temporary fits). Fits could also occur due to scars in the brain tissues after injuries. Too high fever, brain infections/tumours/cysts, stroke, other blood vessel-related abnormalities in the brain could result in epileptic attacks. Some neurological and neurodevelopmental conditions, such as Alzheimer’s disease, cerebral palsy, cerebellar disorders, etc., can also be associated with fits.
What is the diagnosis of epileptic fit?
Diagnosis is based on symptoms and investigations such as MRI and EEG. Family history of fits, the pattern of attacks, frequency of seizures, etc. all play an essential role in diagnosis and treatment. The purpose of the neurological assessments and investigations is to identify any observable cause and understand the fits' nature/type. EEG is performed to evaluate brain wave activity. If fits have occurred secondary to trauma or other conditions, the relevant radiological and blood investigations are advised to treat the seizures and the associated disease.
Epileptic fit: When should one seek medical advice?
It is prudent to seek urgent medical consultation when one experiences fit. Epilepsy is not a progressive condition per se; however, frequent attacks (especially those of high intensity) can affect daily living activities; therefore, early diagnosis and intervention are recommended. This also gives the patient and the family time to understand the condition and be prepared for subsequent attacks (if any).
How to get rid of epileptic fit: Medications and Remedies
- Anti-epileptic drugs are commonly prescribed for epilepsy. These help in reducing the number/frequency of seizures. In extreme cases, deep brain stimulation or vagus nerve stimulation procedure is performed. Likewise, surgery has also been indicated in individual patients to remove the brain's portion causing the seizures. Several herbal medications are used in non-pharmacological treatment of epilepsy, such as Brahmi ghruta, Bali tail, Bryonia alba, Lavandula stoechas, and ferula asafoetida, Coriandrum sativum, Ganoderma lucidum, among others. However, the results of such herbal treatments are variable.
- Regenerative Medicine and cell-based therapy propose using cells with neuroprotective and anti-inflammatory effects to target the pathology of epilepsy. Mesenchymal cells and growth factors can modify the diseased environment in the brain, and replenish the damaged neurons (nerve cells) and their connections, thus benefitting patients with epilepsy. Moreover, this treatment can also help manage the associated health conditions through the cells' varied functions and growth factors, thus being a holistic therapeutic modality.
What are the risk factors related to epileptic fits?
As previously mentioned, trauma, certain medications, and brain infections may be the causes of epilepsy and are also risk factors. Moreover, injudicious alcohol consumption, recreational drugs, and stress may also alter the psychological status and hormonal/chemical imbalances, increasing the risk of seizures. Likewise, family history of seizures and childhood seizures could be related to epilepsy in adulthood.
How to manage the side effects of an epileptic fit?
Management of side effects is mostly symptomatic. In some instances, the healthcare professional may change the dose or the medicine itself to reduce/eliminate the side effects. Common side effects of anti-epileptic medications are tiredness, dizziness, weight gain, gum swelling, memory issues, and decreased bone density. Vitamins and mineral supplements may also be prescribed to reduce the intensity of the side effects.
How can one prevent epileptic fits? Here are some points to remember
Epilepsy should not be considered a social stigma, and it is NOT a mental health condition. It is possible to lead an everyday life with certain lifestyle modifications, exercise, and dietary changes. While it may not be possible to prevent fits, these measures are essential to ensure that the potential risk factors and associated conditions are kept under control. A ketogenic diet, a high-fat, low-carbohydrate diet, has gained popularity in controlling seizures in some people with epilepsy. Patients who do not respond to medications have been advised ketogenic diet with variable results. It has been considered that the ketogenic diet stabilises the function of nerve cells exposed to the electrical challenges. However, the healthcare professional and dietitian should be consulted before beginning any new diet.
FAQs related to Epileptic Fits
- Do medications cause fatal epileptic fits? Drug-induced epilepsy is not uncommon. A study revealed that up to 9% of status epilepticus (multiple long-duration seizures) cases are caused by drugs or poison. However, such cases are self-limiting. Withdrawal of the offending drug leads to resolution of fits. Anti-depressants, stimulants, antihistaminics are commonly associated with drug-induced epilepsy. Nonetheless, prompt management should be initiated because although there may be no long-term sequelae, prolonged or repeated seizure activity may lead to irreversible neurological injury and other life‐threatening complications such as hypoxia, hypotension, pulmonary aspiration, etc.
- How does it feel to live with epileptic fits? Fits can be a daunting and scary experience when the attacks affect daily living activities in children. Therefore, counselling plays a significant role in creating awareness regarding the condition and pharmacological/non-pharmacological management. Participation in a particular sporting or specific high-intensity activities requires caution; however, with recent advances in therapeutics, leading an everyday life with seizures is possible. Support from family and friends go a long way in maintaining confidence in oneself.
- What is the connection between diabetes and epileptic fits? This is an area of active research. Surprisingly, patients with diabetes, especially Type 1 diabetes, are more prone to seizures. Although the exact mechanism is unknown, the possible hypotheses are microvascular lesions in the brain, local brain damage, metabolic factors, and gene mutations associated with diabetes, leading to epilepsy. Therefore, control of diabetic status through medications, diet, and lifestyle changes is essential.
- Is there any self-treatment? Unfortunately, no. It is not advisable to self medicate or attempt to control fits based on random knowledge of the condition.
Conclusion: Overall, it is essential to stay positive, practise meditation/relaxation techniques, avoid known triggers, and follow a disciplined, healthy lifestyle to gain the upper hand over epileptic fits.
[With inputs from Dr Pradeep Mahajan (Regenerative Medicine Researcher, Mumbai)]
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