Treatment of Fit

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The child stared into space grimacing at bystanders. “Stop it,” said the mother, embarrassed by the responses her actions evoked. But the child ignored her, then blinked and followed her obediently. Nobody realised that the little girl had just suffered a fit of atypical epileptic seizure.

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In classical epilepsy, typically, there is a cry followed by rolling up of the eyes and uncontrolled repetitive thrashing of the arms and legs. It usually lasts a few minutes after which the person falls to the ground. There may be no recollection of the event later.

To the untutored bystander, it may appear that the person has lost control of his or her body and been possessed by some “demonic force”. This is why the illness is called epilepsy, from the Greek word “seized”. But epilepsy actually occurs because of sudden unregulated rapid electrical discharges in the brain. It has nothing to do with demons, and exorcism will not help.

All seizures are not the same. Only one half the body, or even just a part — like the arms or face — may be affected. The rapid movements may resemble an uncontrolled tic or twitch. A sudden temporary interruption in the electrical pathways may affect consciousness, awareness, movements or bodily posture. This can result in unfocused staring (absence attacks), or “feelings” of jamais vu (unreality) or déjà vu (familiarity), or disturbances in vision, hearing and balance. In children, the seizures may be even more atypical. The child may just stare inattentively and blankly for a few minutes, suddenly fall forward, or start nodding.

About 2 per cent of adults have a seizure at some time in their life. Often, it is a one-off occurrence. Children are more prone to seizures, particularly when the temperature rises. Such “febrile seizures” occur during an episode of fever, in 3 to 4 per cent of otherwise normal children from the age of nine months to five years. This may recur three or four times during subsequent episodes of fever.

A person is labelled as suffering from a seizure disorder or is an “epileptic” if there have been two or more episodes in the preceding six months, without an obvious precipitating cause. Seizures can occur if:

There is a genetic predisposition (around 30 per cent of epileptics have a close relative with seizures)

The brain structure is abnormal, producing alterations in the electrical pathway. These may be developmental or acquired as a result of trauma or surgery

The person has infections of the brain like encephalitis, meningitis or abscess

There are brain tumours

There is excessive alcohol consumption or sudden withdrawal

The person uses illegal recreational drugs

There are biochemical abnormalities like low blood sugars and other metabolic or electrolyte imbalances

There are disturbances in the blood supply to the brain.

The condition may also be precipitated by physical factors such as flickering lights, sleep deprivation or music.

Seizures are investigated with blood tests, electroencephalogram (EEG), computed tomography (CT) scan and / or magnetic resonance imaging (MRI).

Seizure disorders require regular treatment with medications. These have negligible side effects and most can be taken safely during pregnancy as well. With the patient’s compliance, and correct and adequate medication, seizures are well controlled in 75 per cent of sufferers.

After regular treatment for three to five years, the medications are usually tapered off under supervision. Medication should never be abruptly discontinued or doses missed.

People with seizures can lead normal lives. Their academic performance need not suffer if the disease is managed well. However, driving, operating heavy machinery or working in areas with loud music or flickering lights should be avoided.

In women with epilepsy, fluctuating levels of natural hormones during the course of a normal menstrual cycle can cause an increase in the incidence and frequency of epileptic attacks premenstrually. Fertility is not affected by seizures.

Seizure medications (with the exception of sodium valporate) reduce the efficacy of oral contraceptives. Women with epilepsy who wish to practise contraception need a combination pill containing at least 50 mg of oestrogen. But instead of these higher dose pills, barrier contraception — such as condoms and diaphragms, or an IUCD (intra uterine contraceptive device like copper T) — may be a better option.

During pregnancy, good seizure control should be achieved for the safety of both the baby and mother. The overall risk of birth defects in epileptic women is around 7 per cent as against 3 per cent in the general population. If a woman is planning to become pregnant, she should immediately start folic acid supplements (5mg a day). Folic acid has a protective effect on the baby’s brain and spinal cord development in the first 40 days after conception.

Epilepsy is not a contraindication to breast-feeding, although small amounts of medication do cross over to breast milk. Epileptics can lead normal and productive lives if the condition is adequately controlled with proper medication.

Source:This article is written by Gita Mathai & published in the Telegraph (Kolkata, India)

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