Dr Ranjit Ghuliani
Epilepsy is a very broad term. A better term would be seizure disorder or convulsions, in which epilepsy is one type of seizure disorder.
There is an international body called international league against epilepsy which generally deals with all aspects of seizure disorders including definitions and management protocols.
Now the brain is a very complex organ with billions of cells called neurons and each one of them has billions of interconnections.
The method of communication between these cells – the neurons and the rest of the body- for example- muscles, organs etc is through electrical impulses which travel at great speeds.
A seizure or a convulsion occurs due to an abnormal electrical discharge in the brain. This may present as an abnormal jerky movements of the body, loss of consciousness or more subtle forms as changes in the heart rate or blood pressure etc.
There are many types of seizures with various causes.
Now seizures are broadly classified into generalized seizures- in which the whole body is involved and focal seizures in which part of the body is involved- say only the eyes and one half of the body.
The causes of seizures are many- starting from the newborn period where inadequate breathing at birth or birth asphyxia which is a common cause.
In older children and adults it may be due to genetic causes, any form of damage to the growing brain in a young child, infections- especially tuberculosis, meningitis, tape worm infection. It may be due to brain tumors, head injury, electrolyte imbalances such as low sodium levels, rare metabolic diseases and many other reasons.
Epilepsy per se is a disease where generally there is no obvious cause but there is a genetic predisposition to seizures.
Finally in children we have an innocuous condition called febrile seizures in which young children upto 5 years have a low threshold in the brain to fever and may have a seizure without any major underlying cause.
Coming to the management aspects- first of all there are set protocols for management of the acute phase i.e. the management and control of ongoing seizures. This varies with age- for example a different set of drugs are used in the newborns.
Subsequent management depends on the suspected cause – investigations are planned accordingly- whether a simple blood sugar test in hypoglycemia or neuroimaging i.e. CT Scan or MRI brain in injuries or analysis of CSF- the fluid in brain and spine for infections, an EEG, or more sophisticated genetic or metabolic tests – like I said -depending on the cause suspected.
… and finally the treatment- again depends on the cause- whether correcting the low blood sugar, low sodium levels, antibiotics for infections involving the brain, correcting the metabolic disorder, surgery for tumors or injury. Certain conditions like epilepsy will require a single or a combination drugs called anti-epileptic drugs on a long term basis.
Most of these patients do well and are cured after therapy for an appropriate period of time, some, rarely however, are more difficult to treat and require multiple drugs and or specialized surgery.
Dr Ranjit Ghuliani is Specialist in Pediatrics at Sharda Hospital
