Epilepsy

Epilepsy is a chronic or longstanding condition caused by abnormal electrical conductions in the brain. In its most obvious form, it is characterised by episodic loss of consciousness and repetitive jerky movements of the body. These seizures may be partial, involving only one part of the body, or they may be generalised, involving the entire body, and they may be accompanied by loss of control of bowel or bladder function.

People who get seizures can suddenly lose consciousness and collapse, wherever they are. Their limbs become stiff and the "fit" is characterised by sharp, shaky movements.

Types of seizure:

  1. Grand-mal seizures
    Grand-mal seizures (also called "tonic-clonic" seizures) are the most common type of generalised seizure. Generalised seizures affect all or most of the brain. The person will lose consciousness and won't remember what happened. During the tonic phase of an epileptic attack, the person may lose consciousness, have stiff muscles, which can make them lose their balance and fall to the ground, cry out, or bite their tongue or cheek. During the clonic phase they may have jerking muscles, lose bladder or bowel control, or become very pale. The epileptic attack (also called the ictal phase) is usually preceded by a phase in which the person feels unhappy and fearful, and may experience unusual sensory events, such as the perception of a strange light, or an unpleasant smell. This period just before the attack is also called the pre-ictal phase. After the attack (the post-ictal phase) the person often feels drowsy and confused and may have a headache.
  2. Petit-mal seizures:
    Petit-mal seizures (also called "absence" seizures) happen mainly in childhood. This kind of seizure doesn't involve falling down or having involuntary jerking movements. Instead, the person may lose awareness, look blank and their eyelids might flutter. They may look as if they're daydreaming. Common between the ages of five and nine years, petit-mal seizures may disappear in adolescence, giving way to grand-mal seizures.

    3. Attitudes towards epilepsy:

    People have different views about epilepsy. For example, there is a traditional belief that epilepsy is a form of insanity, caused by supernatural forces or possession by evil spirits. There is also a belief that epilepsy is contagious. Such beliefs are not supported by evidence and can result in negative (prejudiced) attitudes towards those who have epileptic seizures, increasing their social isolation and limiting their access to treatment.

    Causes of epilepsy:

    Mostly there is no known cause of epilepsy and this is called idiopathic epilepsy. But sometimes the reason epilepsy develops is clear. It could be because of a severe blow to the head, a stroke, or an infection of the brain such as meningitis. Epilepsy with a known cause is called symptomatic epilepsy. Epilepsy can also be caused by drug and alcohol misuse, by conditions that affect the structure of the brain, such as cerebral palsy, by birth defects or by problems during birth which cause a baby to be deprived of oxygen (such as the umbilical cord getting twisted, or compressed during labour).

    Sometimes children below five years of age can have a seizure when they have a high fever. This is called febrile seizure. If epilepsy occurs for the first time after the age of 20 years, it is usually symptomatic epilepsy, due to detectable brain damage such as a scar or healed wound in the brain, bleeding inside the brain, or damage because of long-term, excessive use of alcohol. The diagnosis of epilepsy is mainly based on the description of the seizure given by the person themselves and any eye witness accounts.

    Emergency treatment for epilepsy:

    Epilepsy is not usually a life-threatening condition. However, a small number of people die from epilepsy each year, usually as a result of accidents or status epilepticus (severe form of epilepsy). In this section you will learn what you can do if you come across someone during a seizure.

    The best response to a seizure attack is simply to prevent the person from self-injury by moving them away from dangerous sharp edges, placing a soft pillow under their head, and carefully rolling the person into the safe lateral position. To prevent injury, objects should not be placed in the person's mouth during the seizure.

    It is also important not to light matches, give the person anything to drink, or to try to stop the fit by force or by holding them tight. If a seizure lasts longer than five minutes (or the seizures begin to come in "waves" one after the other), this may be a sign of status epilepticus.

    Although rare, status epilepticus is a serious medical emergency characterised by two or more seizures occurring in succession without the person regaining consciousness. Individuals with status epilepticus can be helped by being put in the safe lateral position, by checking blood pressure frequently, and by referring them urgently to the nearest general hospital, accompanied by a close relative or yourself.

    Drug treatment of epilepsy:

    Although there is no cure for epilepsy, it is treatable and can be controlled with regular medication. Symptoms can usually be controlled using a class of medication known as antiepileptic drugs (AED). AEDs do not cure epilepsy, but they do prevent seizures from occurring. It is also important that you emphasise the importance of adherence to treatment.

    Advise the person (and their family) that they should never suddenly stop taking an AED because doing so could cause a new seizure. While taking AEDs, they should not take any other medicines, including traditional medicines, without consulting a doctor. This is because other medicines could cause a dangerous interaction with their AED and cause a seizure.

    Dementia

    Dementia is a common problem which, like epilepsy, is related to problems with the functioning of the brain. People with dementia commonly experience problems with memory and the skills needed to carry out everyday activities. Most cases of dementia are caused by damage to the structure of the brain, leading to the death of brain cells.

    Although it can occur at any age, dementia is more common in older people (but it is not part of normal ageing). The older people get the more likely they are to develop dementia. Dementia usually gets worse slowly, often over many years, and may mean that the person affected can no longer live independently. The disease therefore affects both people who develop dementia and the people who care for them. It can shorten people's lives and is an important cause of disability.

    Useful questions for assessing dementia:

    Questions to ask the family or friends:

    • When did you first notice a problem?.
    • How did the illness start? Does the person have problems remembering things?.
    • Does the person have difficulty in everyday activities such as eating, bathing and using the toilet?.
    • Do they behave in an odd manner?.
    • Have they seemed sad or lost interest in daily life?.

    Questions to ask the person with memory problems:

    In the following, you should award each correct answer with a mark. If a person answers less than six questions correctly then there is a possibility that they have dementia and should be referred for assessment.

    • How old are you?
    • What time is it now?
    • Which woreda do you live in? (kebele, and village and address)
    • What is the month and year?
    • What is the name of the health institution or home address you are at?
    • Do you recognise the people around you?
    • Do you know when you were born?
    • When did the current Ethiopian government win the first election?
    • Who is the prime minister of Ethiopia?
    • Name the days of the week backwards.

    Treatment for dementia:

    Memory loss cannot be reversed, but you can minimise suffering in people affected by dementia by using these tips. There are no medical treatments that reverse the effects of dementia. Drug treatment can, however, help manage some symptoms and improve the lives of people with dementia and their families. Drugs can be used in people with dementia to treat:

    • Cognitive symptoms (symptoms that affect thinking and reasoning)
    • Behavioural symptoms (symptoms that affect behaviour)
    • Depression, anxiety and sleep problems.

    Ways to support a person with dementia and their family or carers:

    • Provide information about dementia using simple, clear language.
    • Ensure that the family know enough to keep the person safe, and provide help with their daily needs.
    • Emphasise that the person should keep active, taking exercise, doing things that they like doing, e.g. seeing friends.
    • Explain how the family can help to keep the person in touch with reality, e.g. by saying what day it is, talking about family.
    • Discuss what help the person needs with washing, dressing and eating, but make sure they can still play an active role for themselves.
    • Listen actively and with sympathy to the concerns of the person and their family/ carer: both may have fears about how the illness will affect their lives.
    • Discuss with the family how they will cope with caring for the person with dementia.
    • Can someone outside the immediate family take over the caring sometimes, to give them a short time away from the responsibilities of caring?.
Last modified: Tuesday, 28 February 2017, 7:00 PM