Normally, brain cells communicate with each other through electrical impulses that work together to control the body's movements and keep the body's organs functioning properly. When thousands to millions of electrical impulses occur at the same time producing abnormal brain electrical activity, the result can be a seizure.

Some people have seizures that last a short time and cause them to stare off into space, giving the appearance that the person is simply daydreaming. Others may experience a more dramatic seizure (tonic-clonic seizure) where the person loses consciousness and the entire body stiffens and then twitches or jerks uncontrollably.

It is not contagious, and it is not a mental illness. Most forms of epilepsy are not inherited, but it may run in some families.

While there is, as yet, no cure for epilepsy, today's treatment options can control most cases. In fact, many people with epilepsy lead normal life and have no symptoms between seizures. The aim of treatment is to stop the seizures.

Symptoms

The medical community classifies epileptic seizures into two major categories: partial and generalized.

Partial seizures: If the abnormal electrical activity involves one area of the brain, the seizure is partial. The person may not lose consciousness, but can experience a range of symptoms: sudden jerk movements of one part of the body, such as an arm or leg; sudden fear; facial movements; disturbances or hallucinations of vision, hearing, or smell; nausea, vomiting or stomach discomfort.

Some types of partial seizures (called complex partial seizures) may cause the person to have a change of consciousness. They may be dazed and confused, unaware of where they are or what they are doing. They may wander around randomly, mumble, and behave in unusual ways. They may exhibit chewing or repetitive arm and hand movements. Moreover, people with this type of seizure will not remember what they have experienced.

Generalised seizures: When the entire brain is involved, the seizure is generalised. Like partial seizures, there are many different symptoms, body movements, and activities. Some people stare off into space, while others may have full convulsion with the complete loss of consciousness and jerking movements of limbs (tonic-clonic seizures).

Just before having seizures, some people experience an aura, which is a sensation or warning of a coming seizure. Some people feel a sense of tension or anxiety, may hear a musical sound, sense an odor or taste, or experience some other change in sensation. Often this aura gives the person time to get to a safe place to avoid injury.

What causes epilepsy?

There is no single cause of epilepsy, and in 70 percent of cases, no known cause is ever found.

Some of the known cause of epilepsy are:

• Injury to the brain before, during, or after birth.
• Infections that damage the brain.
• Injury and lack of oxygen to the brain.
• Disturbance in blood circulation to the brain (stroke & other vascular problems).
• Metabolism or nutrition imbalance.
• Tumors of the brain.
• Heredity disease affecting the brain.
• High fever.
• Other degenerative diseases.

Treatment

Most major epileptic seizures (generalised or tonic-clonic) last only a minute or two and demand little of the bystander. All that is necessary is to let seizure run its course and to ensure that the person is in no physical danger and can breathe.

However, a person who experiences repeated seizures and does not recover consciousness between attacks should get immediate medical attention. This type of repeated seizure medical attention. This type of repeated seizure is called status epilepticus. This is life threatening, and could also cause brain damage.

First aid

The goal of first aid is to keep the person safe:

• Keep calm, help the person to the floor, and loosen clothing around the neck
• Remove sharp or hot objects that could injure
• Turn the person on one side so saliva can flow out of the mouth
• Place a cushion such as a folded coat under the head
• Do not put anything into the person's mouth
• After the seizure, allow the person to rest or sleep if necessary

Some people will be confused or weak after a seizure. They need help getting home

Contact the parent or guardian if a child had the seizure

The most common treatment of epilepsy is daily use of anti-convulsant drugs, which allow many people with epilepsy to enjoy a healthy life and continue normal activities. The drugs prescribed alone or in combination, are adjusted over time until the best combination is found for each person. Many people with epilepsy must take their anti-convulsant drugs for the rest of their lives to prevent further seizures. However, the doctor may advise a slow withdrawal of the drug if a person has had no seizures for several years.

Those for whom anti-convulsant drugs fail to control the seizure, surgery to remove injured brain tissue maybe possible. A thorough evaluation including the recording of a seizure with EEG, video and neuropsychological testing is performed to determine surgical candidacy. Other surgical techniques are being developed that offer new hope to people with uncontrollable epilepsy.

Epilepsy treatment should include discussions about the physical (e.g. side-effects), social, and emotional problems that can accompany the disorder. These discussions should involve family and individual counseling and education. In addition, information about epilepsy should be shared with schools, employers, and friends. Women with epilepsy should seek medical counseling prior to and during pregnancy. Some countries or state regulations mandate that person suffer altered consciousness due to a seizure abstain from driving a motor vehicle for a specific period thereafter.

The writer is a Consultant Neurologist of Apollo Hospitals, Dhaka.