“Are you having seizures or do you have epilepsy? Explore all your options”

What is seizure?

A seizure is the physical findings or changes in behavior that occur after an episode of abnormal electrical activity in the brain. Seizure is a sudden, uncontrolled electrical disturbance in the brain that can cause changes in behavior, movements, emotions, and level of consciousness. When a person has multiple seizures, they are said to have epilepsy.The brain cells either excite or inhibit other brain cells from sending messages. Usually, there is a balance of cells that excite and those that inhibit these messages.

However, when a seizure occurs, there may be too much or too little activity causing an imbalance between exciting and inhibiting these activities – thus an abnormal electrical signaling in the brain.Seizures are not a disease in themselves; instead they are a symptom of many different disorders that can affect the brain.There are different types of seizures depending on its manifestations, cause and location in the brain. Depending on the seizure type, the medication, response to treatment, and long term outcome may be different.If you have seizures, does it mean you are epileptic?Epilepsy is a chronic disorder characterized by recurrent, unprovoked seizures.

A person is diagnosed with epilepsy if they have recurrent unprovoked seizures that are not caused by some known conditions.“All epilepsy is seizure but not all seizures are epilepsy”This statement is true; however, a seizure occurring and lasting for about 5 minutes is term ‘status epilepticus’- a medical emergency. Status epilepticus can also be regarded as seizures occurring before full recovery from the previous episode.Public (traditional and religious) perception of seizure and epilepsy.

Epilepsy is one of the most stigmatized disorders. Stigmas and negative attitudes associated with epilepsy are due to poor public awareness and knowledge. In Africa, persons with epilepsy are shunned and discriminated against in education, employment and marriage because epilepsy is often perceived as a shameful disease.

Epilepsy is also traditionally looked on as a curse by the ancestral spirits or attributed to possession by evil spirit, witchcraft and poisoning, and often thought to be highly contagious.Get help (Explore all options)The foundation to proper management of seizures is the correct diagnosis of the seizure type. As part of the basic diagnostic tool for seizure are; electroencephalography (EEG), Computed tomography (CT) scan, brain magnetic resonance imaging (brain MRI), Positron emission tomography (PET), and single photon emission computed tomography (SPECT).These tests must be done in a center experienced in the diagnosis and management of epilepsy.Electroencephalography (EEG)Monitoring of electrical signals in the brain with electrodes attached to the scalp. Abnormal electrical signals are captured by these electrodes and represented graphically, which is read and interpreted by the attending neurologist.

EEG studies however, can be either routine or a long term monitoring (LTM). Routine EEG is conducted within 30-60 mins or as requested by the neurologist but if a routine EEG is normal, diagnosing seizure may require a stay in an epilepsy monitoring unit (EMU) for continuous video EEG monitoring over several days.These tests are all available at the Regions Stroke and Neuroscience Hospital, Imo State.Radiological testing: some seizures and epilepsies are due to irregularities within the brain tissues, such as scars, tumors, or other lesions that can show up on radiologic imaging. Some of these issues can then be treated by epilepsy surgery. Radiologic tests include;Brain Magnetic Resonance Imaging (brain MRI), Computed Tomography (CT) scan, Positron Emission Tomography (PET), and Single Photon Emission Computed Tomography (SPECT).

Treatment Options
An accurate diagnosis of seizure type informs the best treatment option for the seizure type. However, the treatment options available include;
These includes anti-epileptic drugs (AEDs) of which several options exist but the goal is to find he mediation appropriate for a specific seizure type with minimal side effects. Also depending on the diagnostic report, patient may be placed on a combination of AEDs by the attending neurologist. Response to treatment depends on the correct diagnosis of the type of seizure. This will guide medication selection. If you don’t choose the correct medication, te outcome and response won’t be good. Diagnosis of seizure type and medication selection may involve monitoring in an epilepsy monitoring unit (EMU) using continuous video EEG. This is available at Regions Stroke and Neuroscience Hospital.

Surgery and other therapies
If AEDs are not effective in controlling the seizures, other treatment options include;
Surgery – an epilepsy surgery can be done to resolve the seizure ad stop it from happening. The surgeons locate and remove the area of the brain where the seizure begins.

Vagus Nerve Stimulation (VNS) – a device implanted underneath the skin of the chest stimulates he vagus nerve in the neck, sends signals to the brain that inhibit seizures. Medications may still be needed even with the VNS implant.
Deep brain stimulation (DBS) – doctors implant electrodes within certain areas of the brain to produce electrical impulses that regulate abnormal brain activity. The electrodes are attached to a pacemaker like device placed under the skin of the chest which controls the amount of stimulation produced.
Responsive Neurostimulation – a device is implanted in the surface of the brain or within brain tissues can detect seizure activity and deliver an electrical stimulation to the detected area to stop the seizure.

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