Epilepsy

[Mujtaba Ali]

Dear Friends,

I was diagnosed grandmal epilepsy in 1983 at the age of 11 years. Since, my off & on seizures history linked with ups and down of life. Today, I am on the way to search out treatment possibilities mostly in neurological diseases in Karachi, Pakistan.

5 yrs back, I was unexpectedly offered a job as Medical Assistant/Transcription by my neurologist. To begin a career in this field, I take interest in learning neurology. After practicing and studying patients histories, I would like to highlight my observations little differently compare to articles published before.

Epilepsy is a brain disorder characterized by recurring seizures or fits. It may manifest as a generalized seizure in which the whole body is affected, or as a partial seizure, which may affect a certain part of the body only. There are various types of seizures caused by sudden flurries of electrochemical activity in the brain, which disrupt the ‘conversation’ between neurons due to weak or unhealthy.

During seizure sudden temporary loss of awareness or consciousness, and the disturbance of movements, sensations mood or mental function occur. The patient may become incontinent, may vomit or froth at the mouth and bite his/her tongue during a seizure. The seizure may be preceded by a variety of symptoms such as flashing lights, visual & auditory hallucinations usually a warning sign called ‘aura’.

The cause, type and frequency of seizures will vary from person to person. The impact of the seizures will also depend on the lifestyle of each individual. For some people, epilepsy may have little effect on their lifestyle. For other people, even a few seizures may mean that risks have to be considered and changes have to be made.

If you have been diagnosed with epilepsy, it is important that you understand what this means and why the diagnosis has been made. Choose a doctor who you are comfortable talking to. You should feel you could discuss any concerns freely, so that you can work together to find a treatment program that suits you. If you understand your epilepsy you will also be able to make informed decisions about your lifestyle.

Generally, people are unaware that stress is a known seizure trigger, and regular exercise is a highly recommended way to manage stress. Some people with epilepsy avoid exercise because they are afraid they will have a seizure during the activity. The heavy breathing associated with exercise stops the build-up of carbon dioxide in the blood (hypercapnea). The release of ‘feel good’ brain chemicals (neurotransmitters) during exercise may calm the brain. The benefit of regular exercise, such as improved fitness and wellbeing, may contribute to a reduce seizure risk. It is important to exercise sensibly. You could trigger a seizure minutes or hours after exercise if you unnecessarily strain your body. If you are feeling very hot and tired, slow down or stop. I often asked diagnosed patients about doing jogging and girls to skipping. Both activities are not present.

Ketogenic diet is known useful for epilepsy. Before discussing antiepileptic drugs (AED), I would like to share briefly my own epilepsy and experience during the period.

I always take advantages and disadvantages for better management. After reviewing my life and fit free period nearly 5 years, I was on monotherapy, using ketogenic diet, and regular to my job where physical activity is the part of daily life. I was calm, satisfied with my life, and do my study when I was resident in the foreign country.

Presently, I am trying my best to establish epilepsy society in my city with hope that efforts not go in vein. Sometimes, social challenges cause me losing a better job due to not driving. Working hard and thinks in trying to manage possibilities somehow. All these factors of life sometimes cause me a seizure in depression Since begin an exercise, I note gap between seizures but still on medicines due to remaining time period.

In Pakistan, neurologists don’t have a concept of monotherapy and/or to discontinue medicines on time. Dose increases due to their frequency and patients often use nearly all AED. As time goes, some psychological symptoms also come in their behavior.

Usually, people and organizations often focus highly educated and experience neurologists for epilepsy. Whether they do have any strategy to improve lifestyle or not, instead doing consultation for a limited time. Also, no such NGO working to gather epileptic patient’s and try to convey awareness and manage their behavior in my knowledge. So, there is less possibilities to manage epilepsy.

Discussing about first line and second line drugs, no one can deny that patient’s rehabilitate in the past and it is not a life long disorder. We accept that new drugs contains less side effects compare to old one, but no such AED is guarantee for the solution without changing pleasant environment. I found in histories; if AED not discontinue sensibly in a normal fit free time period, there is always a risk of seizure once again.

As I mentioned some facts above, other major disadvantages are:

1- Patient often feels alone.
2- Sometimes, un standard medicines and interactions.
3- Disturbance of activities.
4- Losing school, job, and life partner.

This topic is vast to explain in more detail. However, I prefer people to manage their lifestyle in a friendly company; take your medicine on time, and manage your activities regularly without any burden. Consult your physician or health professional who sincerely would like to discontinue your AED in a normal time period.

It is not necessary that all of you agree with me. Know your AED side effects which interfere in activities. I welcome your proposals and would like to say in end ‘success is the game of mind and you can come out of it’. Take care.

Mujtaba Ali
Diplomate in Epilepsy &
Behavior Management