Monday, January 4, 2016

Consequences of having repeated seizures

What are the consequences of having seizures? 
Single most important issue is safety, ie physical injuries related to seizures. Seizures occur suddenly without any warning in majority of patients. Even if some patients get a warning (aura), seizures progress to next phase (falling down, loss of consciousness, convulsions, etc) before they can act to protect themselves. Injuries during seizures are more common than recognized. If the person is operating heavy machinery or driving vehicles or he/she is in a precarious situations (like in swimming pool, bath tub, near fire, climbing heights, etc.) when they get seizures, the consequences could be worse. There are many cases of serious bodily harm or fatalities reported due to seizures occurring in such situations.

Can seizure per se cause brain damage?
Yes and no, depends on the seizure type (epilepsy type). For example, a 5 year old child who have had brief (< 30 seconds) seizures once in 6-12 months, with twitching of face and one arm but remaining conscious and aware of the surroundings during seizures, there has been no brain damage known to occur because of these seizures. On the other hand, prolonged seizures lasting for more than 20-30 minutes with convulsive (limb jerking) movements per se can cause damage to brain and other organs unrelated to physical injury if not treated promptly. Its not always, seizure duration and frequency but the overall circumstances and the type of seizures that determine the answer to this question.

Can you predict who will develop prolonged seizures?
No. Though, seizures in most cases stop by themselves in 1-3 minutes without any intervention, in most cases, there is no way of predicting which of the seizures is going to last longer, in a given patient. But seizures in some patients are always prolonged attacks requiring emergency medication(s) to stop seizing during each seizure. Some patients who have always had brief seizures (<30 seconds) can suddenly have a prolonged seizure without any apparent reason. So, there is always an element of uncertainty in daily life of patients with uncontrolled epilepsy. Having said that there are certain high risk factors predisposing to long seizures. Risk factors are past history of having a prolonged seizures (status epilepticus), poor compliance with medications, alcohol intake and sleep deprivation.

Can uncontrolled seizures cause more seizures?
Yes, seizures beget seizures, ie, by having uncontrolled seizures over a course of time (months to years) can cause more seizures. This is due the fact that uncontrolled seizure focus in one part of the brain  can cause permanent changes in the brain network so that other parts of the brain develops spontaneous seizures. This is just due to the bad company! Thus earlier you treat seizures better it is for long term seizure control and the more effective you treat seizure better it gets in the long run.

What is the impact of seizures on the young child's brain?
Developing young brain is vulnerable to damage due to ongoing seizures. Constant "electrical storm" in the brain (related to frequent uncontrolled seizures) can lead to widespread damage to brain networks  and can adversely affect child's normal cognitive development. This results in learning difficulties, difficult behaviors, autism and low IQ. To make things worse, medications prescribed to treat seizures by themselves, especially if three or more medications are used together, cause problems in the developing brain. This is one of the very important aspect of epilepsy treatment not understood by many.

What are the social aspects of having epilepsy?
It is felt to be embarrassing to have a seizure in front of strangers and in social situations. This is mainly due to the social stigma attached to seizures/epilepsy. This leads to modified behavior on part of the patients/families leading to major curtailment of many social activities, avoiding social gatherings and outdoor play. Many children having daily seizures in India do not attend school for various reasons, severely affecting their learning and future employment opportunities. Teenagers and young adults feel socially isolated as they can not participate in outdoor activities as their peers. Patients with epilepsy can not afford to be awake late at nights (seizure trigger) or on online at nights, curtailing their social life. Patients with epilepsy are automatically debarred from certain professions even if they are well controlled, like commercial drivers, pilots, armed forces, operating heavy machinery, etc. Stigma related to employment, marriage and child bearing is a topic in itself. 

I will discuss treatment options in subsequent posts!

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