Overview

What is a Seizure?

A seizure is an abnormal electrical discharge of a group of brain cells. Seizures can produce a variety of symptoms, depending on the location of the seizure focus and the spread of the electrical activity through the brain.

What is Epilepsy?

A person has epilepsy when he/she has more than 1 episode of epileptic seizures.

What is Status Epilepticus?

Status Epilepticus is a condition when a person has:

• continuous seizures for more than 5 to 10 minutes; or
• seizures on and off, each lasting less than 5 minutes, but without regaining consciousness in between seizures.

Status Epilepticus is a medical emergency. When the person has Status Epilepticus, he needs to be send to the hospital immediately.

Causes

People with the following conditions can have epilepsy:

• Brain injury
• Brain infection
• Brain tumour
• Stroke
• Genetic susceptibility

In approximately half the cases, a cause cannot be found.

Symptoms

There are 2 main types of seizures:

Focal Seizures

• Affect one part of the body
• Sensory, motor or visual disturbances
• May remain conscious throughout
• Can also lead to loss of consciousness

Generalised Seizures

• Start as a focal seizure and spread throughout the whole brain
• Loss of consciousness usually between 30 seconds to 5 minutes
• General muscle contraction
• Violent rhythmic muscle relaxation and contraction lasting 1 to 2 minutes
• May exhibit tongue biting, incontinence, difficulty in breathing

Triggers of Seizures

The following conditions can trigger a seizure:

• Forgetting to take medication
• Stress
• Lack of sleep
• Menstruation
• Concurrent Infection like flu or fever

Diagnosis

Epilepsy is diagnosed based on the information of events that happened during the attack, obtained from the patient and/or observers of the events. The doctor may also order a few investigations:

1. Electroencephalogram (EEG)

This test is done to record the electrical activity of the brain and will take about 45 minutes to 1 hour. During the test, many electrodes are attached to the patient's head. The patient will also be asked to perform a few tasks to see if these activities activate epileptic seizures.

2. Brain Scans

Computerised Tomography (CT Scan)
This scan uses computerised X-ray technology to produce pictures of the brain and may reveal structural causes of seizures.

Magnetic Resonance Imaging (MRI)
This is scanning of the brain using a strong magnetic field, instead of X-rays. It is more sensitive in picking up subtle structural abnormality that could be the cause of epilepsy. People who had operations with metal implants inserted are not suitable for this test because of the strong magnetic field.

Treatment Options

1. Medical Treatment

Anti-epileptic Medications
Medications are usually the first-line of treatment. There are many types of anti-epileptic medications available. The patient may be taking more than one type of anti-epileptic medication, depending on the type of seizure he has.

2. Surgical Treatment

Brain Surgery
Patients with focal seizures not responding to anti-epileptic medication might be suitable candidates for surgery depending on where their seizures originate. For those patients without a clear cut resectable lesion, vagal nerve stimulation can be considered.

Side Effects of Medications

Common side effects include:

• Sleepiness
• Dizziness
• Tiredness

Less common side effects include:

• Hand tremor
• Hair loss
• Blurring of vision
• Weight gain

What to Do When Someone is having a Seizure

DO

• Remain calm
• Protect the person from harm
• Turn the person to the side
• Observe the type and duration of seizure

DO NOT

• Restrain the person unless there is danger
• Put anything in the mouth
• Crowd around the person

Prevention

Prevent a seizure from recurring by:

• remember to take anti-epileptic medications
• having sufficient sleep
• learning to relax
• avoiding alcohol

Avoid

• swimming alone/in the sea
• climbing to high places
• playing computer/electronic games for long duration
• bathing in a bathtub
• cooking alone/with open fire

Keeping a seizure diary is useful to:

• record the number of seizures
• evaluate efficacy of medications
• allow the doctor to titrate the medications

Where to go for Support
For many people, it is the lack of knowledge about epilepsy that causes a lot of problems. The Singapore Epilepsy Foundation is set up to provide support for epilepsy patients and carers, and increase awareness about epilepsy to the public.

Contact Information
Singapore Epilepsy Foundation
Tel: (65) 6334 4302
Website: www.epilepsy.com.sg