Epilepsy

Epilepsy

1. Definition
Epilepsy is a chronic neurological disorder in which the brain produces recurrent, unprovoked seizures. It is a common condition that can affect anyone and often interferes with daily activities and learning.

2. Synonyms

• Seizure disorder – used when the focus is on the occurrence of seizures.
• Convulsive disorder – emphasizes the motor component of many seizures.
• Epileptic fits – a traditional term still heard in lay conversation.

3. Causes / Etiology

• Genetic predisposition – mutations in ion‑channel or neurotransmitter‑related genes may be inherited; families often show a pattern of epilepsy.
• Structural brain lesions – tumors, cortical dysplasia, scar tissue from previous injury or infection can create a focus for abnormal firing.
• Metabolic disturbances – hypoglycaemia, hyponatraemia, renal or hepatic failure alter neuronal excitability.
• Infections – meningitis, encephalitis, neurocysticercosis produce inflammation and scarring that predispose to seizures.
• Head trauma – a blow to the head can damage cortical neurons and set up an epileptogenic focus.
• Perinatal insults – birth asphyxia or intracranial haemorrhage in the newborn period may lead to later epilepsy.
• Alcohol or drug withdrawal – abrupt cessation of depressant substances can precipitate seizures in susceptible individuals.

4. Types / Classification

Generalized seizures – involve both cerebral hemispheres from the start.

• Absence (petit‑mal) – brief staring spells, 3–10 seconds, no post‑ictal confusion; often triggered by hyperventilation.
• Myoclonic – sudden, brief jerks of a muscle group; may occur in clusters.
• Tonic‑clonic (grand‑mal) – loss of consciousness, stiffening followed by rhythmic jerking; lasts 1–3 minutes, followed by a post‑ictal sleepiness.
• Atonic – sudden loss of muscle tone, leading to falls; usually brief.

Focal (partial) seizures – start in a limited area of cortex.

• Simple focal – consciousness is retained; symptoms depend on region (e.g., visual hallucinations if occipital lobe involved).
• Complex focal – impaired awareness; automatisms such as lip‑smacking or picking motions may appear.
• Focal to bilateral tonic‑clonic – seizure spreads to involve both hemispheres, ending as a generalized tonic‑clonic attack.

Status epilepticus – a seizure lasting more than 5 minutes or repeated seizures without full recovery; it can be acute (e.g., after head injury) or chronic (in refractory epilepsy).

5. Pathophysiology / Pathology

1. Neurons normally fire in a balanced excitatory‑inhibitory pattern.
2. In epilepsy, this balance is disturbed – either excess excitatory neurotransmitters (glutamate) or deficient inhibitory neurotransmitters (GABA).
3. Faulty ion channels (sodium, potassium, calcium) allow abnormal depolarisation and rapid spread of electrical activity.
4. The abnormal discharge propagates through neuronal networks, producing the clinical seizure.
5. Repeated discharges may cause neuronal loss and gliosis, which further lower the seizure threshold.

6. Clinical Features

General features – sudden, involuntary movements, loss of consciousness, staring, automatisms, tongue biting, urinary incontinence.

Specific features – aura (a warning sensation such as smell, taste, or déjà vu), post‑ictal confusion, fatigue, headache.

Acute features – convulsions, respiratory compromise, injury from falls.

Chronic features – learning difficulties, psychosocial stress, mood disorders, reduced quality of life.

7. Complications

Acute – traumatic injury, aspiration pneumonia, metabolic derangement, status epilepticus (life‑threatening).

Chronic – cognitive decline, psychiatric co‑morbidities, social stigma, sudden unexpected death in epilepsy (SUDEP). Early control of seizures reduces these risks.

8. Investigations / Diagnosis

• Electroencephalogram (EEG) – records abnormal spike‑and‑wave patterns; helps classify seizure type.
• Neuro‑imaging (MRI preferred, CT if MRI unavailable) – detects structural lesions, tumors, vascular malformations.
• Blood investigations – glucose, electrolytes, liver and renal function, serum calcium, magnesium, and drug levels to rule out metabolic causes.
• Lumbar puncture – indicated when infection (meningitis/encephalitis) is suspected.

9. Differential Diagnosis

• Syncope – brief loss of consciousness without tonic‑clonic movements; recovery is rapid and no post‑ictal confusion.
• Migraine with aura – visual or sensory disturbances precede headache; no convulsive activity.
• Psychogenic non‑epileptic seizures – movements are often prolonged, variable, and lack EEG correlates; may be linked to emotional stress.

10. Management / Treatment

General management – educate patient and family about seizure safety, avoid driving or operating heavy machinery until seizure‑free for a prescribed period, maintain a seizure diary, and ensure a safe environment (padded corners, helmets if needed).

Modern medicine treatment –

• First‑line antiepileptic drugs (AEDs) such as carbamazepine, valproate, levetiracetam, or lamotrigine are chosen according to seizure type.
• Dose is titrated slowly to achieve seizure freedom with minimal side effects.
• In refractory cases, options include poly‑therapy, ketogenic diet, vagus‑nerve stimulation, or epilepsy surgery.

Diet and lifestyle advice –

• Adequate sleep (7–9 hours) and regular sleep‑wake cycles reduce seizure frequency.
• Limit alcohol, caffeine, and recreational drugs as they may lower seizure threshold.
• Encourage stress‑reduction techniques (yoga, meditation) because stress is a common trigger.

11. Homeopathic Therapeutics

Remedy 1 – Absinthium

• Causation: exposure to strong spirits or sudden fright.
• Characteristic symptoms: sudden jerking movements, convulsions with a feeling of being “drunk”.
• Modalities: worse from heat, better in cool fresh air.
• Mental state: anxious, restless, fearful of being alone.
• Thirst/appetite: great thirst for cold water, appetite poor.
• Discharges: scant, thin urine; occasional nasal discharge.
• Physical generals: trembling limbs, cold extremities.
• Constitution: young adult, nervous temperament, prone to over‑excitement.
• How it helps: restores balance of neuronal excitability by calming the over‑stimulated nervous system.

Remedy 2 – Belladonna

• Causation: head injury, sudden fright, fever.
• Characteristic symptoms: sudden loss of consciousness, violent convulsions, eyes wide open.
• Modalities: worse from light, noise, and motion; better in darkness.
• Mental state: restless, irritable, feeling of impending doom.
• Thirst/appetite: thirst for cold water, appetite diminished.
• Discharges: profuse, hot sweat; bright red tongue.
• Physical generals: flushed face, dilated pupils, rapid pulse.
• Constitution: hot‑blooded, impulsive, prone to inflammation.
• How it helps: pacifies the hyper‑active cortical centres responsible for tonic‑clonic fits.

Remedy 3 – Cuprum metallicum

• Causation: prolonged mental strain, over‑work, exposure to copper.
• Characteristic symptoms: jerky, twitching movements of limbs, especially at night.
• Modalities: worse from exertion, better when lying still.
• Mental state: anxious, anticipatory fear, feeling of impending collapse.
• Thirst/appetite: thirst for cold water, appetite irregular.
• Discharges: scant, clear urine; occasional metallic taste.
• Physical generals: trembling hands, weak muscles, cold feet.
• Constitution: diligent worker, high‑achieving, prone to over‑exertion.
• How it helps: stabilises the ion‑channel function and reduces motor jerks.

Remedy 4 – Gelsemium sempervirens

• Causation: emotional shock, grief, over‑exertion.
• Characteristic symptoms: trembling, weakness, seizures that start with a feeling of heaviness.
• Modalities: worse from mental effort, better with rest and fresh air.
• Mental state: timid, indecisive, anticipatory anxiety.
• Thirst/appetite: thirst for warm drinks, appetite poor.
• Discharges: thin, watery urine; occasional nasal discharge.
• Physical generals: drooping eyelids, weak pulse, cold extremities.
• Constitution: sensitive, nervous, easily overwhelmed.
• How it helps: calms the nervous system and reduces the propensity for myoclonic jerks.

Remedy 5 – Hyoscyamus niger

• Causation: head injury, exposure to toxic fumes.
• Characteristic symptoms: violent convulsions with frothing at the mouth, pupils dilated.
• Modalities: worse from heat, better in cool, open air.
• Mental state: irritable, aggressive, feeling of being chased.
• Thirst/appetite: great thirst for cold water, appetite erratic.
• Discharges: profuse, foul‑smelling saliva; scant urine.
• Physical generals: hot skin, rapid pulse, dry mouth.
• Constitution: hot‑blooded, impulsive, prone to anger.
• How it helps: reduces excessive cholinergic activity that can precipitate seizures.

Remedy 6 – Ignatia amara

• Causation: acute emotional upset, grief, sudden disappointment.
• Characteristic symptoms: brief, sudden seizures after a stressful event, often with a sensation of choking.
• Modalities: worse from emotional stress, better after a walk in fresh air.
• Mental state: tearful, sighing, feeling of “broken heart”.
• Thirst/appetite: thirst for cold water, appetite reduced.
• Discharges: thin, watery urine; occasional nasal discharge.
• Physical generals: weak pulse, cold hands, slight tremor.
• Constitution: sensitive, emotional, prone to sudden mood swings.
• How it helps: balances the emotional trigger that often precipitates focal seizures.

Remedy 7 – Nux vomica

• Causation: over‑indulgence in stimulants (caffeine, alcohol), irregular lifestyle.
• Characteristic symptoms: seizures after excess, with nausea and vomiting.
• Modalities: worse from heat, late‑night work, better after rest and cool drinks.
• Mental state: irritable, impatient, feeling of “being pressed”.
• Thirst/appetite: great thirst for cold water, appetite disturbed.
• Discharges: scant, acidic urine; occasional vomiting.
• Physical generals: flushed face, rapid pulse, constipation.
• Constitution: ambitious, work‑oriented, prone to excess.
• How it helps: restores digestive and nervous balance, reducing stimulant‑induced fits.

Remedy 8 – Stramonium

• Causation: severe fright, exposure to toxic plants or smoke.
• Characteristic symptoms: violent convulsions with delirium, hallucinations, and a feeling of being possessed.
• Modalities: worse in warm rooms, better in cool, open air.
• Mental state: terrified, confused, sees vivid images.
• Thirst/appetite: thirst for cold water, appetite poor.
• Discharges: profuse, foul‑smelling sweat; scant urine.
• Physical generals: dilated pupils, hot skin, rapid pulse.
• Constitution: highly emotional, prone to nightmares, often in a chaotic environment.
• How it helps: calms the hyper‑active cortical and limbic circuits responsible for convulsive and hallucinatory activity.

12. Prognosis
Most patients achieve good seizure control with appropriate AEDs; about two‑thirds become seizure‑free within a few years. Prognosis is poorer when seizures begin early in life, are refractory to medication, or are associated with progressive brain disease. Early diagnosis and adherence to therapy improve long‑term outcome.

13. Prevention

• Identify and avoid personal triggers such as sleep deprivation, alcohol, flashing lights, and stress.
• Maintain regular medication compliance; missed doses are a common cause of breakthrough seizures.
• Use protective headgear during high‑risk activities to prevent traumatic seizures.
• Regular follow‑up with the physician to adjust therapy as needed.

14. Diet

• Recommended – a balanced diet rich in fruits, vegetables, whole grains, and lean protein; for refractory cases a ketogenic or modified Atkins diet may be advised to reduce neuronal excitability.
• Avoided – excessive caffeine, alcohol, and foods high in simple sugars that can provoke spikes in blood glucose and lower seizure threshold.