Understanding seizures, saving lives

WILLIAM, 67, had just had lunch and was chatting with some neighbors when he abruptly stopped talking and fell to the ground. His arms and hands twitched uncontrollably before he lost consciousness. He was having a seizure, which internal medicine and neurology specialist Dr. Nicholas Maraj explains is a sudden, uncontrolled electrical disturbance in the brain that can cause changes in behaviours, movements, feelings or levels of consciousness. Seizures can range from mild episodes that last a few seconds to severe convulsions that persist for several minutes. A person who suffers with repeated seizures may be diagnosed with epilepsy.The month of February is dedicated to raising awareness about epilepsy which affects around 50 million people worldwide. According to the World Health Organization it is one of the most common neurological disorders. In the Caribbean, epilepsy is a significant public health concern, with many cases going undiagnosed or untreated due to limited access to specialized care.There are about 40,000 people living with epilepsy in T&T, said Maraj.“I run a seizure clinic at the Eric Williams Medical Sciences Complex, and we see more than 25 patients every week,” he added.In T&T, efforts are being made to improve epilepsy care through increased access to neurologists, investigations like electroencephalography (EEG) and MRI, and public education campaigns, said the neurologist.Identifying causesEpilepsy can develop at any age but when it begins in adulthood, it is often linked to identifiable causes. Significant head trauma from accidents, falls or sports injuries can lead to scar tissue in the brain and cause seizures. Years ago, William, who was mentioned at the onset, suffered head trauma from a fall and began having seizures regularly. Stroke is one of the most common causes of epilepsy in older adults- strokes can damage brain tissue leading to seizures. Malignant and benign tumors can disrupt brain activity causing seizures. Encephalitis or meningitis can lead to epilepsy and neurodegenerative diseases like Alzheimer’s disease can damage brain cells and increase the risk of seizures. Severe fluctuations in blood sugar levels (low and high), electrolyte imbalances (low, high sodium, calcium etc.) or liver/kidney disease can provoke seizures, explained Maraj.The incidence of epilepsy is highest in individuals over the age of 65 due to age-related risk factors including increased risk of stroke and neurodegenerative diseases, he said. Additionally older adults often take multiple medications which can interact and lead to seizures. Also, changes in metabolism and cardiovascular health increase seizure susceptibility in aging individuals.People living with epilepsy in T&T have access to several treatment options to help manage their condition. Anti-epileptic drugs (AEDs) are the most common treatment for epilepsy.“The government provides AEDs through public hospitals and health centers, but availability may vary. There are several medications available privately which tend to work a bit better than some of those on CDAP,” said Maraj.There are also surgical options for drug resistant epilepsy, such as anterior temporal lobectomy or Lesionectomy. Epilepsy surgery is available in T&T to specially selected patients who would benefit the most from this costly therapy, said Maraj.Managing triggers like stress, alcohol consumption and sleep deprivation can help reduce the frequency of seizures.Witnessing someone in the throes of a seizure can be scary, fortunately for William, his neighbors sprang into action. Knowing how to respond can make a significant difference in ensuring the person’s safety.If you see someone having a seizure, Maraj recommends the following:Stay calm and stay with the person. Do not leave the person alone until the seizure has completely stopped and he/she has regained consciousness.Protect from injury. Remove any nearby objects that could cause harm such as sharp objects. If the person is on the ground, gently turn them on their side to keep their airway clear.Time the seizure. Take note of when the seizure starts and how long it lasts. If it lasts longer than five minutes, seek medical help immediately.Do not restrain or put anything in their mouth.“Contrary to popular belief, placing objects in a person’s mouth during a seizure can cause injury,” said Maraj. “Also, do not try to hold them down as this can further injure them.”After the seizure. Once the episode ends, provide reassurance and let them rest until they are fully alert, Maraj advises. Offer help if they are confused or disoriented.Seek emergency medical help if:—The seizure lasts more than five minutes—The person has difficulty breathing after the seizure—Another seizure happens immediately after the first—The person gets injured during the seizure—The seizure happens in water.“Ongoing efforts are needed to enhance access to specialist care, improve public awareness, and expand treatment options for those living with epilepsy,” said Maraj. “With proper management and support, individuals with epilepsy can lead fulfilling lives.” Source: trinidadexpress.com, Dr Nicholas Maraj