Seizures and epilepsy: understanding the distinction
Two new epilepsy monitoring units for diagnosis and treatment
This National Epilepsy Week, 16 to 24 June, specialists from two new epilepsy monitoring units at Netcare hospitals are shedding light on common misperceptions about this neurological condition and explaining the importance of accurate diagnosis.
“When people think of epilepsy, a person experiencing convulsive seizures may immediately spring to mind. As doctors we know, however, that seizures may be attributable to other causes and that epilepsy takes various forms – some of which do involve convulsive seizures, but also others that do not,” explains Dr Shaheed Gora, a neurologist practising at the recently opened epilepsy monitoring unit (EMU) at Netcare Mulbarton Hospital in Johannesburg.
What is epilepsy?
“Official estimates vary, but epilepsy, in its various forms, is believed to affect around 55 million people worldwide, and approximately one percent of South Africans. This neurological disease is not contagious and certainly is no indication that a person is mentally deficient,” Dr Gora observes.
“From critically acclaimed novelists Fyodor Dostoyevsky and Laurie Lee, to musicians Lil Wayne and Prince and sport legends such as Jonty Rhodes, many epileptics have distinguished themselves in their chosen fields. It is even believed that the ancient Greek philosopher Socrates, and historical figures including Roman emperor Julius Caesar and French emperor Napoleon Bonaparte – both revered for their political and military strategies – were epileptic.”
Dr. Vanmala Naidoo, a neurologist who also practices at the Netcare Mulbarton Hospital EMU, says that there are many different types of both epilepsy and seizures, and they may present in many different ways. “While some epileptics experience convulsive, or grand mal seizures, characterised by the body stiffening and uncontrolled muscle jerking, other types of epilepsy may involve atonic seizures, where the person briefly loses control of their muscles and collapses, or absence seizures, where the person may simply just stare into the middle distance for up to 10 seconds.”
What are seizures?
A seizure is defined as a surge in the electrical impulses of the brain, causing a number of possible symptoms depending on which area of the brain is affected. Seizures can be caused by epilepsy, but there are numerous other factors that they may be attributable to.
Dr Raksha Sitharam, a neurologist practising at the new EMU at Netcare Waterfall City Hospital in Midrand, says that not everyone who experiences a seizure is necessarily epileptic. “Any illness causing a high fever, meningitis or encephalitis, a head injury, brain tumour, low blood sugar in type 1 diabetics and genetic factors are among the possible alternative causes of seizures. Withdrawal from illegal drugs or alcohol has also been associated with seizures,” Dr Sitharam notes.
“Some people may experience an isolated seizure with no identifiable cause. While this is not necessarily an indication of epilepsy, you should consult your doctor in the event that you have a seizure.”
“As epilepsy is a complex group of conditions, diagnosis is not always simple. There are other conditions that may present in ways similar to certain types of epilepsy, and in order to effectively treat the patient these would need to either be ruled out or confirmed,” Dr Sitharam adds.
Typically, the patient’s medical and family history will be taken into account, and a clinical examination performed. An electroencephalogram (EEG) test will be performed to record electrical activity in the brain. The doctor may also ask for eyewitness accounts of someone who saw the patient having a seizure to help determine what type of seizure it was. MRI or CT scans are also commonly used to help identify the cause of seizures.
Video-EEG and epilepsy monitoring
“Even with the aid of front-line diagnostic tools, further testing may be required to distinguish epileptic seizures from other conditions that may present similarly, such as synocope fainting spells, heart rhythm disorders, sleep disturbances or behavioural disorders,” Dr Sitharam explains.
Dr Gora explains the process: “Video-EEG involves continuous simultaneous EEG and video monitoring over a period of between 24 hours and five days, which enables doctors to see the patient’s physical response on video footage and compare it with simultaneous information recorded on the EEG.
“Through this process, we are able to identify the type of seizures being experienced, and in which part of the brain the seizures originate. We can see how often the patient has seizures, even those types of seizures that might otherwise be difficult to notice,” Dr Naidoo adds.
“As with all medical information, the recordings are treated with the utmost respect for confidentiality. Aside from events of clinical importance, all recordings are permanently deleted.”
Dr Sitharam says that video-EEG also has applications for assessing whether the type and dosage of medication a patient has been prescribed is the most appropriate for their particular condition. “This is especially important because if a person has been prescribed anti-epileptic medicine when they are not actually epileptic, this can have adverse health implications.”
When being admitted to an EMU, patients are encouraged to bring along a close friend or family member who is familiar with their seizures, both to assist in alerting the neurodiagnostic technician to the seizure and for personal support. During their stay at an EMU, patients may bring a laptop, battery-operated CD player, books or craft materials to help them pass the time. They may be required to stay awake for some time, as sleep deprivation testing may be necessary.
“The EMUs at Netcare Mulbarton, Netcare Milpark and Netcare Waterfall City hospitals are equipped with state-of-the-art technology and designed with patient comfort in mind. We aim to make patients’ stay with us as pleasant as possible, and the en-suite bedrooms have television sets to help them while away the hours,” Dr Gora explains.
“With the establishment of these two new EMUs, in addition to the one at Netcare Milpark Hospital which has been operating since 2000, it is hoped that many more people will benefit from the more refined diagnostics so that they can receive the treatment that is best suited to their individual needs, thereby improving their quality of life,” observes Dr Sitharam.
The general managers of Netcare Mulbarton Hospital, Nellie Koen, and Netcare Waterfall City Hospital, Rolien Kuhne, welcomed the addition of EMUs to the service offerings of their respective healthcare facilities. “It is our sincere hope that the introduction of this specialised unit will assist our epileptic patients to find the most appropriate treatment suited to their individual circumstances, and optimise their quality of life,” they concluded.