Discussion Forum For Health Professionals
Important facts about epilepsy
Approximately 0.6 - 1% of Pakistani's have epilepsy. Based on the 1998 census and a Pakistani population of 132,000,000 there are approximately 792,000 (at the very least) patients with epilepsy in Pakistan. Although 70% are controlled on medications (if diagnosed and treated)30% are medically refractory.
A significant number of medically refractory patients have temporal lobe epilepsy. Patients with temporal lobe epilepsy and MRI findings of mesial temporal lobe sclerosis with concordant EEG localization are excellent candidates for resective epilepsy surgery. 70-90% of such patients can be cured of epilepsy with proper surgical intervention (temporal lobectomy). Atypical seizure originating from the mesial temporal lobe consists of episodes of spacing out or staring in space. These are often associated with lip smacking, automatisms and unawareness of the surroundings. Patients with mesial temporal epilepsy only have rare generalized tonic clonic (grand mal) seizures.
A comprehensive epilepsy program requires a multidisciplinary team consisting of a neurologist and neurosurgeon specializing in epilepsy, a neuropsychologist, a neuroradiologist and hospital facility with video EEG telemetry unit.
I am presently working at a comprehensive epilepsy program at the university of Alberta and will be very happy to technically assist in the setting up of such a program in Pakistan.
Posted by: Nizam Posts: 82 :: 18-02-2005 :: | Reply to this Message
Re: Important facts about epilepsy
I really appreciate your dedication and help. I think there are some centers in Pakistan which are running their own epilepsy clinics.
I as an internist, have few questions regaridng the diagnoses of complex partial seizures or petit mall type seizures. I have seen some patients (middle aged or old females) presenting with transient unconciousness without any fits or abnormal movements of the body. Obtaining history from them regarding the episode is most of the time difficult. As far as guidelines and literature are concerned, it says that if you are suspecting such disorder, you need to go for some tests like CT/MRI/EEG. But in our circumstances, we come across numerous poor patients, who are unable to afford such expensive investigations. Therefore, we try to solely rely on clinical diagnosis. I want to know what are the important clues in diagnosing complex partial seizures with a proper certainity?
Posted by: yasir Posts: 90 :: 18-02-2005 :: | Reply to this Message
Re: Important facts about epilepsy
There is no gold standard in diagnosing a seizure other then capturing an event on an EEG. Clinical history, however can provide the diagnoses in most cases. A complex partial seizure is not the same as a "petit mal". Petit mal seizure is another name for "Absence seizure" which is classified as a generalized, non-convulsive seizure. Petit mal/absence seizures typically present between 5-10 years and typically last for a few seconds. Children lose awareness, may lose bladder continence and often have fluttering of eyelids. A typical absence seizure does not necessitate neuroimaging (CT/MRI). EEG is helpful to demonstrate 3 per second spike and wave discharges, but is not obligatory. Patients typically are well controlled on ethosuximide or valproate.
Complex partial seizures on the other hand are seizures with focal onset and associated with loss of awareness. These are classified as partial or localization related seizures. These can start at any age. The typical duration is 40-60 seconds and patients often have a postictal period of confusion which may last 5-10 minutes. Complex partial seizures can evolve into secondarily generalized seizures. Patients can have an aura (warning) of an abnormal smell, taste or a sensation of deja vu. All such patients should be investigated with neuroimaging (ideally MRI) to rule out structural abnormalities such as tumors.
The stereotypical nature of the episodes is the most useful clue in making the diagnosis. Hope this helps.
Posted by: Nizam Posts: 82 :: 21-02-2005 :: | Reply to this Message