Epilepsy is a condition where a person has seizures spontaneously. It often begins suddenly and starts most often in childhood or in old age. 

According to the World Health Organisation, epilepsy affects around 50 million people worldwide. In Singapore, epilepsy affects three to five people in 1,000, and almost 200 children a year will have an afebrile seizure (convulsion not caused by a fever) or develop epilepsy. 

Associate Professor Derrick Chan, president of the Singapore Epilepsy Foundation, sheds light on this long-term condition and how people can help epilepsy sufferers. 

Q. What happens when someone has a seizure and how does epilepsy occur?

Seizures are caused by abnormal electrical signals firing in the brain and occurs in one out of 10 of the population in our lifetime. They can occur when the brain is injured by internal bleeding, severe blows,  blood or oxygen starvation, or when there are tumours or infections. Seizures can also occur without an immediate and obvious trigger. If this happens repeatedly, this is called epilepsy. 

Most people think of seizures as someone falling down and the body jerking or becoming stiff, which is often seen in seizures involving the whole brain, known as generalised convulsive seizures. 

However, if only one part of the brain is firing abnormally (a focal or partial seizure), the seizure will present as an abnormal functioning of that part of the brain. For example, a seizure in the area controlling the right side of the body will cause stiffening or shaking of the right arm and/or leg, while a seizure in the part of the brain responsible for sight can result in the person seeing strange shapes or colours, partial blurring or loss of vision. 

Q. What are some common misconceptions about epilepsy? 

Some people think epilepsy is harmless or can be outgrown without treatment. However, it can be dangerous, especially when someone is having a prolonged seizure, which could lead to brain damage or even death. 

If someone has seizures that occur frequently, they may develop learning and behavioural problems over time. The seizures can also occasionally result in Sudden Unexpected Death in Epileptic Patients (SUDEP). While some worry about the side effects of medication, it is still best to seek medical treatment promptly.

Those with epilepsy are at higher risk of anxiety and depression. Since epilepsy is still not widely understood, some may perceive patients as drunk or mentally ill. Epilepsy is not a mental illness, neither is it an infectious disease.

Another misconception is that people think epilepsy patients are unable to work or study. This is untrue. Given the opportunity, patients with epilepsy can lead productive and successful lives too.

Q. What should I do when someone is having a seizure? 

Do not be afraid – the person having the seizure needs your help in the same way someone who has fallen or is having an asthma attack does. 

You can provide first aid for seizure patients if you are trained. If not, call an ambulance.

Seizure first aid is simple and supportive. Place the person on his/her side and make sure the  airway is clear. Start timing how long the seizure lasts. Do not put a spoon, finger or anything else into the mouth – this is dangerous and can injure the mouth and teeth or the inserted finger.

If the seizures stop within five minutes, keep the person in the recovery position and make sure the mouth and throat are not blocked.

If the seizure does not stop after five minutes, there is a higher risk it will not stop, so seek medical help immediately.. 

Q. How can I care for or support someone with epilepsy?

People with epilepsy may feel different from others because they have to take long-term medication or are unable to do certain things. 

Treat them just as you want to be treated. Be a supportive friend or family member by helping them to fit in and find activities to do together. Stress can also trigger seizures, so encourage them to exercise or maintain a routine of activities, and find ways to release emotions in a healthy manner. 

Ensure they get sufficient sleep and encourage them to avoid alcohol as these can worsen seizures. However, be mindful not to restrict activities unnecessarily for someone with epilepsy. 

Anti-seizure medication can help people with epilepsy lead as normal a life as possible. With good seizure control, they can maintain their independence and freedom, which is vital to one’s happiness and self-worth. 

You can also be more empathetic towards the caregivers of children and adults with epilepsy. When a person, particularly a child, develops epilepsy, their parents or caregivers are sometimes accused of having done something wrong. This places incredible stress on them and may prevent them from seeking the right medical treatment.

Q. What type of treatments are there for epilepsy patients? 

The first-line treatment for epilepsy is anti-seizure medication to help patients control their seizures. 

If medication is insufficient, surgery is another option. This involves removing the part of the brain that causes the seizures. 

If surgery is unsuitable for the patient, other treatments include implanting a vagus nerve stimulator – a medical device that uses electrical impulses to stimulate the vagus nerve – which regulates the functions of the body’s internal organs. 

The ketogenic diet, a high-fat, low-carbohydrate diet, is another type of treatment for epilepsy. Do not start it yourself, but seek medical advice to ensure you are on the appropriate diet.