Epilepsy is a chronic disease manifested as multiple seizure attacks resulting from excessive electrical discharges in the neurons of brain. The excessive discharge or excitation may remain in a small area of the brain i.e. focal (Partial seizure). The causes of this disease are unknown in around 60%, infections e.g. meningitis, neurocysticercosis, tuberculoma, brain tumors, head injury, birth trauma, metabolic etc.

It can largely be controlled by regular use of appropriate medicines & surgical intervention in few cases. But in our society inadequate health infrastructure, lack of quality medical care & counseling services, existing taboos as well as social stigma regarding epilepsy have resulted in the disease being vastly neglected. In Nepal, very few attempts are made to establish centers which are actively involved in treatment and welfare of epilepsy patient.

The modern system of seizure classification draws an essential distinction between partial and generalised seizures. If the excessive electrical discharge is restricted to a given (localised) area in the brain, the seizure is termed partial. If the entire brain is involved, the seizure is generalised.

Epilepsy Syndromes:

Infantile Spasms/West’s Syndrome:
These are found in some epileptic infants less than a year old. The spasms may occur as single events or in clusters – each spasm lasting a very brief (1-3 seconds). The infant often has an appearance of nodding – as if they are flexing and extending back and forth at the head or waist (often call salaam convulsions/attacks). Infantile spasms occur when the infant is sleeping, drowsy, or upon wakening. The infant may give a cry out loud after the spasm which may often be mistaken for colic.

There are two groups of infantile spasms: cryptogenic (no known cause) and symptomatic (known cause).. For the cases of symptomatic infantile spasms, there are many different causes.

Infantile spasms are often observed in children with West’s Syndrome. Note: although Infantile spasms and West’s syndrome are often used interchangeably, not all infantile spasms are related to West’s syndrome. West’s syndrome was first described in 1841 by an English physician who observed symptoms of infantile spasms in his own son. This is related to a more specific type of infantile spasms.

Lennox-Gastaut Syndrome:
Lennox-Gastaut Syndrome affects children between the ages of 1 to 8, with predominance in male children. It is characterised by frequent, often violent seizures. Some of the seizure types associated with this syndrome are: tonic, atonic, atypical absence, myoclonic, and status epilepticus. Status epilepticus has been observed in approximately 50% of children with Lennox-Gastaut.

Like West’s Syndrome, Lennox-Gastaut Syndrome is divided into two types, cryptogenic and symptomatic. Cryptogenic cases (around 30%) usually appear to have no brain defect. Symptomatic cases make up the remaining 70% in which there appears to be some underlying brain damage.

The causes of this syndrome are varied. Possible causes include brain injury or malformation, brain infection, genetics, and many other unknown influences (especially in cryptogenic cases). Many children with Lennox-Gastaut experience developmental delay as well as many behavioural problems as a result.

To date, there is no known cure for Lennox-Gastaut Syndrome. These children are often found to have a higher frequency of drug resistance than unaffected epileptic children. They are often placed on a polytherapy of drugs. The Ketogenic Diet is often recommended for children with Lennox-Gastaut Syndrome as a way to control their epileptic seizures in addition to the prescribed medication.

Other Epilepsy Syndromes: