EPILEPSY campaigners are advising that hundreds of deaths due to epilepsy could be prevented every year if check-ups were more robust, and greater emphasis placed on attending such reviews.

At the same time, they feel that the management of epilepsy may be beyond the expertise of those GPs who don’t have a specialist interest in the disease. SUDEP stands for Sudden Unexpected Death in Epilepsy, an extremely traumatic event for anyone close to the individual involved.

Your lifetime risk of a single seizure is a fairly high 1 in 20, however epilepsy is diagnosed when a person has more than one event. A seizure, also known as a “fit”, occurs when nerve cells in the brain fire in an uncontrolled manner. Symptoms depend on where this abnormal electrical activity starts, and if it affects the brain as a whole, or is limited to one area.

Epilepsy commonly starts in childhood, but can occur at any age. In the UK there are over 450,000 individuals affected.

The condition can occur spontaneously, or may develop after an event or illness such as head injury, stroke or meningitis. Occasionally it is the first symptom of a brain tumour. It can also be a feature of another condition, for example cerebral palsy.

Seizures take many forms, from the easily recognisable tonic-clonic, where the person loses consciousness and the entire body shakes, to those where only one part of the brain is affected. In these “focal” seizures, a person may make abnormal movements of just one limb or there may be altered sensations or a sense of deja-vu. In an absence seizure, the person will briefly lose awareness of their surroundings, during which time they are unresponsive but do not convulse.

The diagnosis of epilepsy is usually made by a neurologist; a specialist in disorders of the nervous system. Tests involve an electroencephalograph (EEG) which looks at brainwave activity in a similar fashion to how an ECG assesses the rhythm of the heart. Magnetic Resonance Imaging (MRI), looks at the anatomy of the brain to identify any abnormality within its structure. However, these tests often come back normal.

Treatment starts with a single medication, the dose of which is increased if the seizures remain uncontrolled. Surgical techniques exist, including operating on the brain itself, but tend to be reserved for if medicines fail.

Epilepsy is a lifelong condition, and on a personal level it requires the individual to take their medication as prescribed, attend follow up appointments, as well as seeking medical help readily if their symptoms aren’t controlled. Certain triggers make a seizure more likely including lack of sleep, stress, excess alcohol and going without regular meals. It is vital to know what yours are and to try to avoid these where possible.

If you find a person having a seizure, please try to stay calm. Remove all objects that may injure them, and do not try to restrain them. If they appear unwell, or the seizure has not stopped in five minutes, telephone for an ambulance immediately.

Ask Dr Zak

Question: I’m still struggling to control my bladder. I had my first child nine months ago and I’ve tried lots of online pelvic floor exercises, but I’m not even sure if I’m doing them right – Joanna, 36

Answer: I am sorry to hear this. It is obvious that you are struggling. Continence issues are unfortunately common, especially after vaginal delivery. It is always worth discussing this with your routine GP. They may wish to examine you, to check for issues including a prolapse. Pelvic floor exercises can often be difficult to master without guidance, but there are dedicated physiotherapists who can be accessed either through the NHS or privately. These exercises can produce good results, provided they are done correctly and you persist with them. Surgery is reserved for those cases where pelvic floor exercises don’t produce the desired outcome, or if there is an obvious abnormality that needs correcting.

Question: How many joint injections is it safe to have? I know I’ve got arthritis in my knees, but I really don’t want an operation – Jack, 75

Answer: There isn’t a set number as a rule. The decision to do more than one is based upon whether you got any benefit from the first one, and how long that benefit lasted. If you get three months good quality pain relief, it wouldn’t be unreasonable to ask for another, however if it was much less, physiotherapy is another option that doesn’t involve surgery. Even if you and your GP decide on a referral to a knee surgeon, this doesn’t commit you to an operation, but will give you the chance to be reviewed by a specialist, which is important if your pain is particularly bad or you are suffering significant disability.

If you have a question for Dr Zak, please email: askdoctorzak@gmail.com

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Dr Uddin’s advice is provided in good faith and in accordance with currently accepted evidence. However, this content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should always seek the advice of a GP, or other qualified health provider, regarding a medical condition.