Unpredictable Epilepsy symptoms can manifest in many ways

06/08/2009
By Eveline Gan, Channel NewsAsia

SINGAPORE: Articulate, affable and happily married, Mary-Anne (not her real name) looks like a carefree middle-aged woman.

But appearances can be deceiving. Beneath her upbeat exterior, Mary-Anne struggles with epilepsy. The neurological disorder came into the spotlight recently, after a 13-year-old sufferer with H1N1 infection died two weeks ago.

Diagnosed at 13 after she started hearing "strange, beeping noises" in her ear, Mary-Anne, 30, is one of approximately 20,000 people in Singapore suffering from epilepsy. For the past 17 years, she has lived through each day not knowing when a seizure will occur.

Once viewed as a mark of demonic possession, epilepsy is caused by a temporary electrical disturbance in the brain.

"For a short time, the brain does not work the way it usually does. The body gets the wrong signals and triggers seizures," explained clinical associate professor Ong Hian Tat, a senior consultant at National University Hospital's University Children's Medical Institute. He added that, like a sneeze, an epileptic seizure cannot be stopped once it starts.

In 70 per cent of the cases, there is no known cause, although certain physical conditions and environments, such as lack of sleep, illness or flickering lights, may trigger seizures.

For the remaining 30 per cent, said Assoc Prof Ong, the reason may be severe head injuries, stroke, brain infection such as meningitis, brain tumour or brain damage caused by a difficult birth.

Seizures occur in different forms

The types of seizures range from brief episodes of staring or blanking out to violent convulsions.

"Depending on where the electrical disturbance occurs in the brain, the symptoms can manifest in many ways during a seizure," said Dr Andrew Pan, a consultant neurologist and epileptologist at Mount Elizabeth Medical Centre.

"For instance, if it affects the part of the brain that controls vision or hearing, the person may see images or hear sounds that are not real," added Dr Pan, who is also a medical advisor to the Singapore Epilepsy Foundation.

The seizures Mary-Anne experiences - called complex partial seizures - are relatively mild, compared with what some epilepsy sufferers have to endure.

In one of the worst scenarios, a person experiencing tonic-clonic seizures loses consciousness, falls, stiffens and convulses violently. He may also lose control of his bladder or bowels.

Mary-Anne relies on daily anti-epileptic medication to control her seizures. It's the prescribed treatment for the majority of adult cases. Even so, the unpredictability of her seizures means that she has to take precautions while engaging in simple activities. Or avoid them altogether.

"Epilepsy has certainly kept my parents and husband very busy because they have to ensure that I am safe. While doing things such as swimming, cooking or crossing the road, I have to make sure that someone is with me," she said. People with epilepsy are also prohibited from driving in Singapore under the current Road Traffic Act.

Living with epilepsy, and its stigma

Besides the unpredictability of the seizures, doctors Today spoke to said patients like Mary-Anne also have to grapple with the stigma attached to their condition.

"Epilepsy has a bad image. There's a lot of misconception and fear surrounding it," said Dr Pan. "Until today, people still think it is contagious or that everyone with epilepsy falls to the ground, convulses and foams at the mouth during a seizure. Because of this, many patients have difficulty finding a job."

For young sufferers, growing up with the condition can be especially difficult.

According to Assoc Prof Ong, babies and children with epilepsy make up about 0.5 to 1 per cent of the population.

He said it is not uncommon for people with epilepsy, especially children, to develop behavioural and emotional problems.

"Sometimes, these problems are caused by embarrassment or frustration associated with epilepsy. Other problems may result from bullying, teasing, or peers avoiding them in school and other social settings," said Assoc Prof Ong.

He added that aside from their condition, children with epilepsy are like everyone else. Many have normal or above-average intelligence.

Mary-Anne, who is in the social work field, said that she had to work harder than her peers to obtain her master's degree because the medications she took affected her memory and concentration.

"Because of my condition, I had to study and work doubly hard in school. In a way, I also wanted to prove that people with epilepsy can do just as well in life," she said.

For more information on the condition, call Singapore Epilepsy Foundation at 6334 4302 or visit www.epilepsy.com.sg.