Handbook on Epilepsy for Physicians
In pursuit of good care of people with Epilepsy
With Compliments from:
Indian Epilepsy Association Bangalore Chapter
Handbook on Epilepsy for Physicians
Editors
PV Rai
Senior Neurologist/Epileptologist Former Associate Medical Director Swiss Epilepsy Center
Zurich, Switzerland
HV Srinivas
Senior Consultant Neurologist, Sagar Hospital and Agadi Hospital, Bengaluru Former Associate Professor Department of Neurology NIMHANS,
Bengaluru, Karnataka, India
P Satishchandra
Advisor and Senior Consultant Department of Neurology/Epileptology Apollo Hospitals, Bengaluru Hon. Professor University of Liverpool, UK Former Director Vice-Chancellor and Ex-Senior Professor Department of Neurology National Institute of Mental Health and Neurosciences (NIMHANS)
Bengaluru, Karnataka, India
GT Subhas
Senior Consultant Neurologist/Epileptologist Former Dean/Director Bangalore Medical College and Research Institute Professor and Head Department of Neurology BMCRI,
Bengaluru, Karnataka, India
Foreword
Bhim S Singhal
Jaypee Brothers Medical Publishers (P) Ltd
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Handbook on Epilepsy for Physicians
First Edition: 2019
9789389188004
Printed at
Late Dr KS Mani
Founder Member of Indian Epilepsy Association
National Body and Bangalore Chapter
“Father of Indian Epileptology”
- Agadi JB
- Senior Consultant Neurologist
- Apollo Hospitals, Bengaluru
- Former Professor and Head
- Department of Neurology
- Bangalore Medical College and
- Research Institute
- Bengaluru, Karnataka, India
- Akshita Hariharan
- MPhil in Clinical Psychology
- Clinical Neuropsychologist
- Consultant at Agadi Hospital and
- Vikram Hospital
- Bengaluru, Karnataka, India
- Bhaskara Rao Malla
- Professor and Head
- Department of Neurosurgery
- National Institute of Mental Health and Neurosciences
- Bengaluru, Karnataka, India
- Chanda Kulkarni
- Advisor—Clinical Pharmacology
- Sakra World Hospital
- Bengaluru, Karnataka, India
- Damodar Rao HK
- Hon. Secretary
- Indian Epilepsy Association
- Bangalore Chapter
- Bengaluru, Karnataka, India
- Delon D'Souza
- Assistant Professor
- Department of Neurology
- St John's Medical College and Hospital
- Bengaluru, Karnataka, India
- Inbaraj G
- PhD Scholar
- Department of Neurophysiology
- National Institute of Mental Health and Neurosciences
- Bengaluru, Karnataka, India
- Johnson Pradeep R
- Associate Professor
- Psychiatry, Medical Ethics
- Institutional Ethics Committee (IEC)
- St John's Medical College and Hospital
- Bengaluru, Karnataka, India
- Kalyanasundaram S
- Consultant Psychiatrist and
- Hon. Secretary
- The Richmond Fellowship Society (India)
- Bengaluru, Karnataka, India
- Muralidharan KV
- Hon. Treasurer, Indian Epilepsy
- Association, Central Office
- Epilepsy Counselor, Indian Epilepsy
- Association, Bangalore Chapter
- Bengaluru, Karnataka, India
- Priyamvada Tatachar
- Attending Epileptologist
- Ann and Robert H Lurie
- Children's Hospital
- Assistant Professor
- Department of Pediatrics and Neurology
- Northwestern University
- Feinberg School of Medicine
- Chicago, Illinois, USA
- Raghavendra K
- Assistant Professor
- Department of Neurology
- National Institute of Mental Health and
- Neurosciences
- Bengaluru, Karnataka, India
- Rai PV
- Senior Neurologist/Epileptologist
- Former Associate Medical Director
- Swiss Epilepsy Center
- Zurich, Switzerland
- Rajendra P Joshi
- Senior Chief Medical Officer (SAG)
- Central Health Services
- Bengaluru, Karnataka, India
- Ravindranadh Chowdary M
- Associate Professor
- Department of Neurology
- National Institute of Mental Health and
- Neurosciences
- Bengaluru, Karnataka, India
- Sanjib Sinha
- Professor and Head
- Department of Neurology
- National Institute of Mental Health and
- Neurosciences
- Bengaluru, Karnataka, India
- Sarma GRK
- Professor
- Department of Neurology
- St Johns Medical College
- Bengaluru, Karnataka, India
- Sathyaprabha TN
- Professor and Head
- Department of Neurophysiology
- National Institute of Mental Health and
- Neurosciences
- Bengaluru, Karnataka, India
- Satishchandra P
- Advisor and Senior Consultant
- Department of Neurology/Epileptology
- Apollo Hospitals, Bengaluru
- Former Director, Vice-Chancellor and
- Ex-Senior Professor
- Department of Neurology
- National Institute of Mental Health and
- Neurosciences
- Bengaluru, Karnataka, India
- Shishir Duble
- Assistant Professor (Ad-hoc)
- Department of Neurology
- National Institute of Mental Health and
- Neurosciences
- Bengaluru, Karnataka, India
- Shiva Kumar R
- Senior Consultant Epileptologist and
- Neurologist
- Institute of Neurosciences
- Sakra World Hospital
- Bengaluru, Karnataka, India
- Sreeram AC
- Senior Consultant Physician
- Director, Mallige Hospital
- Bengaluru, Karnataka, India
- Srinivas HV
- Senior Consultant Neurologist
- Sagar Hospital and Agadi Hospital
- Bengaluru, Karnataka, India
- Subhas GT
- Former Dean/Director
- Bangalore Medical College and
- Research Institute (BMCRI)
- Professor and Head
- Department of Neurology
- BMCRI (1996–2013)
- Bengaluru, Karnataka, India
- Sujit Kumar
- Consultant Neurologist and Epileptologist
- Apollo Hospitals
- Bengaluru, Karnataka, India
- Thomas Mathew
- Professor and Head
- Department of Neurology
- St John's Medical College and Hospital
- Bengaluru, Karnataka, India
- Viswanathan LG
- Postdoctoral Fellow (Epilepsy)
- National Institute of Mental Health and
- Neurosciences
- Bengaluru, Karnataka, India
I am honored to write the foreword for the book “Handbook on Epilepsy for Physicians”, brought out by Indian Epilepsy Association (IEA) Bangalore Chapter. Epilepsy is a common neurological problem seen in day-to-day practice of primary care physicians. Epilepsy can be diagnosed clinically and managed easily in about 70–80% of patients. However, due to paucity of adequate training and knowledge, this eminently treatable condition is often misdiagnosed and not managed correctly. This book addresses several such issues and is handy for the Physicians to quickly refer and make a proper diagnosis and manage.
I should compliment the four distinguished editors for this multi-authored book. They have invited specialists with expertise in the field of epilepsy and having a large practical experience in managing persons with epilepsy to write the various chapters. Each section is devoted to one aspect of epilepsy, which includes diagnosis, investigations, and appropriate management.
The book also dwells into difficult to treat epilepsy/drug-resistant epilepsy, which accounts for about 20–25% of all epilepsies. Investigation of such a case along with the indications for surgery has been well brought out. For readers who would like to have some advanced information, the role of genetics and personalized treatment has been touched upon.
Indian Epilepsy Association Bangalore Chapter has been in the forefront of public education to dispel the myths and misunderstanding about epilepsy. For more than 10 years, members of the Association have been addressing regularly students in schools, colleges, and various social organizations. In addition, street plays are being performed regularly for more than 10 years, by amateur artists to spread the right message to rural and semiurban population. These are conducted in busy places such as bus stand, railway station, schools, and weekly fairs. It is heartening to note that the book also covers several social aspects of epilepsy, which the medical doctors should be aware of to educate their patients and their family members.
This comprehensive “Handbook on Epilepsy for Physicians” should be extremely useful for all those who care for persons with epilepsy including family physicians, internists, pediatricians, neurologists, and psychiatrists.
Bhim S Singhal
Director of Neurology
Bombay Hospital Institute of Medical Sciences
Mumbai, Maharashtra, India
Preface
For the past four to five decades, there has been significant advancement in the diagnosis and treatment for people living with epilepsy (PWE). This is the result of some major developments in the field of neurology and neurosciences, which have resulted in the establishment of a specialization—Epileptology. The progress in epileptology can be traced mainly to three to four major areas such as: (1) the classification of epileptic seizures and epilepsies—by the International League against Epilepsy (ILAE), (2) the development of newer antiepileptic drugs (AEDs), (3) the advancement in the field of medical technology—in particular electroencephalography (EEG) with different forms of application—neuroradiological investigations with computed tomography (CT) scan, magnetic resonance imaging (MRI), positron emission tomography (PET), etc. Further progress is the result of extensive scientific and social programs carried out by the two organizations—ILAE and International Bureau for Epilepsy (IBE) through their worldwide chapters.
Because of these advancements, epilepsy, which was for ages considered as “incurable”, has become an eminently treatable neurological condition with over 70% PWE almost certain to achieve the status of freedom from seizures. Having a variety AEDs available in the market, with proper selection, a single drug can lead to seizure freedom in about 70%. Where drugs do not help, in a small number of people, neurosurgery can make a person free of seizures. Under this positive scenario of epilepsy treatment, the reality is very much different particularly in developing countries including India. A large number of PWE mostly in the rural areas do not get even the basic drug treatment and continue to have seizures, although some of the effective “standard” drugs have become cost-effective and affordable for all sections of society.
Epilepsy is very much a clinical condition. The diagnosis of epilepsy is made on the basis of identification of seizures and the circumstances, which lead to their manifestation. With ongoing Continuing Medical Education (CME) program around the year, every physician should be able to diagnose and treat a PWE in nearly 70% of cases, except in cases of some complicated epilepsies, where neurological consultation may be needed. Managing a PWE at the level of primary healthcare/general medical practice is of utmost importance in view of the present medical and social situation in India. The number of neurologists available in the country is insufficient for the management of huge population of around 10–12 million of PWE in India. With this in our mind, the Indian Epilepsy Association (IEA) Bangalore Chapter has planned to have simple but comprehensive “Handbook on Epilepsy for Physicians”. We hope that this will guide our physicians in day-to-day practice in managing their patients. This is a multi-author book and the authors chosen for this task are highly proficient in their field of work related to epileptology. Thanks to their contribution, the book provides expert and latest information regarding various aspects of epilepsy.
Attempts have been made to present important aspects of epilepsy as separate chapters, so that the readers can select these chapters according to their particular needs. Examples, febrile seizures, new onset epilepsy, epilepsy syndromes in children, epilepsy in the elderly, seizures but not epilepsy, epilepsy and pregnancy, to name only a few of the chapters. The authors have done commendable work in synthesizing their ideas, taking much time, in spite of their busy professional schedule for which we express our gratitude to them.
The book would not have seen the light of the day at this stage of publication but for the incessant work of Dr HV Srinivas in doing maximum amount of the editorial work, in spite of his busy professional activity. He has dedicated weeks and months of his private time for bringing out a neurological book on epilepsy for physicians. We express our sincere thank profusely.
We wish to dedicate this book to our Indian Epilepsy Association founder Professor KS Mani who is known as “Father of Indian Epileptology”. We are thankful to Professor BS Singhal for kindly writing the Foreword for this book. We also thank the Jaypee Brothers Medical Publishers (P) Ltd., New Delhi and their Bengaluru office for bringing out the book in a beautiful form.
Rai PV
Srinivas HV
Satishchandra P
Subhas GT
Acknowledgements
The book is a brainchild of Dr PV Rai, President of Indian Epilepsy Association Bangalore Chapter, who mooted the idea of bring out multi-authored book on behalf of Indian Epilepsy Association (IEA) Bangalore Chapter, which would be of help to Primary Care Physicians dealing with epilepsy.
Sincere thanks to all the contributors from IEA Bangalore Chapter who spared their time willingly to contribute to this book.
Our thanks to Dr BS Singhal for graciously accepting to write the Foreword.
The Editors wish to express their hearty thanks to Dr HV Srinivas for his untiring work of editing, organizing, and “endless” correspondence with Authors and Publishers.
We thank Ms Meena Chandramohan for diligently copyediting the book.
We thank our Secretary Ms Theresa Pinto for typing several drafts ungrudgingly before it took the final shape.
Finally, we are thankful to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr MS Mani (Group President), Ms Chetna Malhotra Vohra (Associate Director—Content Strategy), Ms Pooja Bhandari (Production Head) and Ms Nedup Denka Bhutia (Development Editor) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for giving a go-ahead at the very beginning and helping us in every way possible to bring out this book.