Epilepsy is a relatively common neurological condition. The incidence is estimated at between 30-60 cases per 100,000 population. Males are about 2 times more likely to have epilepsy than females. It is more common in children than in adults especially those under 2 years of age. Age specific incidence rate is about 80-120 cases per 100,000 in the first decade and about 20-40 cases per 100,000 in adulthood and a further increase after the age of 60.

Epilepsy may be defined as a transient disturbance of the electrical activity of the brain. It can be subdivided into 'symptomatic' where there is an underlying cause such as a brain tumour, infection or electrolyte disturbance, or for the majority 'idiopathic' where there is no obvious underlying cause and the mechanism presumed to be genetic or developmental. Depending on the location of the electrical disturbance, a number of clinical syndromes can be identified.

In Grand mal seizures, which is the commonest form of generalized seizure, the electrical disturbance affects both sides of the brain simultaneously resulting in a sudden loss of consciousness and falling down, with tonic clonic jerking movements of the limbs. There may be a temporary cessation of respiration, urinary and/or faecal incontinence. Consciousness is regained over 5-10 minutes. A variable period of confusion and drowsiness may be experienced afterwards.

Petit Mal is another form of generalized seizure, which usually affects children. There is a brief loss of consciousness characterized by a 'starry' or 'vacant' look lasting 5-10 seconds; consciousness is then regained abruptly and the child continues with what he was doing with no memory of what has happened. In contrary to Grand Mal seizures, the patient usually maintains muscle tone and does not fall .

In temporary lobe epilepsy (TLE), another common form of seizure, the abnormal electrical activity arises from the area of the brain known as the temporal lobe. The patient commonly presents with abdominal pain, hallucinations of smell/ taste, and feelings of familiarity (deja Vu) or unfamiliarity ; the patient may display certain 'automatic' motor activity; with the conscious level being impaired to a varying extent.

Different forms of Epilepsy have their own distinctive wave patterns on the Electroencephelogram (EEG) . By means of the EEG, one may gain useful information as to the seizure type, which may help in the selection of the most effective type of drug therapy.

With easy MRI access, an MRI scan of the brain should also be performed in patients with epilepsy irrespective of the age group. In the idiopathic group, underlying mesial temporal sclerosis or cortical dysplasias may be found whereas in the older age group, it is important to rule out 'symptomatic' epilepsy such as underlying tumour or vascular malformation. Epilepsy invokes fear in most patients who are genuinely worried about their condition and wish to have an underlying cause ruled out; likewise it is no longer sufficient to tell an epileptic child's anxious parents that there is 'unlikely' to be an underlying lesion of the brain.

The mainstay of treatment for Epilepsy are Anti-epileptic drugs (AED). Treatment is usually advised after at least 2 seizures. For the majority of patients only one AED is aedequate for control; however, in a small group of patients with severe seizures, drug combinations may be required to obtain satisfactory control. Patient must be taught on the importance of compliance and to take the medications at the same time each day to avoid excessive blood level fluctuation. Potential side effects of the AED must be told to the patient. Periodic blood tests for AED levels may be required for some patients especially if other drugs which may interact with the AED are also being taken.

The period of AED treatment should be for at least 2 years provided that there has been no further epileptic seizures during this entire period. Some patients, on account of their occupation may request to remain on treatment for much longer for "fear" of possible recurrence. On the contrary, patients with a lot of side effects from their medications may wish to come off treatment some what earlier. Patients should be advised to avoid things which are known to precipitate seizures ie alcohol, lack of sleep, disco or flashing lights. Patients with epilepsy are prohibited by law from driving.

Surgical treatment of epilepsy is reserved for a special group of patients who is refractory to drug treatment and have a definite focus identified on investigations.

Pregnant mothers on AED have a higher incidence of giving birth to babies with congenital malformations and it is important to inform your doctor if you become pregnant while taking AEDs.

The social stigma and prejudice against epileptics have changed significantly over the years. The improved attitude has a lot to do with public education and awareness that has removed a lot of the mystery and misinformation surrounding this condition. However, the visual image of a Grand Mal seizure is still a frightening one and explains why some patients ( especially company executives) may wish to continue on long term treatment rather than risk possible seizure relapse in front of a client or during an important presentation. The social stigmata of epilepsy will not disappear completely even though the society has a duty to treat this group of patients with dignity and respect rather than alienation and prejudice.

When parents ask regarding restrictions on the activities of their epileptic child, I do my utmost to reassure them that with aedequate treatment, the child should be seizure free, and should be encouraged to lead as normal a life as possible. The school teacher should be notified of the child's condition and the medications he is taking; he should be supervised during swimming and be exempted from dangerous and contact sports.

Keywords, MRI scan of brain, AED and congenital malformations, driving, AED compliance