I. INTRODUCTION
Epilepsy, also called seizure disorder, chronic brain disorder that briefly interrupts the normal electrical activity of the brain to cause seizures, characterized by a variety of symptoms including uncontrolled movements of the body, disorientation or confusion, sudden fear, or loss of consciousness. Epilepsy may result from a head injury, stroke, brain tumor, lead poisoning, genetic conditions, or severe infections like meningitis or encephalitis. In over 70 percent of cases no cause for epilepsy is identified. Some 40 to 50 million people suffer from epilepsy worldwide and the majority of cases are in developing countries. According to the World Health Organization (WHO), an estimated 2 million new cases are diagnosed each year globally.

II. TYPES OF SEIZURES
Epileptic seizures vary in intensity and symptoms depending on what part of the brain is involved. In partial seizures, the most common form of seizure in adults, only one area of the brain is involved. Partial seizures are classified as simple partial, complex partial (also known as psychomotor), and absence (also known as myoclonic or petit mal) seizures.
People who have simple partial seizures may experience unusual sensations such as uncontrollable jerky motions of a body part, sight or hearing impairment, sudden sweating or flushing, nausea, and feelings of fear.
Complex partial seizures, also called temporal lobe epilepsy, last for only one or two minutes. The individual may appear to be in a trance and moves randomly with no control over body movements. The individual's activity does not cease during the seizure, but behavior is random and totally unrelated to the individual's surroundings. This form of seizure may be preceded by an aura (a warning sensation characterized by feelings of fear, abdominal discomfort, dizziness, or strange odors and sensations).
Absence seizures, rare in adults, are characterized by a sudden, momentary loss or impairment of consciousness. Overt symptoms are often as slight as an upward staring of the eyes, a staggering gait, or a twitching of the facial muscles. No aura occurs and the person often resumes activity without realizing that the seizure has occurred.
In a second type of epilepsy, known as generalized seizure, tonic clonic, grand mal, or convulsion, the whole brain is involved. This type of seizure is often signaled by an involuntary scream, caused by contraction of the muscles that control breathing. As loss of consciousness sets in, the entire body is gripped by a jerking muscular contraction. The face reddens, breathing stops, and the back arches. Subsequently, alternate contractions and relaxations of the muscles throw the body into sometimes violent agitation such that the person may be subject to serious injury. After the convulsion subsides, the person is exhausted and may sleep heavily. Confusion, nausea, and sore muscles are often experienced upon awakening, and the individual may have no memory of the seizure. Attacks occur at varying intervals, in some people as seldom as once a year and in others as frequently as several times a day. About 8 percent of those subject to generalized seizures may have status epilepticus, in which seizures occur successively with no intervening periods of consciousness. These attacks may be fatal unless treated promptly with the drug diazepam.

III. DIAGNOSIS
In persons suffering from epilepsy, the brain waves, electrical activity in the part of the brain called the cerebral cortex, have a characteristically abnormal rhythm produced by excessive electrical discharges in the nerve cells. Because these wave patterns differ markedly according to their specific source, a recording of the brain waves, known as an electroencephalogram (EEG) is important in the diagnosis and study of the disorder. Diagnosis also requires a thorough medical history describing seizure characteristics and frequency.

IV. TREATMENT
There is no cure for epilepsy but symptoms of the disorder may be treated with drugs, surgery, or a special diet. Drug therapy is the most common treatment-seizures can be prevented or their frequency lessened in 80 to 85 percent of cases by drugs known as anticonvulsants or antiepileptics. Surgery is used when drug treatments fail and the brain tissue causing the seizures is confined to one area and can safely be removed. A special high-fat diet known as a ketogenic diet produces a chemical condition in the body called ketosis that helps prevent seizures in young children. Like any medical condition, epilepsy is affected by general health. Regular exercise, plenty of rest, and efforts to reduce stress can all have a positive effect on a person with a seizure disorder.
First aid for generalized seizures involves protecting the individual by clearing the area of sharp or hard objects, providing soft cushioning for the head, such as a pillow or folded jacket and, if necessary, turning the individual on the side to keep his or her airway clear. The individual having a seizure should not be restrained and the mouth should not be forced open-it is not true that a person having a seizure can swallow the tongue. If the individual having the seizure is known to have epilepsy or is wearing epilepsy identification jewelry, an ambulance should only be called if the seizure lasts longer than five minutes, another seizure closely follows the first, or the person cannot be awakened after the jerking movements subside.

ANTI-EPILEPTIC ALLOPATHIC DRUGS

TEGRETOL Carbamazepine
This is a powerful anti-epileptic drug with a wide range of activity. It is available as white tablets of two strengths (100 mg and 200 mg), and is usually given twice a day (say after breakfast, and then after the evening meal, around 12 hours later). An average sized adult usually requires between one and two tablets (200 mg size, twice a day).
If the dose is too high, the patient may appear to be "drunk", with drowsiness, lack of co-ordination in walking, etc. Reduction of the dose, based on blood levels, is all that is required.
Side effects (unwanted symptoms occurring in someone whose levels are correct) are common in the first few days or week or two, especially giddiness and light headedness, mild nausea, and dryness of the mouth. These usually disappear within a few days. They are less likely to occur if Tegretol is introduced in a gradual way. A measles-like rash sometimes occurs during Tegretol treatment, and in this event, Tegretol must be replaced by another anti-epileptic drug. Serious side effects are fortunately rare. They include jaundice due to liver involvement, and lowering of the white cell count of the blood, resulting in persistent ulceration of the throat and mouth.
The manufacturers recommend that blood tests (full blood count, tests of liver and kidney function) be carried out before starting Tegretol, and that the full blood count be repeated weekly for the first month of treatment, then monthly for the first year.
In practice, Tegretol side effects are usually mild, and disappear within the first week or two. It is arguably the most powerful and useful anti-epileptic drug currently available.

EPILIM Sodium valproate
This is another extremely useful drug with a wide range of anti-epileptic activity. It is thought to act by increasing the brain's levels of the inhibitory neurotransmitter, GABA.
Epilim is presented as lilac colored tablets of 200 mg and 500 mg strength. These should be swallowed whole. It is also available as crushable tablets of 100 mg strength, and as syrup of 200 mg/5ml strength, and sugar free liquid of similar strength.
It is usual to give Epilim twice a day, with meals, with roughly 12 hours between doses. Since blood levels of Epilim are unreliable as a guide, adjustment of the dosage is made according to the patient's body weight, and the adequacy of seizure control. The usual dose range is 20 to 30 mg/kg body weight/24 hours.
Mild side effects, especially nausea and diarrhea in the first few days, are common. A fine tremor of the hands is often noticed in patients taking Epilim over the long term. Weight gain and loss of hair (usually reversible) can also occur.
Very rarely, Epilim may produce acute liver disease, and there have been instances of acute liver failure, some fatal. Small children and infants with serious underlying medical conditions are most at risk. The question of the safety of Epilim has received careful study by Australian health authorities, and its continued use has been endorsed, for it is in practice a widely used, effective, and well tolerated medication.
It is suggested that Epilim be avoided in patients with a history of liver disease, and that blood tests to check liver function and the level of platelets in the blood (sometimes reduced by Epilim) be carried out before starting treatment, and repeated after one month's treatment, and thereafter at intervals of not more than 6 months. Minor abnormalities of liver function are common in patients taking most anti-epileptic drugs, but evidence of increasing abnormality would require substitution of Epilim.
Symptoms of this rare complication of liver failure include severe nausea persistent abnormal pain, jaundice (yellowish discoloration of the skin), severe nausea, weakness and tiredness, and swelling of the face. Any of these symptoms should be reported to the treating doctor.

DILANTIN Phenytoin sodium
This is the oldest of the effective major anti-epileptic drugs. It is still one of the most potent in preventing major seizures of tonic-clonic and other types, but its troublesome side effects have meant that the other, newer drugs such as Tegretol and Epilim are usually selected instead. Dilantin has a powerful action in controlling seizures, and is very useful as an additional drug where seizures cannot be controlled by one drug alone, or when it is not intended to continue treatment over a very long period (for example, when anti-epileptic drugs are given routinely for a year or two after brain surgery).
Dilantin is presented in capsule form (100mg, orange and white capsules, 30mg, all white capsules), in liquid form (30 mg/5ml strength for children, 100 mg/5ml. "Dilantin Forte Suspension" for adults), and as chewable tablets for children (50 mg, "Infatabs")
The drug is slowly released, so that theoretically it would be possible to take the medication as a dingle daily dose; however, people's memories being what they are, it is recommended that the medication be taken twice a day (e.g. after breakfast, and after the evening meal as a routine). The usual dose for an adult of average size is 3 to 4 capsules of 100 mg strength per 24 hours.
Dilantin overdose produces symptoms similar to drunkenness, with drowsiness, unsteadiness on the feet, etc. Blood levels of Dilantin will indicate the true picture.
Short term side effects of Dilantin are not usually a problem, but side effects developing gradually over a period of years do present serious objections to its long term use, especially as other effective anti-epileptic drugs which do not have these problems are now available. These long-term side effects of Dilantin are the growth of hair on the face, arms and legs, especially in female patients of dark complexion, unhealthy overgrowth of the gums, with a tendency for them to bleed, and mental sluggishness and loss of memory.
If Dilantin is to be taken over a long period, special attention should be paid to brushing the teeth and generally maintaining good oral hygiene. An uncommon complication of Dilantin therapy is the development of an allergic measles like rash, which requires substitution of the drug with another.

ZARONTIN Ethisyxunudem
This drug is effective in controlling one form of epilepsy only, namely absence seizures (formerly known as "petit mal"). As this form of epilepsy begins in childhood, Zarontin is made available as a red syrup (250 mg/5 ml) and as capsules (250 mg). The dose required will vary according to blood levels and body weight, the average dose for a child aged 6 years being one capsule, 2 or 3 times a day.
Side effects are not common, but include nausea and digestive upset, drowsiness and sleep disturbance.

Benzodiazepine Drugs
These drugs have sedative and anti-anxiety properties as well as being anti-epileptic. They are in fact only fairly week drugs against epilepsy, while their tendency to produce sedation and dependency greatly limit their usefulness. In practice, these drugs should never be used as a first choice, but rather reserved for those situations where epilepsy remains uncontrolled despite treatment with adequate doses of other anti-epileptic drugs.
The benzodiazepine drugs include:
RIVOTRIL (Clonazepam).
FRISIUM (Clobazepam).
VALIUM (Diazepam).
MOGODON (Nitrazepam).
The main side effects of these drugs are sedation and drowsiness in the daytime. There is a risk of producing drug dependency. Also, patients may experience various unpleasant side effects, such as restlessness, sleep disturbances, etc. when these drugs are withdrawn after a long period of administration.

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