Dr. Veerendra Kumar Jain

The word epilepsy brings to mind visions of people frothing at the mouth and rolling on the ground. However, epilepsy affects each patient in a different way. This can make it hard to recognize at times. In the more serious cases of epilepsy, an epileptic attack can make a patient injure himself or develop other life threatening conditions. In rare cases, epilepsy can even cause death. Thus it becomes imperative to understand how to deal with epilepsy.

Treatment options for epilepsy can be categorized as medication, surgical procedures and dietary changes.

Medication
Medication for epilepsy is prescribed on the basis of the symptoms presented and the type of epilepsy the patient is suffering from. In most cases, seizures can be controlled with a single type of medication, but in others, the doctor may need to prescribe a combination of medicines to control epilepsy. These forms of medication do have side effects and hence any reactions to the medication must be immediately brought to the doctor's notice. The dosage for epilepsy medication may need to be varied with time. An epileptic patient should never discontinue medication on their own.

Surgery
Depending on the type of seizures and the area of the brain affected, a doctor may advise surgery in cases of severe epilepsy. Surgery can help reduce the number of seizures experienced or completely stop them. Surgery to treat epilepsy is of many types. Some of the common procedures are:

1. Surgery to remove tumor of any such conditions that may be triggering the epileptic attacks
2. Surgery to remove a small section of the brain from where a seizure originates. This may also be referred to as a lobectomy.
3. Multiple subpial transaction or a surgery that involves making a series of cuts in the brain to prevent the seizures from spreading to other parts of the brain.
4. Surgery to sever the neural connections between the right and left hemispheres of the brain.
5. Surgery to remove half the brain's cortex or outer layer

Dietary changes
A diet rich in fats and low in carbohydrates can help reduce seizures. This is known as a ketogenic diet and aims at making the body break down fats instead of carbohydrates. It can cause a buildup of uric acid in the body and thus should be practiced only under the guidance of a dietician. In cases where epileptic attacks are triggered by malnutrition and birth defects, taking vitamin supplements can help lower the frequency of seizures. In case you have a concern or query you can always consult an expert & get answers to your questions!

The word acute coronary syndrome refers to a group of symptoms that are caused by blockage of the blood flow to the heart muscles.  The most common result of this is myocardial infarction or heart attack as it is popularly called. Reduced blood flow leads to death of some portion of the heart muscle wall. While the word heart attack sounds almost fatal, it need not be the case. Knowing how to identify an attack and being aware of some simple measures can help save lives. 

Symptoms
The tell tale signs of a heart attack are as follows:

• Chest pain and discomfort usually described as a tightness or burning in the chest region
• Pain along the left side of the shoulder and neck, going up into the jaw, down to the arm
• Nausea and vomiting 
• Profuse sweating 
• Difficulty breathing 
• Dizzy or fuzzy feeling 
• Tired, extreme fatigue
• Anxious, apprehensive feeling 

However, be also aware that there are a lot of people who experience a silent heart attack. Women, obese, elderly, and diabetic patients can have silent attacks and depending on severity, either they go on with life as usual or can have a fatal attack.

Diagnosis
Once you are doubtful of a heart attack, the next step is to reach the closest medical facility for a diagnosis.  In addition to a detailed examination and history, the following two tests will be performed.

1. Electrocardiogram (ECG): A 12-lead ECG will measure electrical activity of the heart and identify irregular electrical activity, which is indicative of a myocardial infarction.
2. Blood tests:  Presence of certain enzymes in the blood, CK-MB and troponin are indicative of a heart attack.  A complete electrolyte profile also will be done, and increase or decrease of some electrolytes is helpful in diagnosing a heart attack.
3. In addition to these two, chest radiography, cardiac angiography, echocardiogram, stress test, and computed coronary tomography may also be required to confirm the diagnosis.

Management
Once diagnosed, the first step would be to relieve the symptoms, negate the effects of reduced blood flow, and restore cardiac function. 

1. Dissolve the clot: Using thrombolytics like clopidogrel 
2. Nitroglycerin: To dilate the blood vessels and improve blood flow, especially to the heart muscles
3. Anticoagulant therapy: Blood thinners are usually used to avoid blood clot formation; aspirin and heparin are the most commonly used agents.
4. Drug therapy: Blood pressure maintaining drugs like beta blockers and/or angiotensin-converting enzyme (ACE) inhibitors are also used
5. Use of Statins: Statins are used to reduce the amount of cholesterol in the blood and stabilize plaque deposits.

In very severe cases, angioplasty and stenting or coronary bypass surgery may be required. Educating people on how to identify a heart attack and manage it is very useful and can help save lives.