�ݺ�ߣ

‫رلا‬‫ا‬ ‫رلا‬‫م‬‫بس‬
‫رلا الرحيم‬‫ن‬‫الرحم‬
‫طءاء‬َ‫ءا‬ ‫ع‬َ‫ءا‬ ‫ن‬ْ ‫ع‬ ‫ع‬َ‫ءا‬‫ا‬‫ن‬ْ ‫ع‬ ‫م‬ِ‫ن‬ ‫ة‬ً ‫م‬‫أ‬َ‫ءا‬‫ر‬َ‫ءا‬ ‫م‬ْ ‫ع‬ ‫ا‬ ‫ك‬َ‫ءا‬ ‫ركي‬ِ‫ن‬ ‫أ‬ُ‫ر‬ ‫ال‬َ‫ءا‬ ‫أ‬َ‫ءا‬ ‫س‬ٍ ‫َبءا‬ّ‫عٍسا‬َ‫ءا‬ ‫ن‬ُ‫ر‬ ‫ب‬ْ ‫ع‬‫ا‬ ‫ل ى‬ِ‫ن‬ ‫ل‬َ‫ءا‬ ‫قءا‬َ‫ءا‬ ‫ل‬َ‫ءا‬ ‫قءا‬َ‫ءا‬ ‫ح‬ٍ ‫بءا‬َ‫ءا‬‫ر‬َ‫ءا‬ ‫ب ى‬ِ‫ن‬‫أ‬َ‫ءا‬ ‫بن‬ْ ‫ع‬
‫ت‬ْ ‫ع‬ ‫ل‬َ‫ءا‬‫ءا‬‫ق‬َ‫ءا‬‫ف‬َ‫ءا‬ - ‫ ى‬ّ‫ٍسا‬ ‫َب‬ِ‫َنن‬ّ‫الٍسا‬ ‫ت‬ِ‫ن‬ ‫ت‬َ‫ءا‬‫أ‬َ‫ءا‬ ‫ء‬ُ‫ر‬ ‫دا‬َ‫ءا‬‫و‬ْ ‫ع‬ ‫َس‬ّ‫ٍسا‬ ‫ال‬ ‫ة‬ُ‫ر‬‫أ‬َ‫ءا‬‫ر‬ْ ‫ع‬ ‫م‬َ‫ءا‬ ‫ل‬ْ ‫ع‬‫ا‬ ‫ه‬ِ‫ن‬‫ذ‬ِ‫ن‬‫ه‬َ‫ءا‬ ‫ل‬َ‫ءا‬ ‫قءا‬َ‫ءا‬ .‫ل ى‬َ‫ءا‬‫ب‬َ‫ءا‬ ‫ت‬ُ‫ر‬ ‫ل‬ْ ‫ع‬‫ق‬ُ‫ر‬ ‫ة‬ِ‫ن‬ ‫َن‬ّ‫جٍسا‬َ‫ءا‬ ‫ل‬ْ ‫ع‬‫ا‬ ‫ل‬ِ‫ن‬ ‫ه‬ْ ‫ع‬ ‫أ‬َ‫ءا‬
‫ِن ى‬ّ‫إأ ى‬ِ‫ن‬‫ع‬ُ‫ر‬ ‫ر‬َ‫ءا‬ ‫ص‬ْ ‫ع‬ ‫أ‬ُ‫ر‬‫ك‬ِ‫ن‬ ‫ل‬َ‫ءا‬‫و‬َ‫ءا‬ ‫ت‬ِ‫ن‬ ‫ر‬ْ ‫ع‬ ‫َب‬َ‫صءا‬َ‫ءا‬ ‫ت‬ِ‫ن‬ ‫ئ‬ْ ‫ع‬‫ش‬ِ‫ن‬ ‫ن‬ْ ‫ع‬ ‫إ‬ِ‫ن‬ » ‫ل‬َ‫ءا‬ ‫قءا‬َ‫ءا‬ .‫ل ى‬ِ‫ن‬ ‫َلل‬ّ‫ٍسا‬َ‫ءا‬ ‫ا‬ ‫ع‬ُ‫ر‬ ‫د‬ْ ‫ع‬ ‫فءا‬َ‫ءا‬ ‫ف‬ُ‫ر‬ ‫َش‬ّ‫ٍسا‬ ‫ك‬َ‫ءا‬ ‫ت‬َ‫ءا‬‫أ‬َ‫ءا‬ ‫ِن ى‬ّ‫إأ ى‬ِ‫ن‬‫و‬َ‫ءا‬ ،
‫ن‬ْ ‫ع‬ ‫أ‬َ‫ءا‬ ‫َلل‬ّ‫ٍسا‬َ‫ءا‬ ‫ا‬ ‫ت‬ُ‫ر‬ ‫و‬ْ ‫ع‬ ‫ع‬َ‫ءا‬ ‫د‬َ‫ءا‬ ‫ت‬ِ‫ن‬ ‫ئ‬ْ ‫ع‬‫ش‬ِ‫ن‬ ‫ن‬ْ ‫ع‬ ‫إ‬ِ‫ن‬‫و‬َ‫ءا‬ ‫ة‬ُ‫ر‬ ‫َن‬ّ‫جٍسا‬َ‫ءا‬ ‫ل‬ْ ‫ع‬‫ا‬‫يك‬َ‫ءا‬‫ف‬ِ‫ن‬‫عءا‬َ‫ءا‬ ‫كي‬ُ‫ر‬‫ِن ى‬ّ‫إأ ى‬ِ‫ن‬ ‫ت‬ْ ‫ع‬ ‫ل‬َ‫ءا‬‫قءا‬َ‫ءا‬‫ف‬َ‫ءا‬ .‫ر‬ُ‫ر‬ ‫َب‬ِ‫صن‬ْ ‫ع‬ ‫أ‬َ‫ءا‬ ‫ت‬ْ ‫ع‬ ‫ل‬َ‫ءا‬‫قءا‬َ‫ءا‬‫ف‬َ‫ءا‬ .« ِ‫ن‬
،‫ف‬َ‫ءا‬ ‫َش‬ّ‫ٍسا‬ ‫ك‬َ‫ءا‬ ‫ت‬َ‫ءا‬‫أ‬َ‫ءا‬ ‫ال‬َ‫ءا‬ ‫ن‬ْ ‫ع‬ ‫أ‬َ‫ءا‬ ‫َلل‬ّ‫ٍسا‬َ‫ءا‬ ‫ا‬ ‫ع‬ُ‫ر‬ ‫د‬ْ ‫ع‬ ‫فءا‬َ‫ءا‬ ‫ف‬ُ‫ر‬ ‫َش‬ّ‫ٍسا‬ ‫ك‬َ‫ءا‬ ‫ت‬َ‫ءا‬‫أ‬َ‫ءا‬‫عءا‬َ‫ءا‬ ‫د‬َ‫ءا‬‫ف‬َ‫ءا‬‫الجزء‬ :‫الَبخءارى‬ ‫صحيح‬ .‫هءا‬َ‫ءا‬ ‫ل‬َ‫ءا‬
‫بءاب‬ .‫الَسءابع‬70:‫حدكيث‬ .555

By:
Dr: Samir MM Al- Minshawy
Lecturer of Neuropediatrics
Minia University
Egypt

We will discuss:
• Epilepsy awareness and knowledge
•Modern technology and epilepsy
•Exercise and epilepsy
•Stress and epilepsy
•Diet and epilepsy
•Others

Epilepsy in modern life gained much benefit
from new technology regarding diagnostic procedures
and therapeutic modalities including: epilepsy surgery,
vagus nerve stimulation, gene therapy and alternative
medicine approaches like: yoga, relaxation techniques,
biofeedback, nutritional & herbal supplements ,
dietary measures and acupuncture.
On the other hand, modern life is still adding risk
factors for epilepsy which presents multiple
challenges to the clinicians.

Attitude, Awareness and
Knowledge
‫رلا‬ ‫رلا‬ ‫رلا‬ ‫رلا‬ ‫رلا‬ ‫رلا‬ ‫رلا‬Paradigm ‫رلا‬Shift ‫رلا‬???

Although ‫رلا‬a ‫رلا‬revolution ‫رلا‬has ‫رلا‬been ‫رلا‬done ‫رلا‬in ‫رلا‬epilepsy ‫رلا‬research, ‫رلا‬
recent ‫رلا رلا‬technologies ‫رلا‬didn’t ‫رلا‬make ‫رلا‬this ‫رلا‬paradigm ‫رلا‬shift ‫رلا‬in ‫رلا‬perception ‫رلا‬
and ‫رلا‬understanding ‫رلا‬of ‫رلا‬epilepsy ‫رلا‬in ‫رلا‬general ‫رلا‬population.
Epilepsy ‫رلا‬ has ‫رلا‬ frequently ‫رلا‬ been ‫رلا‬ portrayed ‫رلا‬ in ‫رلا‬ literary ‫رلا‬ works, ‫رلا‬
films ‫رلا‬ and ‫رلا‬ television ‫رلا‬ (TV) ‫رلا‬ series, ‫رلا‬ often ‫رلا‬ relating ‫رلا‬ it ‫رلا‬ with ‫رلا‬ madness, ‫رلا‬
evil, ‫رلا‬violent ‫رلا‬behaviors ‫رلا‬or ‫رلا‬possession ‫رلا‬by ‫رلا‬the ‫رلا‬divine ‫رلا‬or ‫رلا‬ghosts. ‫رلا‬This ‫رلا‬
marks ‫رلا‬the ‫رلا‬awareness ‫رلا‬and ‫رلا‬knowledge ‫رلا‬people ‫رلا‬have ‫رلا‬about ‫رلا‬epilepsy ‫رلا‬
and ‫رلا‬epileptic ‫رلا‬patients. ‫رلا‬

Epilepsy ‫رلا‬has ‫رلا‬been ‫رلا‬always ‫رلا‬stigmatized ‫رلا‬(and ‫رلا‬still).
- ‫رلا‬ History ‫رلا‬ declared ‫رلا‬ that ‫رلا‬ much ‫رلا‬ discrimination ‫رلا‬ measures ‫رلا‬
were ‫رلا‬taken ‫رلا‬against ‫رلا‬epileptics ‫رلا‬even ‫رلا‬in ‫رلا‬20th
‫رلا‬century.
- ‫رلا‬In ‫رلا‬old ‫رلا‬civilizations ‫رلا‬and ‫رلا‬beliefs ‫رلا‬misunderstanding ‫رلا‬about ‫رلا‬
epilepsy ‫رلا‬ and ‫رلا‬ epileptic ‫رلا‬ patients ‫رلا‬ was ‫رلا‬ the ‫رلا‬ base, ‫رلا‬ ‫رلا‬ one ‫رلا‬ of ‫رلا‬
exceptions ‫رلا‬ which ‫رلا‬ was ‫رلا‬ done ‫رلا‬ by ‫رلا‬ the ‫رلا‬ pure ‫رلا‬ sunnah ‫رلا‬ in ‫رلا‬
Islam. ‫رلا‬

NARRATED 'ATA BIN ABI RABAH: IBN 'ABBAS
SAID TO ME, "SHALL I SHOW YOU A WOMAN OF
THE PEOPLE OF PARADISE?" I SAID, "YES." HE
SAID, "THIS BLACK LADY CAME TO THE
PROPHET AND SAID, 'I GET ATTACKS OF
EPILEPSY AND MY BODY BECOMES
UNCOVERED; PLEASE INVOKE ALLAH FOR ME.'
THE PROPHET SAID (TO HER), 'IF YOU WISH,
BE PATIENT AND YOU WILL HAVE (ENTER)
PARADISE; AND IF YOU WISH, I WILL INVOKE
ALLAH TO CURE YOU.' SHE SAID, 'I WILL
REMAIN PATIENT,' AND ADDED, 'BUT I BECOME
UNCOVERED, SO PLEASE INVOKE ALLAH FOR
ME THAT I MAY NOT BECOME UNCOVERED.' SO
HE INVOKED ALLAH FOR HER.
SAHIH BUKHARI" VOLUME 7, BOOK 70,
NUMBER 555

‫طءاء‬َ‫ءا‬ ‫ع‬َ‫ءا‬ ‫ن‬ْ ‫ع‬ ‫ع‬َ‫ءا‬‫ا‬‫ة‬ً ‫م‬‫أ‬َ‫ءا‬‫ر‬َ‫ءا‬ ‫م‬ْ ‫ع‬ ‫ا‬ ‫ك‬َ‫ءا‬ ‫ركي‬ِ‫ن‬ ‫أ‬ُ‫ر‬ ‫ال‬َ‫ءا‬ ‫أ‬َ‫ءا‬ ‫س‬ٍ ‫َبءا‬ّ‫عٍسا‬َ‫ءا‬ ‫ن‬ُ‫ر‬ ‫ب‬ْ ‫ع‬‫ا‬ ‫ل ى‬ِ‫ن‬ ‫ل‬َ‫ءا‬ ‫قءا‬َ‫ءا‬ ‫ل‬َ‫ءا‬ ‫قءا‬َ‫ءا‬ ‫ح‬ٍ ‫بءا‬َ‫ءا‬‫ر‬َ‫ءا‬ ‫ب ى‬ِ‫ن‬‫أ‬َ‫ءا‬ ‫بن‬ْ ‫ع‬
- ‫ ى‬ّ‫ٍسا‬ ‫َب‬ِ‫َنن‬ّ‫الٍسا‬ ‫ت‬ِ‫ن‬ ‫ت‬َ‫ءا‬‫أ‬َ‫ءا‬ ‫ء‬ُ‫ر‬ ‫دا‬َ‫ءا‬‫و‬ْ ‫ع‬ ‫َس‬ّ‫ٍسا‬ ‫ال‬ ‫ة‬ُ‫ر‬‫أ‬َ‫ءا‬‫ر‬ْ ‫ع‬ ‫م‬َ‫ءا‬ ‫ل‬ْ ‫ع‬‫ا‬ ‫ه‬ِ‫ن‬‫ذ‬ِ‫ن‬‫ه‬َ‫ءا‬ ‫ل‬َ‫ءا‬ ‫قءا‬َ‫ءا‬ .‫ل ى‬َ‫ءا‬‫ب‬َ‫ءا‬ ‫ت‬ُ‫ر‬ ‫ل‬ْ ‫ع‬‫ق‬ُ‫ر‬ ‫ة‬ِ‫ن‬ ‫َن‬ّ‫جٍسا‬َ‫ءا‬ ‫ل‬ْ ‫ع‬‫ا‬ ‫ل‬ِ‫ن‬ ‫ه‬ْ ‫ع‬ ‫أ‬َ‫ءا‬ ‫ن‬ْ ‫ع‬ ‫م‬ِ‫ن‬
‫ِن ى‬ّ‫إأ ى‬ِ‫ن‬ ‫ت‬ْ ‫ع‬ ‫ل‬َ‫ءا‬‫قءا‬َ‫ءا‬‫ف‬َ‫ءا‬‫ع‬ُ‫ر‬ ‫ر‬َ‫ءا‬ ‫صص‬ْ ‫ع‬ ‫أ‬ُ‫ر‬‫ت‬ِ‫ن‬ ‫ئ‬ْ ‫ع‬‫ش‬ِ‫ن‬ ‫ن‬ْ ‫ع‬ ‫إ‬ِ‫ن‬ » ‫لص‬َ‫ءا‬ ‫قءا‬َ‫ءا‬ .‫ل ى‬ِ‫ن‬ ‫َللص‬ّ‫ٍسا‬َ‫ءا‬ ‫ا‬ ‫عص‬ُ‫ر‬ ‫د‬ْ ‫ع‬ ‫فءا‬َ‫ءا‬ ‫ف‬ُ‫ر‬ ‫َش‬ّ‫ٍسا‬ ‫ك‬َ‫ءا‬ ‫ت‬َ‫ءا‬‫أ‬َ‫ءا‬ ‫ِن ى‬ّ‫إأ ى‬ِ‫ن‬‫و‬َ‫ءا‬ ،
‫نص‬ْ ‫ع‬ ‫أ‬َ‫ءا‬ ‫َللص‬ّ‫ٍسا‬َ‫ءا‬ ‫ا‬ ‫تص‬ُ‫ر‬ ‫و‬ْ ‫ع‬ ‫ع‬َ‫ءا‬ ‫د‬َ‫ءا‬ ‫تص‬ِ‫ن‬ ‫ئ‬ْ ‫ع‬‫ش‬ِ‫ن‬ ‫نص‬ْ ‫ع‬ ‫إ‬ِ‫ن‬‫و‬َ‫ءا‬ ‫ةص‬ُ‫ر‬ ‫َن‬ّ‫جٍسا‬َ‫ءا‬ ‫ل‬ْ ‫ع‬‫ا‬ ‫كص‬ِ‫ن‬ ‫ل‬َ‫ءا‬‫و‬َ‫ءا‬ ‫ت‬ِ‫ن‬ ‫ر‬ْ ‫ع‬ ‫َب‬َ‫ءا‬‫ص‬‫ص‬َ‫ءا‬‫يكص‬َ‫ءا‬‫ف‬ِ‫ن‬‫عءا‬َ‫ءا‬ ‫كي‬ُ‫ر‬‫ت‬ْ ‫ع‬ ‫ل‬َ‫ءا‬‫قءا‬َ‫ءا‬‫ف‬َ‫ءا‬ .« ِ‫ن‬
،‫فص‬َ‫ءا‬ ‫َش‬ّ‫ٍسا‬ ‫ك‬َ‫ءا‬ ‫ت‬َ‫ءا‬‫أ‬َ‫ءا‬ ‫ال‬َ‫ءا‬ ‫نص‬ْ ‫ع‬ ‫أ‬َ‫ءا‬ ‫َللص‬ّ‫ٍسا‬َ‫ءا‬ ‫ا‬ ‫عص‬ُ‫ر‬ ‫د‬ْ ‫ع‬ ‫فءا‬َ‫ءا‬ ‫فص‬ُ‫ر‬ ‫َش‬ّ‫ٍسا‬ ‫ك‬َ‫ءا‬ ‫ت‬َ‫ءا‬‫أ‬َ‫ءا‬ ‫ِنص ى‬ّ‫إأ ى‬ِ‫ن‬ ‫تص‬ْ ‫ع‬ ‫ل‬َ‫ءا‬‫قءا‬َ‫ءا‬‫ف‬َ‫ءا‬ .‫ر‬ُ‫ر‬ ‫َب‬ِ‫صصن‬ْ ‫ع‬ ‫أ‬َ‫ءا‬‫عءا‬َ‫ءا‬ ‫د‬َ‫ءا‬‫ف‬َ‫ءا‬.‫هءا‬َ‫ءا‬ ‫ل‬َ‫ءا‬
‫بءاب‬ .‫الَسءابع‬ ‫الجزء‬ :‫الَبخءارى‬ ‫صحيح‬70:‫حدكيث‬ .555

Modern Technology and Epilepsy

Photosensitive Epilepsy (PSE)
• It is a good example for effect of technology, it’s a form of reflex
epilepsy in which seizures can be triggered by flickering or
intermittent light stimulation, occurring in 1/4000 of the population,
common in childhood and more in girls. With age, it can disappear but
75% stay photosensitive for life.
• Seizures vary from brief absence seizures to tonic–clonic seizures,
May preceded by “aura” and this can serve as a warning. Flashing
lights or rapidly changing or alternating images (as in clubs, around
emergency vehicles, in action movies or television programs, cinema,
theatre…….. etc.) are examples especially in luminance contrast. Red
color is a good trigger. The photoparoxysmal response in EEG helps
in diagnosis. Treatment remains the removal of the offending stimulus
with drug therapy (as sodium valproate).

*Television is the most common source of seizures in PSE
especially in a dark room, at close range and with flickering.
Some patients self-induce seizures by waving their fingers in
front of their eyes with TV watching.
*For protection:
• The room should be well-lit.
• light source is placed on top of or behind the TV to balance the
screen brightness.
• Flat screen or LCD (liquid crystal display) units don’t flicker at
all.
• Sitting away (2.5 meters).
• Use a remote control or cover one eye to reduce flickering.
• Take a five-minute break every 30 minutes.

• Seizures triggered by VGs were reported, not only in photosensitive,
but also in nonphotosensitive epileptic children.....Preventive
measures concerning the characteristics of images VGs (flash rate,
choice of colours, patterns, and contrast).
• Playing video games on a LCD TV screen
• No playing with the feeling of tiredness
• Taking a 5-minute break away every 15 minutes
• Switching off immediately with dizziness , blurring of vision, muscle
twitching and being uncomfortable in any way .

• It is recommended that computer screens have a refresher
frequency of at least 73 Hz or use LCD screen, the
computer screen should not show any glare, which can
result in a flickering.
• The risk of a seizure depends on the material being
viewed. Some software, especially games, cartoons and
web designs contain flickering images.
• Use an anti-glare screen to reduce fatigue and discomfort
• Take regular breaks away (5 minutes every 15 minutes).

Going to cinema and theatre is safe with epilepsy.
Films with special effects (including laser and
flashing lights) could potentially trigger seizures in
people with photosensitive epilepsy. Think carefully
about where is the seat.

• It is more beneficial to use natural light or old-
fashioned light bulbs. Energy-saving bulbs are
small fluorescent tubes. Older strip fluorescent
light tubes flicker more and should be exchanged
regularly.

Electromagnetic fields (EMFs) emitted by mobile
phones had been shown to increase cortical
excitability and modulate inter-hemispheric
synchronization of temporal and frontal resting EEG
rhythms.
Inhabitants living nearby mobile base stations are at
risk for developing neuropsychiatric problems and
some changes in the performance of neurobehavioral
functions either by facilitation or inhibition.

Although that exposure wasn’t above accepted international
guidelines, studies had reported increased prevalence of adverse
neurobehavioral symptoms , such as headache, memory changes,
dizziness, tremors, depression, sleep disturbances and more significant
increases in the frequency of seizures in epileptic patients if living at
distances <500 m from base stations which suggesting that current
guidelines may be inadequate in protecting health. Other studies added
the dose response relationship, duration exposure and other variables,
such as sociodemographic data.
Future research should address critical and neglected issues such
as investigation of repeated, intensive and chronic exposures, especially
in in highly sensitive populations such as epileptic children to provide
safe rules for the use of mobile

Finally, research related to the effects on health of using mobile
phones is inconclusive. So until there is more evidence, it is sensible for
everyone, whether they have epilepsy or not, to restrict their mobile
phone use to short and essential calls only.
-People with epilepsy who use mobile phones often should carefully
monitor their seizure frequency.
-Mobile phones should be kept away from vagus nerve stimulation
devices.
-Children with epilepsy should be discouraged from using mobile
phones.

Although microwave ovens are recommended as
a safe cooking alternative for epileptic patients but
hand burns in complex partial seizures are reported.
The use of gloves and heating foods (not boiling
liquids) is recommended.

Both physical (work related) and mental stress are
commonly believed to precipitate seizures in some patients
with epilepsy. Stress itself may also be associated with other
seizure-provoking factors such as sleep deprivation.
Stressful life events as wars can be provocative factors for
the occurrence of seizures. Typical absence seizures are
more likely to be provoked by stress then other types of
seizures.

Epileptic patients have previously been discouraged from
participation in sports dx- for fear of inducing seizures or increasing its
frequency. Although there are rare cases of exercise-induced seizures,
studies have shown that it improves both physical and psychosocial
outcomes.
The majority of sports are safe provided adequate seizure control
and preparation of family and trainers. Contact sports including football
don’t induce seizures.
Water sports and swimming are safe if seizures are well
controlled and direct supervision is present with exception for those who
have bathing epilepsy or hot-water epilepsy.
Additional care must be taken in sports involving heights such as
gymnastics, or horseback riding. Sports such as hang-gliding, diving are
not recommended, given the risk of severe injury or death, if a seizure
were to occur during the activity.

Generally, most sports are safe as long as
patients avoid overexertion, dehydration and
hypoglycemia. If a seizure occurs, it is most likely to
be after the exercise (15 minutes to three hours later)
and can occur suddenly without warning.

• Travelling by cars and trains: Patients should sit away from
watching fast moving or jerking shapes on roads, also light
reflection on rapidly moving vehicles which can trigger seizures in
PSE.
• Air travel increases seizures frequency. Provided that seizures are
controlled with medication, epileptic Patients can travel by air.
• Epilepsy is thought to be one of the essential contraindication for
driving a motor vehicle on public roads. There is a tendency
toward a greater liberalization of driving standards for people with
epilepsy.

Foods that thought to be seizure triggers in some patients include:
artificial colors, preservatives especially Propionate in addition towheat,
cows milk and cheese (but not sheep cheese), tomatoes, tea, grapes and
other salicylate-containing foods; chocolate, pork, banana, amine-
containing foods and other glutamate containing foods (Egger et al,
1989). ).

Others
• Pollution
• Noise
• Smoking
• Radiation

�ݺ�ߣ

Epilepsy and Modern Life

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