Table of Contents
Epilepsy is one of the most common neurological disorders which usually appears due to factors that interfere with different electrical impulses in the brain. The entire nervous system produces sudden, excessive and disorganized electrical discharges that lead to convulsions. These convulsions temporarily interfere with muscle control, faecal elimination, speech, vision and the general awareness of a person. Seizures are extremely dangerous, especially if they are severe. Fortunately, when chosen properly, treatment reduces abnormal electrical impulses in the brain and can control the effects of a seizure. Epilepsy is not a form of mental illness and is not contagious in any way.
The causes of epilepsy are not fully discovered yet. Less than half of the people suffering from epilepsy developed this illness because of a common, identifiable cause. In most cases, epilepsy is a result of the effects of other affections such as:
Cranio-cerebral trauma should be treated with utmost seriousness because it has dangerous implications, over half of the deaths in the world being caused by it. Depending on the severity of each case, some of them can be treated at home, but the rest require special treatment. It is highly important to evaluate and treat this affection early, especially if it implies secondary cerebral lesion which can lead to worsening the existent condition (e.g. epilepsy).
Brain tumors can occur at any age in a person’s life. Given this reason, everyone has a certain risk of developing brain tumors. Children and elderly people face the highest risk of suffering from this affection. The types of tumors developed in the case of different age groups vary greatly. For instance, glioblastoma has the highest incidence in the elderly while the medulloblastoma is more common in children and adults. Both types can cause death, but they behave completely different in the process.
A stroke occurs when a brain blood vessel or an artery breaks or is blocked by blood clot. In a few minutes after the incident occurred, the nerve cells in that area are affected and they can die in as little as a few hours. As a result, the part of the body that is controlled by the brain area which was previously affected can no longer function as it should. If symptoms of stroke occur, an emergency treatment is immediately required. If medical treatment will be started as soon as possible after the onset of a symptom, fewer nerve cells will be affected.
Epilepsy can also occur in the case of people without suffering from the aforementioned affections. The cause of epilepsy is not identified in all the existent cases. Recent studies show that epilepsy is found in children much more often than in adults. This is the reason why scientists tend to believe that family history is one of the key factors in encountering epilepsy in one’s life.
Other body conditions that could lead to epilepsy:
Encountering seizures is the only visible symptom of epilepsy. There are several types of convulsions and the symptoms of each type can manifest completely different for each person suffering from epilepsy. Convulsions can last either a few seconds or a few minutes. Losing consciousness is a common effect of having a seizure, depending on the type of epilepsy that the patient has. Some people remember what is happening during a seizure, while others are not able to do so. Convulsions that imply falling on the ground or muscle tension are often ending up with serious consequences. Many seizures do not involve these reactions and can be extremely difficult to notice.
For instance, some patients might be experiencing blank stares for a few seconds. Other seizures consist of a few muscle spasms. Some epilepsy patients stated that they started scenting smells that people around them couldn’t feel at all. Epileptic convulsions often occur without a prior warning signal, although some people mention an overall bad feeling before the onset of the actual convulsion. Convulsions cease when the abnormal electrical activity happening in the brain ends and returns to normal.
There are two types of existent seizures:
The symptoms of a suddenly-installed seizure that can last just a few seconds can include the following:
Affections that are similar to seizures:
Other risk factors that can cause seizures:
Taking anti-epileptic drugs for people who, in reality, are not suffering from epilepsy can cause seizures that would otherwise not have occurred.
How does epilepsy function?
Although epilepsy is one of the most common neurological disorders involving the entire nervous system, specialists can’t explain exactly the reason why the disease occurs and how the abnormal electrical discharge happens at a cerebral level. Epilepsy has no predictable evolution. It can occur at any age and may worsen after a period of apparent improvements. Although it is very unusual, this disease initially affects a certain brain area and then extends or even moves entirely to another one. Some types of childhood epilepsy disappear completely once adolescence is reached. Other types of epilepsy persist for life. Epilepsy cause by a cranio-cerebral trauma can disappear after a few years or can persist until the end of the patient’s life. There is no cure for epilepsy, but fortunately, there are some treatments that can control epileptic seizures and prevent their recurrence.
The prevalence of epilepsy is extremely high, affecting about 50 million people in the whole world, which represents approximately a 3% risk of developing it. The classification of epilepsy is particularly difficult and reflects the etiological diversity of each form of this affection. The most widely accepted classification is developed by ILAE and is one of the most exact ones for establishing aetiology, pathology and research facts and also for choosing the appropriate treatment and assessing a prognosis for the future.
The epilepsy treatment is (or at least, should be) closely related to the cause of the disease. Since this is tremendously difficult to determine, this makes it an almost impossible task. In most cases, epilepsy is labelled as idiopathic, although a large proportion of the existent cases (up to almost one third) are caused by identifiable precipitating risk factors. The most common causes, as mentioned before, include ischemic/haemorrhagic cerebrovascular accidents, trauma, tumors, neurodegenerative disorders, intoxications etc. It is important to identify these cases as they may not meet the epilepsy diagnosis criteria and may sometimes benefit from a curative treatment that can be distinct from idiopathic strategies.
The current treatment for epilepsy it’s not very wide, including the existent supportive and pharmacological strategies that patients use. Appreciating the requirements for initiating a treatment and the methods of selecting the exact medication for epilepsy is a very complicated task, even for specialists. An analysis of the effectiveness and current role of surgical interventions for treating epilepsy should also be taken into account.
Managing epilepsy has become a multidisciplinary effort, patient-centered and holistic in its ethos. It is paramount to remember the importance of allied medical specialists and social support in coping with epilepsy. This is not just a physical illness, but also one which has social implications, because it can badly affect the quality of life for a patient. Including psychological support along with the treatment is a must before anything else.
The progression of epilepsy varies for each patient and clinical syndrome in part. It is difficult to generalize the progression of the disease and to predict exactly the prognosis at a general level. In pharmacological terms, one of the most important questions doctors need to answer in the symptomatic treatment of epilepsy is when do the patients have to start their treatment. The answer to this question is never exact, but the actual evidence suggests that after a single, unprovoked seizure (and therefore, before the definitive diagnosis of epilepsy), the recurrence rate without pharmacological treatment is 25%. A randomized trial has shown that early treatment after a single seizure affects the short-term chances of not experiencing recurrent, but not long-term symptoms of epilepsy. However, the risk of those with more than one seizures to new seizures is 75%, therefore prophylactic treatment in these patients is generally successful. Pharmacological management is a complex intervention with variable efficacy, which should be adjusted for each individual patient.
Generally, antiepileptic medication is effective in controlling a seizure in about 60-70% of cases, although frequently this result is reached through a trial-and-error method. Choosing a first-line drug is a complicated but important process. The initial selection will require the clinician to appreciate both the patient and his wishes. Therapeutic monitoring, side effects, teratogenicity and even the price of the treatment are important, but the ultimate goal is usually to achieve effective and rapid seizure control with minimal side effects. The randomized SANAD study by Marson et al. tried to establish the first-line drug for newly diagnosed epilepsy patients with generalized or partial seizures. This study has attracted much attention, and despite its solid character, it was highly criticised.
The results, if accepted, suggest that sodium valproate is the primary intent for generalized seizures, and lamotrigine in partial seizures. Note that three new anti-epileptic drugs (levetiracetam, zonisamide and pregabalin) have been introduced since the onset of the study. None of these were considered in the study.
Generalized idiopathic epilepsy
For pharmacological interventions, the first-line drug in idiopathic generalized epilepsy is sodium valproate. The efficacy of this preparation was accidentally discovered in 1963 when valproic acid was used as solvent for various compounds evaluated for antiepileptogenic properties in electrical models of epilepsy in mice. The exact mechanism of action of the drug has never been fully explained, but what is known at the moment is that it appears to inhibit the action of succinyl semidaldehyde dehydrogenase, thus lowering the succinic acid concentration and cancelling the inhibition of L-glutamic acid decarboxylase (GAD). GAD in this way is free to convert L-glutamic acid to gamma-aminobutyric acid (GABA) inhibitory neuromodulator.
More recent work has shown that it can also act by increasing the concentration of the neuropeptide Y in the thalamus and temporal lobe and thus reducing epileptiform oscillations. The concept of an antiepileptic drug simply increasing inhibitory factors and thus reducing the epileptiform paroxysmal discharge is sure to be grossly simplified. Although sodium valproate is useful in a variety of forms of epilepsy, including tonic-clonic (grand mal), myoclonic and abscess, the main limitations are its teratogenicity and the wide list of adverse effects. Of these, the most common are tremor, thrombocytopenia and weight gain. From idiosyncratic reactions are mentioned hair loss and impaired liver function.
In the last two decades the stereotactic neurosurgical approach has transformed surgical practice entirely and significantly improved clinical outcomes. These benefits have generally been made by improving the existent surgical accuracy provided by this technique. Analogous performances include the application of magnetoencephalography and DW tractography to the treatment of epilepsy. These techniques improve the localization of lesions in the brain and improve the resolution of the resection margins in order to completely eliminate the lesion and keep the cortex functional.
Clinical applications of these techniques are still being investigated, but progress needs to be made with caution, given that some unusual cases have been reported, such as relying exclusively on imaging techniques without other investigative methods have led to some detrimental results. The role of white matter tractography is currently under investigation in the epilepsy surgical treatment. In the same way, transcranial magnetic stimulation and deep brain stimulation attract ever more interest in this context. Other invasive treatments with revolutionary potential benefits include stem cell, drug and even viral implantation with affinity to epileptic outbreaks.