Epilepsy which is a neurological condition affecting the nervous system, also known as a seizure disorder and can affect anyone with a brain. It is usually diagnosed after at least two seizures not caused by some known medical condition. Epileptic seizures are caused by disturbances in the electrical activity of the brain. Most of the time the cause is for the seizure in epilepsy is unknown however in some cases it may be related to a brain injury or a family tendency. According to the World Health Organization, epilepsy is the most common serious brain disorder worldwide with no age, racial, social class, national or geographic boundaries. Epileptic seizures are like unexpected electrical “storms” in the brain. A seizure is characteristic of epilepsy but not all seizures are due to epilepsy for e.g. febrile seizures or drug-induced seizures (1). A seizure is defined as a disruption of the electrical communication between neurons. Impact of seizures on the lives of epilepsy patients is in many ways including creating barriers to employment and education and facing a sense of discrimination and isolation from their peers.
More than three million people in the U.S. and over 65 million people worldwide live with epilepsy. In the U.S.A. itself, there are 3.4 million people living with active epilepsy which mounts to be more than Autism Spectrum Disorders, Parkinson’s, Multiple Sclerosis and Cerebral Palsy combined. In spite of the broad impact of epilepsy disease it receives one-tenth the research funding than any one of the neurological disorders. To spread the awareness about epilepsy the word that epilepsy can affect anyone with a brain, and anyone with a brain can affect, epilepsy should be spread. Purple Day is an international grassroots effort dedicated to increasing awareness about epilepsy worldwide. Every year on March 26th people in countries around the world is invited to wear purple and host events in support of epilepsy awareness. It is a special event which promotes awareness and on this day people join together to celebrate and highlight the problems faced by epilepsy patients, their families, and carers.
The epileptic seizure could also be called an unknown onset when it is not witnessed by anyone, for example when seizures happen at night or in a person who lives alone. A seizure is characterized by many different symptoms. Other disorders can also cause changes in behavior and can be confused with epilepsy. Diagnosing the type of seizure or epilepsy syndrome can be difficult without the knowledge of seizure type. The treatment of seizures depend on an accurate diagnosis hence the first critical step is to make sure that a person has epilepsy, and what type it is. Seizures are classified into different classes. Generalized Onset Seizures, which affect both sides of the brain at the same time. Focal Onset Seizures talks about the location of seizure. Focal seizures can start in one area or group of cells on one side of the brain. Focal Onset Aware Seizures, which occur when a person is conscious or aware during a seizure. It is also called a simple partial seizure. Focal Onset Impaired Awareness, where awareness is affected during a focal seizure and it is the complex partial seizure. Unknown Onset Seizures, when the beginning of a seizure is not known. What happens during a seizure is one of the most important pieces of information and the information given to the doctor and other health care professionals by witnesses is extremely important.
Some symptoms are seen more often in people with seizures and they could be related to the seizures or epilepsy. For example, mood problems or changes could be related to times of seizures or side effects of medicines. The area of the brain causing the seizures may also be causing mood problems. Most importantly people must learn how to respond to seizures in a variety of situations and be prepared to handle. Living with seizures also means learning how to handle the way epilepsy affects life including social, emotional and physical well-being. Some people may notice that their seizures occur in response to very specific stimuli and is called reflex epilepsy. In this type, seizures occur consistently in relation to a specific trigger. For example, one type of reflex epilepsy is photosensitive epilepsy where seizures are triggered specifically by flashing lights. Other types of reflex epilepsies may be seizures triggered by the act of reading or by noises. Though these are not common, knowing what to do in this form of epilepsy helps to learn how to manage them.
Various treatment options are available for epilepsy and antiepileptic medications are the first line treatment. There are 29 different antiepileptic medications available in the US, however, one-third of patients still experience intractable seizures. Intractable seizures are defined as the failure of adequate trials of two tolerated and appropriately chosen antiepileptic medication schedules with adequate doses. Intractable epileptic patients have a significantly increased risk of injuries and premature death and poorly controlled epileptics experience decline in memory and cognition . In intractable epilepsy, other alternative non-pharmacological treatment including epilepsy surgery, neurostimulation therapy, and diet therapy such as the ketogenic diet can be considered. Depression and anxiety have been seen to be common and more prevalent in patients with epilepsy compared to the general population. Of the established epilepsy drugs, ethosuximide acts on T-type calcium channels, implicated in the thalamocortical disturbance believed for decades to underlie generalized epilepsies. A small, non-randomized study has suggested that ethosuximide may be also associated with a greater chance of long-term remission . Not all patients respond equally to medication. Clinical imaging and EEG study, comparing those patients responsive to valproate to those who are resistant, suggested different patterns of activation may underlie the varying therapeutic responses.
Public misunderstanding about epilepsy causes social challenges like bullying, discrimination, and depression. People don’t want to talk about it, but we can no longer ignore it. Recent epilepsy research has started to change thinking and approach to patients in a broader way.
- Riviello JJ. Classification of seizures and epilepsy. Curr Neurol Neurosci Rep. 2003 Jul; 3(4):325-31.
- Kapur J, Macdonald RL. Rapid seizure-induced reduction of benzodiazepine and Zn 2+sensitivity of hippocampal dentate granule cell GABA A receptors. J Neurosci. 1997;17:7532–7540.
- Berg AT, Levy SR, Testa FM, Blumenfeld H. Long-term seizure remission in childhood absence epilepsy: might initial treatment matter? Epilepsia. 2014;55:551–557. doi: 10.1111/epi.12551.