Epilepsy

Introduction

Epilepsy is a group of neurologic disorders associated with sudden seizures. The disorder has been known since the ancient times, and yet, there are no preventive actions and cure. More than 2.5 million people in America are afflicted by epilepsy. For this reason, epilepsy is a relevant subject for discussion. Considering 5 W’s of epidemiology, one can state that epilepsy is diagnosed in the people of different age (more often in elder people), race, and gender (men suffer from it more often than women) with no specific region of development. However, it is more common in the developing countries, epilepsy has no time boundaries, it is not contagious, and the cause of it is unknown (apart from brain damage). It is a complicated task to make a prognosis because one cannot predict individual response to the medications, but generally, seizures can be controlled. The current paper concentrates on describing epilepsy, demographics that suffer from it, symptoms, diagnosis, etiology, and known treatment.

The term ‘epilepsy’ is a descriptive word that, when translated from Greek, stands for ‘to seize’ or ‘to attack’. Despite the long history of the study of epilepsy, this disease still has unexplained features that are rooted in historical and social concepts of a supernatural. Epilepsy was fraught with controversy based on social and medical descriptions. Even though it was Hippocrates who had written about epilepsy in 400 B.C, the disorder was adequately defined by John Hughlings Jackson only in 1873. According to the neurologists, epilepsy is “a sudden, excessive, and rapid discharge of gray matter of some part of the brain that would correspond to the patient’s experience.” The modern medicine recognizes epilepsy as “a chronic disorder of the cerebral cortex with various etiologies characterized by recurrent seizures due to an excessive paroxysmal discharge of cortical neurons, associated with a variety of semiologic manifestations.”

Demographics

Epilepsy is a disorder that is registered more often that Parkinson’s disease, cerebral palsy, and multiple sclerosis. Although epilepsy is a chronic illness, there risk of having one seizure during a lifetime is close to 10%. People younger than 20 years old are not likely to develop epilepsy. The risk of experiencing seizures increases for people by the age of 75. Approximately 50 million people worldwide suffer from epilepsy, and 25% of them do not have any control over the disorder even when they receive treatment.^{2(p 118)} Epilepsy is a medical problem that requires a proper diagnosis. Sometimes, patients may be misdiagnosed because epilepsy is a condition associated with seizures and it has no other apparent symptoms and causes.

Etiology

For most people who develop epilepsy, the cause of it remains unclear. Even the contemporary studies conclude that epilepsy may be the result of a brain damage, but the exact etiology is unknown. According to an epidemiological survey, the cause of epilepsy “is vascular disorder (10%), followed by congenital complications (8%), brain trauma (6%), tumor (4%), degenerative disorders (4%), and infectious diseases (3%).”⁾ The etiology of epilepsy depends on the congenital disorders, brain damages and tumors as well as cerebrovascular and degenerative disorders that become more frequent when people get older.

The etiology of seizures varies with their location. They may begin focally in some area of the brain or generalize all over the brain. It is hard to establish reasons that provoke a seizure, but sometimes, people may be able to define certain ‘triggers’ that include: stress or anxiety, sleep deficiency, drugs (anti-psychotic medication and anti-depressants), a low blood sugar level due to irregular meals, alcohol drinking, menstruation cycle, fever, and others. Flickering lights may also be the reason of seizures, which is why this condition manifests itself while playing video games or being in a cinema.

Recently, scientists have emphasized the importance of genetic factors. Thus, epilepsy is associated with gene mutations. Various defects in genes do not necessarily cause epilepsy, but they can alter the excitability of brain in a way that makes an individual predisposed to seizures that is “relevant to generalized seizures, including absence, generalized tonic-clonic, and myoclonic seizures.”⁾

Clinical Sings and Diagnosis

In most cases, epilepsy is diagnosed if a patient experiences repeated spontaneous seizures for some time. During seizures, eyes of an individual who suffers from epilepsy are usually open; an individual loses consciousness and he or she may turn blue and breathe deeply or appear not to be breathing. The diagnosis is difficult to determine because the seizure types vary. It is important to distinguish this heterogeneous state from the isolated seizures provoked, for instance, by cerebral disorders. Epilepsy may be confused with other “frequently occurring non-epileptic events requiring distinction and exclusion” such as pseudoseizures and syncope.

The anatomy of the condition in question is based on the structure of a brain. In other words, epilepsy is developed when there is some damage in the brain. Each of 50-100 billion neurons creates approximately 10,000 contacts with each other, so there are trillions of connections that exist in a brain.¹ Seizures appear when there is even a small dysfunctional part of a brain that provokes the synchronous discharging of neurons.

Seizures may be of different kinds depending on the damaged area of the brain. According to the International League Against Epilepsy (ILAE), there are generalized seizures (tonic-clonic seizures, clonic seizures, typical and atypical absence seizures, spasms, myoclonic seizures, etc.) and focal seizures (sensory and motor seizures, gelastic seizures, hemiclonic, and other types). Epileptic syndromes are classified as follows: ohtahara syndrome, idiopathic photosensitive occipital lobe epilepsy, HH syndrome, Rasmussen syndrome, reflex epilepsies, neocortical epilepsies, etc. In order to diagnose epilepsy, one should take into consideration a type of seizures, etiology, and the age of a patient. To ensure the accuracy of a diagnosis, electroencephalogram (EEG) is used.

Treatment

Seizures are the main manifestation of epilepsy as a medical condition but they do not necessarily indicate that a patient has epilepsy, which is why treatment may be complicated. Medication may help to control seizures that are a result of a severe head injury. The problem is that neurological impairments and those related to epilepsy may still be present after the treatment. There are also patients that may acquire bland neurological problems but may have severe seizures that do not respond to drugs applied in cases of epilepsy.

Epilepsy may not be cured completely, but it can be effectively controlled in about 60% of patients. For example, juvenile myoclonic epilepsy is treated with valproic acid, and absence seizures respond well to ethosuxamide. A list of the effiecient medications in the management of epilepsy is as follows: phenobarbital, leviteracetam (Keppra), clonazepam (Klonipin), topiramate (Topamax), ethosuxamide (Zarontin), felbamate (Felbatol), oxcarbazepine (Trileptal), carbamazepine (Tegretol, Carbatrol), lamotrigine (Lamictal), zonisamide (Zonegran), and other medicine.

If drugs fail to cope with the symptoms of epilepsy, another medicine may help. However, if medications are ineffective, one should consider applying other types of therapy such as a brain surgery, the ketogenic diet, and vagal nerve stimulation. There are alternative treatments, for instance, the usage of cannabinoids, but the positive results have not been proven yet. It should be noted that epilepsy requires constant medical attention.

Conclusion

Epilepsy is a neurological disorder characterized by seizures, and in most instances, the etiology of epilepsy is unknown. Clinical sings, types of seizures, and the age of a patient are defining factors in choosing a particular method of treatment. The choice of medication is a serious matter as drugs have their side effects and they are not always effective. In most cases, epileptic seizures can be controlled. In order to treat epilepsy, further research is required.

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