Pharmacy and Health Blog from myGenericPharmacy.com

Understanding Epilepsy: A Neurological Perspective

What is Epilepsy?
Epilepsy is a chronic neurological disorder characterized by recurrent, unprovoked seizures resulting from abnormal, excessive, or synchronous neuronal activity in the brain. The International League Against Epilepsy (ILAE) defines epilepsy as at least two unprovoked seizures occurring more than 24 hours apart, or one unprovoked seizure with a high probability of further seizures.

Epidemiology:
Epilepsy affects approximately 50 million people worldwide, making it one of the most common neurological disorders globally. Incidence varies by age, with the highest rates in children and older adults.

Seizure Classification: The ILAE 2017 Framework

The ILAE updated seizure classification in 2017 to improve diagnostic accuracy and treatment planning

Focal Onset Seizures:

• With retained awareness: Previously “simple partial” (affecting ~60% of adults with epilepsy)
• With impaired awareness: Previously “complex partial.”
• Focal to bilateral tonic-clonic: Previously “secondarily generalized.d”

Generalized Onset Seizures:

• Absence (typical and atypical)
• Myoclonic
• Tonic-clonic
• Tonic, atonic, clonic

Unknown Onset Seizures:

• Whether the onset is unclear

Diagnostic Evaluation: Evidence-Based Approaches

Clinical Assessment:
A thorough history from patients and witnesses remains the cornerstone of diagnosis [6]. Key elements include:

• Detailed description of seizure semiology
• Frequency, duration, and timing patterns
• Precipitating factors and warning signs (auras)
• Postictal symptoms and recovery time

Diagnostic Testing:

• EEG: Standard awake and sleep-deprived EEG has 29-55% sensitivity for detecting epileptiform discharges in patients with epilepsy [7]. Prolonged video-EEG monitoring increases yield to 80-90% [8].
• Neuroimaging: Brain MRI with epilepsy protocol detects structural abnormalities in 12-14% of newly diagnosed adults and up to 40% of drug-resistant cases [9].
• Genetic Testing: Recommended for epilepsy with developmental delay, specific epilepsy syndromes, or family history [10].

Treatment Modalities: Evidence and Guidelines

Pharmacological Management:
First-line treatment involves anti-seizure medications (ASMs). According to the 2018 ILAE treatment guidelines [11]:

• Focal seizures: Lamotrigine, levetiracetam, and carbamazepine have Level A evidence
• Generalized tonic-clonic seizures: Valproate, lamotrigine, and levetiracetam are first-line
• Absence seizures: Ethosuximide and valproate are most effective
• Important consideration: Valproate should be avoided in women of childbearing potential due to teratogenic risk [12]

Surgical Interventions:
For drug-resistant epilepsy (failure of ≥2 appropriately chosen ASMs), surgical evaluation is recommended [13]:

• Anterior temporal lobectomy: 60-70% seizure freedom at 10 years for mesial temporal lobe epilepsy [14]
• Responsive neurostimulation (RNS): 75% median seizure reduction at 9 years post-implant [15]
• Vagus nerve stimulation (VNS): ≥50% seizure reduction in 50-60% of patients at 12 months [16]

Dietary Therapies:

• Classic ketogenic diet: 4:1 lipid:non-lipid ratio, effective in 30-40% of drug-resistant cases [17]
• Modified Atkins diet: Less restrictive, similar efficacy in some populations [18]

Special Populations and Considerations

Women with Epilepsy:

• Hormonal fluctuations can affect seizure frequency (catamenial epilepsy affects ~30% of women) [19]
• Enzyme-inducing ASMs (carbamazepine, phenytoin) reduce contraceptive efficacy [20]
• Periconceptual folic acid supplementation (4-5 mg/day) is recommended for all women with epilepsy [21]

Older Adults:

• Most common age group for new-onset epilepsy [22]
• Age-related pharmacokinetic changes require dose adjustments
• Higher risk of drug interactions due to polypharmacy

SUDEP Prevention:
Sudden Unexpected Death in Epilepsy (SUDEP) affects approximately 1 in 1000 adults with epilepsy annually [23]. Risk reduction strategies include:

• Maximizing seizure control
• Night-time supervision or monitoring devices
• Education about SUDEP risk factors

Emerging Research and Future Directions

Digital Health Innovations:

• Wearable seizure detection devices show 70-90% sensitivity for generalized tonic-clonic seizures [24]
• Machine learning algorithms analyzing EEG data show promise for seizure prediction [25]

Genetic Advances:

• Next-generation sequencing identifies causative variants in 25-48% of early-onset epilepsies [26]
• Precision medicine approaches targeting specific genetic mutations are in development

Novel Therapeutics:

• Fenfluramine shows efficacy in Dravet and Lennox-Gastaut syndromes [27]
• Cannabidiol (FDA-approved for specific epilepsy syndromes) demonstrates 40-50% seizure reduction in treatment-resistant cases [28]

Quality of Life and Psychosocial Aspects

Comorbidities:

• Depression affects 30-35% of people with epilepsy [29]
• Anxiety disorders are 2-3 times more common than in the general population [30]
• Cognitive impairment, particularly memory difficulties, affects 20-50% [31]

Stigma Reduction:

• Public education programs improve knowledge and attitudes [32]
• Disclosure decisions should balance privacy needs with safety considerations
• Employment discrimination protections exist under the Americans with Disabilities Act

Disclaimer

This blog provides educational information based on current evidence but does not substitute for personalized medical care. Treatment decisions should be made in consultation with a qualified neurologist or epileptologist. For emergencies, call 911.

Reference:
https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-20350093
https://pmc.ncbi.nlm.nih.gov/articles/PMC10911047/
https://www.epilepsy.com/what-is-epilepsy/seizure-types/focal-onset-impaired-awareness-seizures
https://pmc.ncbi.nlm.nih.gov/articles/PMC5115226/

Medications that have been suggested by doctors worldwide are available on the link below
https://mygenericpharmacy.com/category/disease/epilepsy

The estimated number of Americans affected by epilepsy is 1.2 percent, according to the Centers for Disease Control and Prevention (CDC). That is approximately 344 million people. Around 50 million people worldwide are estimated to be affected by epilepsy, according to World Health Organization (WHO) estimates. Approximately 80% of them reside in nations with low or middle incomes. Seizures are the main symptom for the majority of epileptics. These are spikes in the brain’s electrical activity. The location of these seizures within the brain can change how they impact the body as a whole.

In addition to controlling their seizures, people with epilepsy frequently struggle with stigma. According to the authors of one study, people with epilepsy report that their quality of life is significantly impacted by the stigmatizing nature of the condition and the psychological distress it causes. Disseminating information about epilepsy to the public is one way to lessen stigma. We address 13 myths about epilepsy below. We have enlisted the assistance of Dr. Clifford Segil, a neurologist at Providence Saint John’s Health Center in Santa Monica, California, for his valuable insight.

Anyone who has seizures has epilepsy
While epilepsy is arguably the most well-known seizure disorder, there are other types as well. Different conditions may have different mechanisms, but abnormal electrical activity in the brain is the cause of epilepsy. For example, non-epileptic seizures can be brought on by low blood sugar or cardiac issues. Dissociative seizures, also known as psychogenic non-epileptic seizures (PNES), are the most prevalent type of non-epileptic seizures. PNES are linked to several things, such as psychological trauma and mental health issues. It’s important to remember that 10% of individuals with PNES are thought to also experience epileptic seizures.

People with epilepsy cannot work
It’s a myth. People with epilepsy or seizures can work as long as their seizures are managed with medication, according to Dr. Dot Segil in an interview with Medical News Today. He also disclosed to us that he has known medical professionals who have epilepsy. Only a few occupations—truck driving and piloting, for example, prohibit people with seizure disorders from employment.

Epilepsy is contagious
This is an outdated misconception that persists, especially in some regions of the world: epilepsy is not communicative. Even though specialists are aware that epilepsy cannot be contagious, pinpointing the cause remains difficult. In roughly 50% of cases worldwide, the disease’s cause is still unknown, according to the WHO. Some possible causes of epilepsy include brain damage sustained during or shortly after birth, genetically derived brain malformations, severe head trauma, strokes, infections such as meningitis or encephalitis, certain genetic syndromes, and brain tumors.

People with epilepsy are emotionally unstable
Epilepsy has a great deal of stigma associated with it. The idea that those who have the illness are more prone to experience emotional instability is one aspect of this stigma. This is untrue. Most epilepsy patients are happy and most cases of epilepsy can be easily controlled with monotherapy. or the use of one seizure medication. It is unsettling to have a seizure disorder and know that a seizure can strike at any time, but patients with epilepsy are not emotionally unstable.

Epilepsy is a mental illness
In keeping with the previous myth, epilepsy is not a mental illness. According to the Epilepsy Foundation, the great majority of epileptics do not experience any cognitive or psychological issues. Psychological problems related to epilepsy are primarily restricted to individuals with severe and uncontrolled epilepsy.

All people with epilepsy lose consciousness and convulse during seizures
Not every epileptic experiences a seizure in which they lose consciousness and convulse. The Epilepsy Society states that not all seizures cause jerking or shaking sensations. Seizures come in more than forty varieties. Seizures can have a variety of looks. For instance, a person might become completely disoriented or go “blank” for a brief period.

If someone is having a seizure, you should force something into their mouth
This is just another widespread misconception. Dr. Segil clarified, “Most seizures last for 30 to 90 seconds, and there is no reason to restrain a patient with a seizure.”. A hallmark symptom of an epileptiform seizure is that it is not suppressible, which means they don’t stop when you hold a person down. But he clarified that it “makes sense to put someone on their side. Additionally, he said that recording the seizure using a smartphone could enable a physician to alter the patient’s seizure treatment.

Seizures are painful
Ictal pain pain experienced during a seizure is uncommon. In one study, ictal pain was reported by just 0.9% of 5,133 patients who visited the Jefferson Comprehensive Epilepsy Center in Philadelphia, PA. On the other hand, some individuals may feel pain following a seizure. This might be the result of extended muscle contractions or a fall or injury sustained during the seizure. A headache may strike a person before, during, or following a seizure.

Strobe lights always trigger seizures in people with epilepsy
The only individuals who can have seizures when they see strobing lights are those who have photosensitive epilepsy. About 5% of cases of epilepsy are photosensitive epilepsy. It is not just strobe lighting that can cause a seizure in these individuals. They may also be triggered by other visual stimuli, like moving shapes and patterns.

People with epilepsy should not get pregnant
Dr. Segil clarified to MNT that although this is untrue, medical professionals view pregnancies in individuals with seizures as high risk. This implies that compared to people without a seizure disorder, they will see their obstetrician a few times more frequently. He clarified that their neurologists are also keeping a closer eye on them during this time. While there are still many seizure medications that are unsafe to use while pregnant in 2021, many more are now safe for both the mother and the unborn child.

People often swallow their tongue during a seizure
There is a myth about epilepsy that goes beyond that. In actuality, swallowing one’s tongue is impossible in all situations. However, the person can break or injure their teeth in some other way during a seizure. They may also bite their tongue or lips.

No treatments help epilepsy
Fortunately, this is just another myth. Although there isn’t a cure for epilepsy, there are several helpful treatments. Anti-epileptic medications successfully stop seizures in a lot of people. As long as they are taking the proper medication, 7 out of 10 epileptics may be able to stop having seizures, according to the Epilepsy Society. Other options include surgery, vagus nerve stimulation, and even dietary interventions that can be helpful for people who do not respond to medication. Scientists are getting closer to a cure for epilepsy as they carry out more research. The work is ongoing even though it might not happen for some time. Here is information on providing first aid for seizures.

REFERENCES:
https://www.medicalnewstoday.com/articles/medical-myths-all-about-epilepsy?utm_source=ReadNext#13.-No-treatments-help-epilepsy

Medications that have been suggested by doctors worldwide are available here
https://mygenericpharmacy.com/index.php/therapy,49