Dr. Sowmya. M, Senior Consultant – Neurology, Aster RV Hospital

When you hear the word epilepsy, what comes to mind? For many, it’s a vague image of someone having a seizure – but there’s much more to it.

According to WHO, 50 million people worldwide suffer from epilepsy, a major neurological disorder. Seizures, often unpredictable, define epilepsy as a chronic condition that affects individuals of all ages. Despite available treatments, many struggle with epilepsy control, highlighting the need for awareness, research, and proper care. Epilepsy is a neurological condition affecting the brain where nerve cells send irregular signals resulting to seizure. A seizure is a sudden attack that produces losses of muscle control as well as control of perceptions, emotions, and capabilities. A seizure resembles a circuit surge, where neurons synchronously fire briefly, disrupting brain circuits. These seizures may range from loss of consciousness to only muscle jerking called myoclonus. There are two primary types of seizures: Focal (localized to one part of the brain) and Generalized (involving to both sides of the brain simultaneously).

Causes

• Most of the time a person gets epilepsy, there is no such definite reason of why it happened. Researchers have identified some common triggers, even though the exact causes of epilepsy remain elusive:
• Genetics: A family’s genetic history increases susceptibility for some individuals due to their gene pool.
• Brain injury: Vehicular accidents and sports related severe injuries may develop epilepsy.
• Infections: They include Viral encephalitis, Meningitis and other infection which can inflame and damage neuronal cells and hence cause epilepsy among others Structural causes like tumours, malignancies
• Developmental disorders: There are associations between Autism and Neurodevelopmental disorders and epilepsy or seizure risk. Developmental malformations, cortical dysplasias can result in epilepsy
• Strokes: Seizures can also arise due to stroke

Treatment

The goal of epilepsy management lies in the management of seizures, patient’s overall functioning and minimizing side effects. Current options include:

• Medication: Anti-seizure drugs are the first treatment option, and they work for about two-thirds of the patients. They play a huge role in helping to prevent future recurrence of seizures.
• Surgery: If the drugs do not effectively manage the seizures, there are surgicsl options. Epilepsy Surgeries like lobectomy or alternatively vagal nerve stimulation (VNS) can in some cases alleviate or totally eradicate seizures.
• Dietary Therapy: Keto Diet has an evidence basis; it works best for children who have epilepsy and have not responded to any medication. This diet has more of fat and protein and low carbohydrates and can be effective in decreasing the seizures by modifying the metabolism in brains.
• Neurostimulation Devices: Developers create new devices to target specific areas of the brain and help reduce the frequency of seizures. For example, the Responsive Neurostimulation (RNS) places a device within the human brain that sends electrical currents to interrupt events causing seizures.

While researchers have developed various treatment approaches, they continue to seek a permanent cure. They hypothesize that genetically driven epilepsy could be treated through gene therapy by reversing the identified mutated genes that cause seizures. Also, research on precision medicine creates the opportunity for the correspondingly targeted therapy basing on patients’ genetic characteristics. Epilepsy continues to pose a significant global concern, with immense social stigma persisting in low- and middle-income countries where treatment remains insufficient. According to WHO potentially 70% of the people with epilepsy could be free from seizures if adequately managed however only 10% of patients in developing nations get the treatments they require.

Epilepsy affects millions worldwide, and with the right combination of research, resources, and support, there is hope for a future where treatment is accessible to all.

  Dr. Sowmya. M, Epilepsy, Understanding Epilepsy