Epilepsy

What it is

Epilepsy is a fairly common neurological condition, affecting approximately one in every 100 people. The disease is characterized by the occurrence of epileptic seizures, which recur at varying intervals. These seizures are the clinical manifestations of an abnormal discharge of neurons, which are the cells that make up the brain

Causes

The disease can have various causes, which vary depending on the type of epilepsy and the patient’s age. In children, for example, neonatal anoxia (lack of oxygen in the brain during childbirth) and inborn errors of metabolism (metabolic disorders present from birth) are common causes of epilepsy

In older adults, on the other hand, cerebrovascular diseases (such as stroke) and brain tumors are among the most frequent causes

Signs and Symptoms

There are several types of epileptic seizures, each with different characteristics. One of the most common types is the tonic-clonic seizure, commonly referred to as a “convulsion.” This type of seizure is easily recognizable, as the patient experiences generalized muscle jerks, sialorrhea (excessive salivation), and often bites their tongue and loses control of urine and feces

Other types of seizures, however, may go unrecognized by patients, their families, and even doctors, as they present with subtle manifestations such as slight behavioral changes, a blank stare, and automatic movements

In children, for example, absence seizures are common. These are characterized by a brief pause in the activity the child was doing, sometimes accompanied by blinking or automatic hand movements. Absence seizures can occur many times a day. In some cases, they are not immediately recognized, and it is only when the child begins to show poor academic performance—usually pointed out by the teacher—that this possibility is considered

Diagnosis

Diagnosis is made through an evaluation of the patient’s medical history, including information about the types of seizures experienced, the age at symptom onset, family history, among other factors. Additional tests are important to support the diagnosis, such as electroencephalogram (EEG), cranial CT scan, and brain MRI. An accurate diagnosis of epilepsy and the specific type of seizure the patient experiences allows for the selection of the most appropriate treatment

Treatment

Epileptic seizures are treated with specific medications known as antiepileptic drugs. There are currently more than 20 drugs available for the treatment of epilepsy—though not all are marketed in Brazil

With clinical treatment (using antiepileptic medications), about two-thirds of patients achieve seizure control. However, a significant number—around one-third—continue to experience seizures despite medical treatment

For these patients, other treatment options may be considered, such as the ketogenic diet (similar to the Atkins diet), especially in children, and surgical treatment. Neuromodulation, involving stimulation of the brain or peripheral nerves, may also be a therapeutic option for patients with hard-to-control epilepsy. More recently, cannabidiol—one of the compounds found in the cannabis plant—has been used in epilepsy treatment with good results. It is important to note that cannabidiol has no psychoactive effects and is considered safe for use in both adults and children

Most people with epilepsy are able to control their seizures with medication and can therefore lead normal lives with little or no limitation. Recognizing the seizures and making an accurate diagnosis allows for the best treatment to be started early, enabling the patient to resume their activities normally

Prevention

Some causes of epilepsy, such as neonatal anoxia and cerebrovascular diseases, can be prevented. Therefore, proper prenatal care and good assistance during childbirth can certainly help reduce the number of epilepsy cases related to birth complications

Similarly, appropriate control of risk factors for cerebrovascular diseases—such as high blood pressure and diabetes—leads to a reduction in the number of strokes and, consequently, in the cases of epilepsy resulting from this condition

By the Einstein Editorial Board