Introduction
Epilepsy is one of the most devastating neurological health issues which is associated with recurring seizures in affected individuals. The concept of recurring seizures is linked with the transmission of worn signals from a cluster of neurons or nerve cells in the brain. In the event of a seizure, an individual is known to behave in a strange manner and have varying emotions and sensations. In most cases, epilepsy is known to be constituted with violent behaviour, loss of consciousness, and muscle spasms. The direct cause of epilepsy is not known but researchers claim that is maybe a result of brain injury, illness, and abnormal brain development. Most cases of epilepsy and their actual cause of diagnosis is unknown. In order to confirm the diagnosis of epilepsy, most doctors would utilize a series of brain scans. In order to control severe forms of epilepsy, early treatment is required. Based on current evidence, there is no medical cure for epilepsy but current medications do prevent the onset of seizures. Most advanced means of treatment include implanted devices (nerve stimulators) that are used when medications do not have a therapeutic achievement. In the case of children with epilepsy, diets have found to help with seizures.
The source of human epilepsy is the human brain. In most cases of epilepsy, the symptoms of seizure are known to affect varying parts of the body but the electrical pulses mainly take place in the brain. The location and spread of the event and how much of the brain is affected would have profound effects in the body. The impact on the brain and the spread of the impulses are key factors that would assess the impact on the individual. Epilepsy is known to affect the individual’s quality of life. Epilepsy is known to affect people of all age groups and is the 4th most common neurological disorder in the world. Epilepsy is the same as seizure disorders. Most epileptic attacks affect the person and create other health disorders. The seizure attacks vary from person to person and is unpredictable making it one of the most life-threatening disease.
Incidence
The incidence of epilepsy is around 150,000 in the US every year which is approximately 48 individuals for every 100,000 people. The global average is around 100 per 100,000 people. Based on the report from the WHO, every 48 out of 100,000 individuals in the US are bound to develop epilepsy. Based on current evidence, there is high risk of epilepsy in young children and adults. In other words, epilepsy is bound to develop in these age groups more often than other age groups. Epilepsy is known to be looked over a lifetime but based on information, 1 in 26 individuals are known to develop epilepsy at later stages of their life.
Prevalence
The actual prevalence of epilepsy is not known due to varying statistical information and number of studies conducted over the years. Many studies have varying factors due to which researchers find it difficult to assess the prevalence of epilepsy. Based on information from the WHO, the prevalence of epilepsy could range from 1.3 million to 2.8 million people. This number may not be accurate but is based on current literature and reports gathered from the WHO database. 2.1 million are diagnosed with epilepsy every years which correlates to 7,1 individuals for every 1,000 people. Based on current evidence, a large number of people report to have active epilepsy which is estimated to be 8.4 for every 1,000 people. Researchers have also claimed that the number increases if individuals are asked about their medical condition related to epilepsy. This is also known as lifetime prevalence. Based on a critical analysis over 100,000 individuals, 16 people out of 1,000 people reported to have epilepsy at some point in their life which relates to unaccounted cases of epilepsy. Epilepsy is known to affect over 65 million people in the world and it is predicted to affect nearly 1% of the population by the age of 20. It is known to be common in males and affects nearly 3% of the people at age of 75 (Banerjee PN, et al. 2009 and Bateman LM, et al. 2012)
Treatment
Treatment of epilepsy is mainly based on drug therapy and most doctors would prefer drug therapy (anti-convulsants) as the first-line treatment for epilepsy. The drug-based treatment is based on several factors such as the severity of the seizures, overall health, frequency of seizures, and medical history. Age is a crucial factor in prescribing such medications. In order to get the best health outcomes, an accurate diagnosis of epilepsy and its type is highly recommended. There are many drugs to treat epilepsy and most of these have been approved by competent health authorities worldwide. There are conventional (old) medications that are still being prescribed for epilepsy that include: Phenobarbital, Depakene Depakote, Dilantin or Phenytek, Carbatrol, Mysoline or Tregretol, Depakote ER, Valium, Zarontin, and tranquilizers like Klonopin and Tranxene. Some of the new drugs recently approved by health authorities include: Zonegran, Lamictal, Lyrica, Neurontin, Gabitril, Topamax, Felbatol, and Topamax (Birbeck GL. 2012; Deonna T. 2005; Goldenberg MM. 2010 and Linehan C, 2011)
There are different medications for different types of epilepsy and most drugs are commonly available for the treatment. However, the choice of treatment is mainly based on the response of the patient and the potential side-effects and its tolerance by the patient. Doctors would also consider existing illnesses and other treatment modalities (Masino S., et al. 2009).
In rare cases, wherein medications do not provide best health outcomes, most researchers suggest a brain surgery as an alternate and effective modality. The surgery would constitute of the removal of the part of brain that is associated with seizures. However, surgery is required if: (a) Partial or focal seizures (only single area of brain) causes seizures and (b) Removal of the brain part that may not result in loss of function or any damage to the body (Saxena VS, Nadkarni VV. 2011 and St. Louis EK, et al. 2009).
In some cases, drug therapy and brain surgery may not result in best health outcomes. In such cases, doctors recommend an alternate treatment modality. One of the most advanced and rated treatment modality for epilepsy includes the vagus nerve stimulation (VNS). In some cases, deep brain stimulation (DBS) is also recommended. Both these treatments have found to be effective in patients intolerant to drug therapy and surgery. However, some reports have claimed major side-effects and loss of brain function (Meador KJ, et al. 2011). Based on current evidence, there is a simple method to control seizures and improve the quality of life of patients by implementing a ketogenic diet in their routine lifestyle. The diet often constitutes of diet low in carbohydrates and protein, and high in fats. Since the diet is linked with cellular functions it is known to alter chemical compositions in the brain that may prevent, control, or reduce seizures. This treatment was considered to be one of the most effective treatments before drug therapy was available. However, many doctors and researchers have criticized the use of ketogenic diet due to its high fat diet and its association to major health issues including cardiovascular disease and diabetes (Mehndiratta MM, 2015)
Conclusion
Epilepsy is one of the most devastating neurological health issues claiming around 5 million lives worldwide every year. There have been many advancements in the treatment and management of epilepsy in order to reduce the burden of the disease worldwide. There is a need for research in order to improvise treatment, management, and control of seizures among patients. The WHO, NHS, and CDC may play an important role in the control of epilepsy in the future. Many clinical guidelines could help researchers and healthcare professionals to improvise the health outcomes. Many non-governmental organizations such as the Epilepsy Foundation and Epilepsy Free are known to provide low-cost medication and free healthcare services to the poor sectors of society (Rogovik AL, Goldman RD. 2010).
Figure 1. Simple Partial Seizures (Ngugi AK, et al. 2011)
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Figure 2. Complex Partial Seizures
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Figure 3. Memory Impairment (Components) in epilepsy
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Figure 4. Common Medications for Epilepsy
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References
Banerjee PN, Filippi D, Hauser WA. The descriptive epidemiology of epilepsy-a review. Epilepsy research. 2009;85(1):31-45.
Bateman LM, Begley CE, Ben-Menachem E, et al. Overcoming Barriers to Successful Epilepsy Management. Epilepsy Currents. 2012;12(4):158-160.
Birbeck GL. Revising and Refining the Epilepsy Classification System: Priorities from a Developing World Perspective. Epilepsia. 2012;53(Suppl 2):18-21.
Birbeck GL. Epilepsy Care in Developing Countries: Part I of II. Epilepsy Currents. 2010;10(4):75-79.
Deonna T. Management of epilepsy. Archives of Disease in Childhood. 2005;90(1):5-10.
Goldenberg MM. Overview of Drugs Used For Epilepsy and Seizures: Etiology, Diagnosis, and Treatment. Pharmacy and Therapeutics. 2010;35(7):392-415.
Linehan C, Tellez-Zentano J, Burneo JG, Berg AT. Future directions for Epidemiology in Epilepsy. Epilepsy & behavior : E&B. 2011;22(1):112-117.
Masino S., Kawamura M, Wasser CD, Pomeroy L., Ruskin D. Adenosine, Ketogenic Diet and Epilepsy: The Emerging Therapeutic Relationship Between Metabolism and Brain Activity. Current Neuropharmacology. 2009;7(3):257-268.
Meador KJ, French J, Loring DW, Pennell PB. Disparities in NIH funding for epilepsy research. Neurology. 2011;77(13):1305-1307.
Mehndiratta MM, Wadhai SA. International Epilepsy Day - A day notified for global public education & awareness. The Indian Journal of Medical Research. 2015;141(2):143-144.
Ngugi AK, Kariuki SM, Bottomley C, Kleinschmidt I, Sander JW, Newton CR. Incidence of epilepsy: A systematic review and meta-analysis. Neurology. 2011;77(10):1005-1012.
Rogovik AL, Goldman RD. Ketogenic diet for treatment of epilepsy. Canadian Family Physician. 2010;56(6):540-542.
Saxena VS, Nadkarni VV. Nonpharmacological treatment of epilepsy. Annals of Indian Academy of Neurology. 2011;14(3):148-152.
St. Louis EK, Rosenfeld WE, Bramley T. Antiepileptic Drug Monotherapy: The Initial Approach in Epilepsy Management. Current Neuropharmacology. 2009;7(2):77-82.
