- Epilepsy is a chronic neurological disorder characterized by recurrent, unprovoked seizures resulting from abnormal electrical activity in the brain.
- A seizure occurs when clusters of neurons fire excessively and synchronously, disrupting normal brain function. These seizures can vary widely in their presentation, ranging from brief lapses in attention or muscle twitches to full-body convulsions and loss of consciousness.
- Epilepsy is not a singular condition but rather a spectrum of disorders with diverse causes, seizure types, and treatment responses, affecting people of all ages, backgrounds, and lifestyles.
- The causes of epilepsy are multifactorial and can be broadly classified as genetic, structural, metabolic, immune, infectious, or unknown (idiopathic). In some individuals, epilepsy results from identifiable brain abnormalities such as traumatic brain injury, stroke, tumors, or developmental malformations. In others, especially in childhood-onset epilepsy, genetic mutations affecting ion channels or neurotransmitter systems may play a significant role. Despite technological advancements, a substantial percentage of epilepsy cases remain idiopathic, with no clear underlying cause identified.
- Epilepsy is typically diagnosed after two or more unprovoked seizures occur more than 24 hours apart. Diagnosis involves a detailed clinical history, neurological examination, and diagnostic tests such as electroencephalography (EEG) and brain imaging (MRI or CT scans). EEG plays a central role by recording the brain’s electrical activity and identifying patterns specific to various epilepsy syndromes. Classification of epilepsy depends on seizure type (focal or generalized), underlying cause, and age of onset, which helps guide treatment decisions.
- Seizures are classified based on where they originate in the brain. Focal seizures arise from a specific area and may or may not impair consciousness. Generalized seizures involve both hemispheres of the brain and often result in loss of consciousness. Subtypes include absence seizures, myoclonic seizures, tonic-clonic seizures, and atonic seizures. Some individuals experience status epilepticus, a medical emergency characterized by prolonged or repeated seizures without recovery in between, which requires immediate intervention.
- The cornerstone of epilepsy treatment is antiseizure medications (ASMs), which aim to reduce the frequency and severity of seizures. While many individuals achieve seizure control with a single medication, others may require a combination of drugs. However, about one-third of patients have drug-resistant epilepsy, meaning their seizures do not adequately respond to medication. For these individuals, alternative treatments may be considered, including surgical resection of the seizure focus, vagus nerve stimulation (VNS), responsive neurostimulation (RNS), or dietary therapy such as the ketogenic diet, which has been particularly effective in children with certain types of epilepsy.
- Beyond the physical manifestations, epilepsy can have profound psychological, social, and cognitive effects. Individuals with epilepsy often face stigma, anxiety, depression, learning difficulties, and restrictions on daily activities such as driving or working in certain environments. Comprehensive care, therefore, must address the full spectrum of challenges associated with the condition and include support from neurologists, psychologists, social workers, and patient advocacy groups.
