Epilepsy is a chronic neurological disorder characterized by recurrent, unprovoked seizures. These seizures result from abnormal electrical activity in the brain and can vary in type and severity. It is one of the most common neurological conditions, affecting approximately 50 million people worldwide.
Pathophysiology of Epilepsy
Epilepsy arises from an imbalance between excitatory and inhibitory neurotransmission in the brain, leading to hyperexcitability and hypersynchrony of neuronal networks.
1. Neuronal Hyperexcitability:
Excessive depolarization occurs due to increased excitatory neurotransmitters like glutamate.
Voltage-gated sodium and calcium channels play a key role in propagating this excitability.
2. Loss of Inhibitory Control:
A reduction in inhibitory neurotransmitter gamma-aminobutyric acid (GABA) disrupts the regulation of neuronal activity. Dysfunction of GABA-A and GABA-B receptors is implicated in seizure generation.
3. Structural and Functional Alterations:
Brain injuries, tumors, genetic mutations, or infections can lead to structural changes in the brain that predispose individuals to epilepsy. Abnormal neuronal connectivity in regions such as the hippocampus is often observed.
Etiology of Epilepsy
Epilepsy can be classified based on its underlying causes:
1. Genetic Causes: Mutations in genes encoding ion channels (e.g., SCN1A, CACNA1H) are associated with inherited epilepsy syndromes.
2. Structural Causes: Brain malformations (e.g., cortical dysplasia) or traumatic brain injury.
3. Metabolic Causes: Disorders such as phenylketonuria and mitochondrial diseases.
4. Infectious Causes: Central nervous system (CNS) infections like neurocysticercosis, meningitis, or encephalitis.
5. Immune Causes: Autoimmune encephalitis can trigger seizures.
6. Unknown Causes: Approximately 30–40% of epilepsy cases have no identifiable cause.
Types of Seizures in Epilepsy
The International League Against Epilepsy (ILAE) classifies seizures into:
1. Focal Seizures (Partial Seizures): Originate in one hemisphere of the brain.
Focal Aware Seizures: The person remains conscious.
Focal Impaired Awareness Seizures: Consciousness is impaired.
2. Generalized Seizures: Involve both hemispheres of the brain.
Types include:
Absence Seizures: Sudden lapses in attention (commonly seen in children).
Tonic-Clonic Seizures: Involves muscle stiffening (tonic phase) and rhythmic jerking (clonic phase).
Myoclonic Seizures: Brief, jerky movements of muscles.
Atonic Seizures: Sudden loss of muscle tone.
3. Unknown Onset Seizures: Seizures that cannot be classified due to limited information.
Clinical Features
1. Seizure Episodes: Recurrent and unpredictable episodes of altered consciousness, motor activity, sensory disturbances, or autonomic symptoms.
2. Aura: A warning sensation (e.g., visual flashes, strange smells, or dizziness) that may precede a seizure.
3. Postictal Phase: After a seizure, individuals may experience confusion, fatigue, or temporary neurological deficits (e.g., Todd’s paralysis).
Diagnosis of Epilepsy
1. Clinical History and Examination: A detailed description of seizure episodes, including triggers, duration, and associated symptoms.
2. Electroencephalogram (EEG): Detects abnormal electrical activity in the brain. Interictal epileptiform discharges (spikes and sharp waves) are characteristic findings.
3. Neuroimaging: Magnetic Resonance Imaging (MRI) to detect structural brain abnormalities. Computed Tomography (CT) for acute cases.
4. Blood Tests: To identify metabolic causes or genetic factors.
5. Genetic Testing: Useful for hereditary epilepsy syndromes.
Treatment of Epilepsy
1. Pharmacological Therapy:
Antiepileptic Drugs (AEDs): These medications aim to control seizures. Examples include:
Sodium channel blockers: Phenytoin, Carbamazepine.
GABA enhancers: Benzodiazepines, Valproic acid.
Calcium channel modulators: Ethosuximide.
Drug choice depends on seizure type, patient age, and comorbidities.
2. Non-Pharmacological Therapy:
Ketogenic Diet: High-fat, low-carbohydrate diet that has shown effectiveness in drug-resistant epilepsy.
Vagus Nerve Stimulation (VNS): Electrical stimulation of the vagus nerve reduces seizure frequency.
Responsive Neurostimulation (RNS): Implanted devices detect and suppress abnormal brain activity.
3. Surgical Treatment: For drug-resistant epilepsy with focal lesions. Procedures include lobectomy, lesionectomy, or corpus callosotomy.
4. Lifestyle Modifications:
Adequate sleep, stress management, and avoidance of seizure triggers like alcohol and flashing lights.
Conclusion
Epilepsy is a multifaceted disorder requiring a comprehensive approach to diagnosis, treatment, and management. Advances in medical technology and neuroscience are paving the way for better understanding and innovative treatments, improving outcomes and quality of life for individuals with epilepsy.
