In 2023, International Epilepsy Day will focus on the global stigma that people living with epilepsy face and stamp out the myth around epilepsy.

world epilepsy day: Causes, Epidemiology of Epilepsy, Diagnosis, Treatment.

About international epilepsy day

International Epilepsy Day is a yearly event co-organized by the International Bureau for Epilepsy (IBE) and the International League Against Epilepsy (ILAE) to raise awareness about epilepsy and its impact on individuals, families, and communities worldwide. It falls on second Monday of February and for year 2023, the day will be celebrated on 13th February.

What is epilepsy

These are a group of disorders of the CNS characterized by paroxysmal cerebral dysrhythmia, manifesting as brief episodes (seizures) of loss or disturbance of consciousness, with or without characteristic body movements (convulsions), sensory or psychiatric phenomena. These episodes are unpredictable and their frequency is highly variable. Epilepsy has a focal origin in the brain, manifestations depend on the site of the focus, regions into which the discharges spread and postictal depression of these regions. Recognised from the dawn of history as ‘disease of lightening’, it was correctly described by JH Jackson little over a century ago.


History of international epilepsy day

One of the oldest known medical diseases in the world, epilepsy has been documented from the dawn of written history. it was viewed as a spiritual issue back then. A person who underwent an exorcism while being possessed by a moon deity is mentioned in a prehistoric Mesopotamian manuscript from 2000 B.C. Seizures were ascribed to demonic possession by the ancient Babylonians. Epilepsy was seen by the ancient Greeks as a form of spiritual possession, but they also connected it to genius and heavenly interventions.

Epilepsy stigma is a historical issue as well. People in ancient Rome did not share plates or pots with those who had epilepsy whether they were eating or drinking. In several regions of Africa up until the second half of the 20th century, epilepsy was thought to be contagious and the result of possession, witchcraft, or poisoning.

Today, more than 120 nations throughout the world observe International Epilepsy Day.

timeline

10th Century B.C., The Oldest Record of Epilepsy

The "Sakikku," a medical document written in Babylonian cuneiform, has the earliest complete description of epilepsy.

10 BCE

5th Century B.C., Hippocrates Rejects Epilepsy as a Spiritual Problem

Hippocrates believes that epilepsy is a medically treatable condition originating in the brain at a period when most people considered it as a spiritual condition.

5 BCE

The First Effective Anti-seizure Medication is Introduced

The clinical utility of the antiepileptic drug bromide was discovered.

1800s

epilepsy defined by ILAE

Epilepsy was defined conceptually in 2005 as a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures.

2005

A New Definition of Epilepsy

A person is considered to have epilepsy if they have

  • At least two unprovoked (or reflex) seizures occurring greater than 24 hours apart.
  • One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years.
2014

Causes of Epilepsy

Epilepsy is not contagious. Although many underlying disease mechanisms can lead to epilepsy, the cause of the disease is still unknown in about 50% of cases globally. The causes of epilepsy are divided into the following categories: structural, genetic, infectious, metabolic, immune and unknown. Examples include:

Brain Damage

Stroke

Severe Head Injury

Brain Infection

Congenital Brain Malformations

Brain Tumour


Common Causes of Epilepsy by Age

Epidemiology of epilepsy

  • Epilepsy is a chronic non-communicable disease of the brain that affects people of all ages.
  • Around 50 million people worldwide have epilepsy, making it one of the most common neurological diseases globally.
  • Nearly 80% of people with epilepsy live in low- and middle-income countries.
  • It is estimated that up to 70% of people living with epilepsy could live seizure- free if properly diagnosed and treated.

Indian scenario of epilepsy

Of the 70 million persons with epilepsy (PWE) worldwide, nearly 12 million PWE are expected to reside in India; which contributes to nearly one-sixth of the global burden

nearly 12 million persons with epilepsy (PWE) are expected to reside in India; which contributes to nearly one-sixth of the global burden.

The overall prevalence (3.0-11.9 per 1,000 population) and incidence (0.2-0.6 per 1,000 population per year).

More men than women have epilepsy. Children and adolescents are more likely to have epilepsy of unknown or genetic origin. Brain injury or infection can cause epilepsy at any age. The Epilepsy Foundation also reports that 70 percent of children and adults with newly diagnosed epilepsy can be expected to enter remission after having gone five years or more without a seizure while on medication.


Diagnosis

A doctor makes his or her epilepsy diagnosis based on symptoms, physical signs and the results of such tests as an electroencephalogram (EEG), computed tomography (CT or CAT scan) or magnetic resonance imaging (MRI). The routine protocol followed to diagnose a patient with epilepsy are

Telling What Happened

The medical history is the foundation of the diagnosis of epilepsy. The doctor needs ALL the information about what happened before, during, and after your seizures. If you cannot give enough information, then others who have seen the seizures happen should contribute what they know. If some of the details are vague, the doctor needs to know that too.

Laboratory tests

Routine blood studies are indicated to identify the more common metabolic causes of seizures such as abnormalities in electrolytes, glucose, calcium, or magnesium, and hepatic or renal disease. A screen for toxins in blood and urine should also be obtained from all patients in appropriate risk groups.

Electrophysiological studies

The electrical activity of the brain (the EEG) is easily recorded from electrodes placed on the scalp. The characteristics of the normal EEG depend on the patient’s age and level of arousal. The rhythmic activity normally recorded represents the postsynaptic potentials of vertically oriented pyramidal cells of the cerebral cortex and is characterized by its frequency.

Brain imaging

Almost all patients with new-onset seizures should have a brain imaging study to determine whether there is an underlying structural abnormality that is responsible. MRI has been shown to be superior to computed tomography (CT) for the detection of cerebral lesions associated with epilepsy. In some cases, MRI will identify lesions such as tumors, vascular malformations, or other pathologies that need urgent therapy.

Prevention

An estimated 25% of epilepsy cases are preventable.

Preventing head injury is the most effective way to prevent post-traumatic epilepsy.

Adequate perinatal care can reduce new cases of epilepsy caused by birth injury.

The use of drugs and other methods to lower the body temperature can reduce the chance of febrile seizures.

The prevention of epilepsy associated with stroke is focused on cardiovascular risk factor reduction

In low and middle income countries elimination of parasites and education on how to avoid infections can be effective ways to reduce epilepsy worldwide


Treatment

Therapy for a patient with a seizure disorder is almost always multimodal and includes treatment of underlying conditions that cause or contribute to the seizures, avoidance of precipitating factors, suppression of recurrent seizures by prophylactic therapy with antiseizure medications or surgery, and addressing a variety of psychological and social issues. Treatment plans must be individualized, given the many different types and causes of seizures as well as the differences in efficacy and toxicity of antiseizure medications for each patient. In almost all cases, a neurologist with experience in the treatment of epilepsy should design and oversee implementation of the treatment strategy. Furthermore, patients with refractory epilepsy or those who require polypharmacy with antiseizure drugs should remain under the regular care of a neurologist.

Coping and living with epilepsy

Be patient with yourself as you learn to live with epilepsy. Expect ups and downs, and understand that what you're going through is common and natural. Changes that appear difficult or impossible now will become second nature in time. Take small steps at a time and keep moving forward. And, if you need it, don't be afraid to seek assistance, including from a mental health professional. One can opt for following steps if he/she is diagnosed from epilepsy so that he/she could have better quality of life.

Be your own epilepsy expert


Monitor your epilepsy


Connect with others


Be active


Stick to a sleep schedule


Watch what you drink


Epilepsy-proof your home


Always carry identification