Epilepsy: Overview and Significance of the Problem
Epilepsy is one of the most common serious neurological disorders, second in frequency only to stroke [3]. In developed countries, its prevalence is about 0.5% of the population, and the lifetime risk of receiving this diagnosis reaches 2-3% [3]. This chronic condition is characterized by recurring unprovoked seizures that can significantly impair patients' quality of life. Understanding the causes, mechanisms of development, and modern methods of diagnosis and treatment of epilepsy is critical for the effective management of this disease.
Causes and Risk Factors for Developing Epilepsy
Epilepsy can develop due to multiple causes, but certain factors significantly increase the risk of its occurrence:
- Advanced age: Over recent decades, the incidence of epilepsy among elderly people has been steadily growing. It is projected that by 2030, in some industrially developed countries, a third of the population will be over 65 years old, which will lead to a significant increase in the number of elderly patients with epilepsy [1]. This creates a serious burden on healthcare and pension systems.
- Stroke: This is the most frequent cause of epilepsy in elderly individuals [1]. Overall, there is an increase in the prevalence of seizures following ischemic and hemorrhagic stroke, which is likely related to improvements in post-stroke patient management and the wider use of continuous EEG monitoring [8]. Post-stroke seizures are associated with longer hospital stays and increased mortality, highlighting the importance of their timely prevention and treatment [8].
- Multiple sclerosis (MS): There is a bidirectional relationship between multiple sclerosis and epilepsy [2]. Gray matter involvement and inflammatory processes in MS can influence epileptogenesis—the process of forming an epileptic focus [2]. The manifestation of an epileptic seizure in a patient with MS may indicate a relapse or exacerbation of the inflammatory process [2].
Diagnosis of Epilepsy: Challenges and Methods
Diagnosing epilepsy, especially in elderly patients, can be difficult [1]. This is due to atypical presentations of seizures, the presence of comorbidities, and the complexity of differential diagnosis with other conditions mimicking convulsions. For an accurate diagnosis, prolonged video-EEG monitoring may be required to capture seizures and assess the electrical activity of the brain [1].
Modern Approaches to Epilepsy Treatment
The primary goal of epilepsy treatment is to achieve complete seizure control with minimal side effects, allowing patients to lead a fulfilling life. The standard approach is the use of antiseizure medications (ASMs), which are prescribed for recurrent seizures regardless of their etiology [8].
- Drug therapy: There is a wide range of ASMs, the choice of which depends on the type of seizures, the patient's age, comorbidities, and individual tolerability.
- Surgical treatment: In some cases when drug therapy is ineffective, surgical intervention may be considered, especially in elderly patients [1].
- Specialized clinics: Studies show that the quality of care for people with epilepsy may be inadequate in general neurological or medical clinics. This underscores the need for specialized epileptology centers and services focused on the comprehensive management of such patients [3].
Specifics of Managing Patients with Comorbidities
Epilepsy management is often complicated by the presence of other chronic conditions:
- Epilepsy in the elderly: These patients often have multiple comorbidities, complicating the choice of ASMs due to potential drug interactions and an increased risk of side effects [1]. Furthermore, status epilepticus in acute symptomatic epilepsy in elderly individuals often leads to a fatal outcome, making this issue increasingly urgent for healthcare [1].
- Epilepsy in multiple sclerosis: The combination of seizures and MS significantly complicates the treatment process [5]. There are no specific guidelines for managing such patients [2, 5]. Questions arise regarding how to properly approach diagnosis and treatment, as well as how to modify the MS treatment strategy taking epilepsy into account [5]. It remains an open question whether disease-modifying therapies used for MS can prevent or mitigate the development of epilepsy [2].
- Post-stroke seizures: The prevalence of post-stroke seizures is growing, and they are associated with increased hospital stay duration and mortality [8]. Therefore, the prevention and timely treatment of these seizures are critically important [8]. However, there are currently no established guidelines for the prophylactic use of ASMs after stroke [8]. Further research is needed to determine the risk factors for seizure recurrence in this patient group [8].
Challenges and Perspectives in Epileptology
Given the aging population and the growing number of epilepsy patients, especially among the elderly, healthcare systems will face a serious burden [1]. Further research is needed to develop more effective and safer treatments, as well as to create clear guidelines for managing patients with comorbidities such as multiple sclerosis and stroke sequelae [2, 5, 8]. The development of specialized epileptology clinics and a multidisciplinary approach to treatment remains a priority for improving the quality of life of epilepsy patients [3].
Sources
- Epilepsy in the elderly: facts and challenges.
- Epilepsy in multiple sclerosis as a network disease.
- WITHDRAWN: Epilepsy clinics versus general neurology or medical clinics.
- Management of seizures in patients with multiple sclerosis; an Iranian consensus.
- Incidence, Implications, and Management of Seizures Following Ischemic and Hemorrhagic Stroke.
Disclaimer: The information provided in this article is for informational purposes only and cannot replace professional medical advice. Always consult a qualified specialist for diagnosis and treatment.