Epilepsy- A lifelong condition

Epilepsy- A lifelong condition

Around 50 million people worldwide suffer from epilepsy, a chronic noncommunicable brain condition. Recurrent seizures are its defining feature. Seizures are brief bursts of involuntary movement that might affect either a portion of the body (partial) or the full body (generalised). They can occasionally be followed by loss of awareness and control over bowel or bladder function.

Excessive electrical discharges in a cluster of brain cells cause seizure episodes. Such discharges can occur in various areas of the brain. The smallest muscular jerks or attention lapses can be seizures. As well as severe convulsions that last for a long time. The rate of seizures may also differ, from fewer than one per year to several per day.

Up to 10% of people worldwide experience one seizure in their lives, thus having one does not necessarily indicate epilepsy. Two or more unprovoked seizures are considered to be epileptic seizures. Written accounts of epilepsy date as far back as 4000 BCE, making it one of the oldest recognised medical diseases in the world. Epilepsy has been shrouded in fear, misinformation, prejudice, and social shame for millennia. The quality of life for those who have the condition and their family may be negatively impacted by this stigma, which persists in many nations today.

Signs and symptoms

Seizures can have a variety of characteristics, depending on where in the brain the disruption first appears and how far it develops. Temporary symptoms include loss of awareness or consciousness as well as impairments in movement, mood, or other cognitive processes, as well as changes of sense (including vision, hearing, and taste).

Both physical issues (such as fractures and bruising from seizures-related traumas) and psychological issues, such as feeling depressed and anxious, are more common in people with epilepsy. Similar to this, patients with epilepsy have a risk of dying prematurely which is up to three times higher than that of the general population. Rural areas and low- and middle-income countries having the highest rates of early mortality.

Many of the epilepsy-related causes of death, particularly in low- and middle-income nations. It is possible to prevent falls, drowning, burns, and prolonged seizures.

Epilepsy causes abnormal brain activity, which can interfere with any brain-coordinated function.

Temporary confusion, a staring spell, rigid muscles, involuntary jerking movements of the arms and legs, loss of consciousness or awareness, and psychological sensations like fear, worry, or deja vu are some of the indications and symptoms of seizures.

The type of seizure determines the specific symptoms. The symptoms will be consistent from episode to episode since, in the majority of situations. A person with epilepsy tends to experience the same sort of seizure every time.

According to how and where the aberrant brain activity starts, doctors typically categorise seizures as either focal or generalised.

Psychological effects of epilepsy

According to studies, up to 50% of epilepsy patients experience the onset of psychiatric problems. the most prevalent of which are sadness, anxiety, and psychotic disorders. We can classify these psychiatric diseases as ictal, peri-ictal (pre-ictal/prodromal, post-ictal), or inter-ictal depending on when they first appear in relation to seizure onset. Multiple risk factors, which can be broadly categorised into biological such as the kind and severity of epilepsy, psychosocial, and iatrogenic such as antiepileptic medicines, surgery, are linked to an increased risk of psychiatric issues in epilepsy.

Causes of epilepsy

Epilepsy cannot spread. Though various underlying diseases can cause epilepsy, in roughly 50% of cases around the world the disease’s origin is still unknown. The following categories of causes of epilepsy exist: structural, genetic, infectious, metabolic, immunological, and unknown. A severe head injury, a stroke that reduces the quantity of oxygen to the brain, a brain infection like meningitis, encephalitis, or neurocysticercosis, certain genetic disorders, and a brain tumour are a few examples of prenatal or perinatal reasons for brain damage. Other causes include congenital abnormalities or genetic conditions with associated brain malformations.

Socio-economic impacts of epilepsy

In terms of the global burden of disease, which is based on years of life lost to premature mortality and years spent in less-than-optimal health, epilepsy represents more than 0.5% of the total. Epilepsy has major financial repercussions in terms of medical expenses, preventable deaths, and missed productivity at work.

Personal expenses and lost productivity can place a heavy burden on households. According to a cost-effectiveness analysis conducted in India, public funding for both first- and second-line therapy as well as additional medical expenses helps reduce the financial burden epilepsy causes.

It is frequently more difficult to overcome the stigma and discrimination associated with epilepsy than the seizures themselves. People with epilepsy and their families could encounter targeted prejudice. Widespread beliefs that epilepsy is incurable, contagious, or the result of immoral behaviour might make patients reluctant to seek treatment and keep them isolated.

Treatment of epilepsy

seizures are manageable. With the proper administration of antiseizure medications, up to 70% of patients with epilepsy could go seizure-free. After two years without seizures, we may have the option to cease the anti-epileptic medication after taking into account relevant clinical, social, and private factors. The two most reliable indicators of seizure recurrence are a known aetiology for the seizure and an abnormal electroencephalography (EEG) pattern. About 75 per cent of epileptic patients may not obtain the necessary care in low-income nations. The “treatment gap” refers to this.

Anti-seizure medications are not widely available in many low- and middle-income nations. The researchers discovered that less than 50% of generic antiseizure drugs were typically available in the public sector of low- and middle-income countries. This can make it difficult to get treatment. The basic healthcare level can diagnose and treat most epileptic patients without the need for advanced technology.

According to WHO pilot studies, teaching primary healthcare professionals how to recognise and treat epilepsy can significantly close the treatment gap for the condition. Patients who respond poorly to pharmacological therapies may benefit from surgery.

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