Epilepsy is a neurological disorder characterised by recurrent, unprovoked seizures. It affects people of all ages and backgrounds, and is one of the most common neurological conditions globally. In this article, we will explore the neurological aspects of epilepsy and the impact it has on the brain.
To understand better the effects of this disorder we must first understand its causality. The brain relies on a delicate balance of electrical and chemical signals to function properly. In individuals with epilepsy, this balance is disrupted, leading to abnormal electrical activity, which can lead to seizures. These seizures result from the sudden and excessive firing of neurons in the brain, causing a temporary disturbance in normal brain function. There are various causes of epilepsy, including genetic factors, brain injuries, infections, and developmental disorders. However, in some cases, the exact cause remains unknown which further emphasises the complexity of this disorder.
There are two main types of seizures: focal (partial) seizures and generalised seizures.
Focal seizures originate in a specific area of the brain and can be further classified into simple and complex focal seizures. Simple focal seizures may cause involuntary movements or sensations in one part of the body, while complex focal seizures can alter consciousness and lead to unusual behaviours. Generalised seizures involve widespread areas of the brain from the onset. Tonic-clonic seizures, characterised by convulsions and loss of consciousness, are perhaps the most widely recognised type of seizure.
Looking out for signs and symptoms
Common temporary symptoms are loss of awareness or consciousness, loss of sensation (including vision, hearing and taste) or other cognitive functions. People with epilepsy tend to have more physical problems such as fractures and bruising and the risk of premature death is up to three times higher than the general population. Studies have also shown that the highest rates of premature death occur in low- and middle income countries, however they have the highest potential to be prevented such as falls, drowning and burns.
The recurrent nature of epileptic seizures can have profound effects on the brain's structure and function. Prolonged or severe seizures, known as status epilepticus, can be particularly damaging and may result in permanent neurological impairment.
Epilepsy is often associated with cognitive difficulties, affecting memory, attention, and overall cognitive function. The impact on cognition can vary depending on many factors such as the frequency and severity of seizures, age of onset, and the specific brain regions involved. Chronic epilepsy may lead to structural changes in the brain, visible through imaging techniques like magnetic resonance imaging (MRI). These changes can contribute to ongoing seizure activity and further exacerbate cognitive impairment. Individuals with epilepsy are at an increased risk of developing psychiatric conditions, including depression and anxiety. The neurological and psychological aspects of epilepsy often intertwine, creating a complex interplay between the disorder and mental health.
How can we treat and manage this disorder?
While epilepsy cannot always be cured, it can often be effectively managed with a combination of medication, lifestyle modifications, and, in some cases, surgery. Anti-epileptic drugs (AEDs) are commonly prescribed to control seizures by stabilising electrical activity in the brain. Additionally, dietary therapies, such as the ketogenic diet, and neurostimulation techniques may be recommended. There are around 630,000 people with epilepsy living in the UK (October 2023), which is around one in every 100 people and every day 80 new people are diagnosed.
The stigma and discrimination that surrounds epilepsy worldwide are often more difficult to overcome than the seizures themselves. Inaccurate myths that epilepsy is incurable, or contagious can result in prejudice against family members or morally bad behaviour. Epilepsy is a multifaceted neurological disorder with far-reaching effects on an individual's life. Understanding the neurological basis of epilepsy is crucial for developing effective treatments and providing support for those living with the condition. Ongoing research and advances in neuroscience continue to enhance our understanding of epilepsy, offering hope for improved management and, ultimately, a better quality of life for those affected.