What’s Known About Epilepsy Today
In the past 20 years, science has made tremendous leaps in improving diagnosis and treatment of epilepsy and uncovering the mysteries of how and why brain seizures occur. We now know that epilepsy is not a single disease, but rather a broad category of chronic, neurological disorders affecting some 50 million people worldwide, making it the fourth most common neurological diseases in people of all ages and the most common in pediatric neurology patients. In 2015, the Centers for Disease Control and Prevention (CDC) estimated the number of people with active epilepsy in the United States totaled 3.4 million (about 1.2 percent of the US total population – 3 million adults and 470,000 children ages 18 and younger).
Seizures occur when the electrical activity in the body’s nervous system is disrupted, resulting in disorganized communication among neurons in the brain. Stroke, head trauma, high fever, infection of the central nervous system and even certain metabolic conditions can all cause this type of abnormality. When seizures become recurrent, however, epilepsy is usually the diagnosis.
Epilepsy negatively affects quality of life, making it difficult for a patient to go to work or school or participate in social activities. The disease also carries a stigma that can result in a patient’s social isolation.
Scientists believe genetics plays a role in epilepsy, but the hunt is on for other causes as well. Research has indicated a possible connection between epilepsy and Down syndrome, Alzheimer’s disease, autism and various autoimmune diseases, including type I diabetes mellitus, psoriasis, ulcerative colitis and rheumatoid arthritis.
In fact, a study reported in a November 2016 online issue of "Neurology" indicated that children born of mothers who had rheumatoid arthritis at the time of their pregnancy are 90 percent more likely to develop epilepsy than the children of healthy mothers. Another early 2016 study found that the offspring of mothers diagnosed with epilepsy are at increased risk of becoming autistic.
By learning more about how epilepsy and other disorders are connected, doctors hope to find better methods for diagnosing and treating these diseases.
Medications can control seizures in roughly 70 percent of epilepsy patients; however, about one third of patients with epilepsy continue to have seizures. When the disease is severe or drug-resistant, various surgical options are available, including removal of epileptic-associated brain lesions, procedures that interrupt the flow of seizure impulses in the brain and the implantation of nerve stimulators to minimize seizures or stop them before they occur.
Dietary treatment can also be considered to help control seizures in some epilepsy patients that do not respond to at least two seizure medicines or anti-epileptic drugs (AEDs). The ketogenic diet (KD, high-fat, low-carbohydrate and controlled protein) and the modified Atkins diet (MAD, special high-fat, daily limit-carbohydrate and unlimited protein), are diets normally prescribed by physicians and carefully monitored by nutritionists. Although no one is certain how the diet works, it is believed that metabolic changes in the body affect the brain chemistry. Studies have shown that KD and MAD are effective in reducing or preventing seizures in many children whose seizures could not be controlled by AEDs.
More exciting are some of the latest study results, pointing to new, potentially more effective treatments for epilepsy. For example, in July 2016, scientists at the University of Exeter, United Kingdom, reported a new method for more closely identifying regions of the brain responsible for seizures. The finding could give surgeons a more effective tool for determining where in the brain to perform procedures that would have the most benefit to patients.
Learning to Cope
Until – or unless – a magic pill is developed to cure epilepsy, patients will have to continue coping with the disease. For those who have the disorder, here are a few quick tips:
- Take all medications as prescribed.
- Manage your stress and avoid stressful situations. Stress is a known trigger for brain seizures.
- Maintain a record of your seizures. Knowing when and in what situations they occur can help you identify other potential triggers.
- Get sufficient sleep because being overtired or not sleeping well can trigger a seizure.
- Eat regularly and maintain a balanced diet.
- Exercise safely.
- Never swim or ride a bike alone.
- Avoid alcohol intake or excessive caffeine intake.
- Avoid bright flashing lights or patterns.
- Certain medications can lower the seizure threshold.
- Fever and illnesses can lower the seizure threshold.
- Seizure may be associated with hormonal changes or menstrual cycle in some women.
- Females contemplating pregnancy should start taking folic acid before conception. There are also certain AEDs known to cause congenital malformation such as neural tube defect and cleft palate. It is important to consult with your neurologist prior to becoming pregnant.
Elizabeth Ng, MD is a pediatric neurologist, epileptologist and neurophysiologist at CareMount Medical. She is board certified by the American Board of Pediatrics and the American Board of Psychiatry and Neurology. Dr. Ng sees patients at CareMount’s Fishkill (Merritt), Poughkeepsie (Columbia) and Kingston campuses.