Epilepsy is a serious disorder that affects people of all ages and varies widely in its presentation. Unfortunately, a considerable amount of misinformation and stigma continues to surround epilepsy patients and clouds our collective understanding of the disorder’s morbidity and treatment.
Whether you are a parent looking to learn more about treatment options for your children or an aspiring medical professional like John Gorecki MD, looking to separate the facts from the spin, it is worth taking some time to study epilepsy. What follows is a high-level look at epilepsy that, properly used, can serve as the basis for further research and understanding.
An Ancient Disorder
Epilepsy’s ancient pedigree is evident in its name: “Epilepsy” is an ancient Greek word that roughly translates as “to seize” or “to possess.” As one might expect, the ancient world’s relationship with epilepsy was very different from our modern conception of the disorder. Epilepsy and its most obvious symptom — epileptic seizures — were largely seen as a supernatural affliction signifying some sort of imbalance in the universe. Sufferers were often actively ostracized or even subjected to violent persecution, though records of how systematic and widespread such treatment was are difficult to come by.
Presentation and Morbidity
As one of the first widely recognized and diagnosed neurological afflictions, epilepsy has been studied with some rigor for hundreds of years. Epileptic seizures are classified as idiopathic or secondary. Idiopathic seizures have no identified underlying cause or abnormality seen on MRI. Secondary seizures have an underlying cause such as scar or tumor and are also described as lesional seizures.
Epileptic seizures vary in duration and intensity, with more severe seizures involving a substantial risk of aspiration and other potentially life-threatening complications. Causes vary widely; some patients evidence a genetic predisposition, while others appear to develop symptoms after sustaining a neurological injury.
Treatment Options for Patients of All Ages
Separately from acute interventions designed to minimize serious or life-threatening side effects, epilepsy treatment options include:
- Medication (beneficial in about 70% of cases)
- Standard or minimally invasive (stereotactic) surgery
- Neurologic stimulation (various nerve centers, vagal nerve stimulation)
- Ketogenic diet (high-fat, low-carbohydrate, adequate-protein)
- Removal of indirect triggers, such as rapid-frame blue light
Cutting-Edge Research May Hold New Promise
There are several promising avenues for epilepsy research, some of which may soon result in new treatments or intervention options. In particular, minimally invasive stereotactic surgery appears to have similar or even superior outcomes to standard surgery without the attendant risks and long-term effects of more invasive interventions. Additionally, EEGs are being used with increasing accuracy to predict seizures and pinpoint their source, though no systematic prediction scheme has yet been achieved.
It is clear that the final chapter in the story of epilepsy has yet to be written. However, our understanding of this affliction is more complete and nuanced than at any time in history. As such, the future for the treatment and management of epilepsy looks brighter than ever before. That is certainly hopeful news for millions of epilepsy sufferers around the world.