International Epilepsy Day Spotlight: Prevalence, Causes, and More Uncovered
Epilepsy is one of the most common neurological disorders globally, affecting around 50 million people worldwide[3]. To raise awareness and understanding about this condition, the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE) jointly launched the International Epilepsy Day which is marked on the second Monday of February every year.
As we approach February 12, 2024, which marks this year's International Epilepsy Day, it presents an opportunity to shed light on different aspects of this disorder - from the symptoms and causes to diagnosis, treatment options, and the social challenges that patients with epilepsy face.
Understanding Epilepsy
Epilepsy is defined as a disorder of the brain characterized by an enduring predisposition to generate seizures or episodic disruptions of normal brain function[1]. In simpler terms, it is a neurological condition that makes people susceptible to seizures. A seizure refers to the sudden abnormal electrical activity in the brain that causes momentary lapses or shifts in attention, movement, emotion, sensation, or level of consciousness. Seizures associated with epilepsy often have no identifiable cause.
Symptoms and Types of Seizures
The main symptom of epilepsy is recurrent seizures. But the characteristics of seizures - how they look and feel - vary greatly. Some major types of seizures include[1][2][3]:
- Focal (partial) seizures: These affect only a specific part of the brain and symptoms experienced depend on that part of the brain involved. For instance, temporal lobe seizures may cause auditory or visual hallucinations.
- Generalized seizures: These affect neurons on both sides of the brain at once and generally cause loss of consciousness, falls, muscle stiffness, and jerking movements of the arms and legs. These include absence seizures (staring spells) and tonic-clonic seizures (characterized by loss of consciousness and violent muscle contractions)
- Febrile seizures: These are seizures triggered by high fever and often happen in young children.
Apart from the overt symptoms during a seizure, epilepsy can also cause more subtle signs like memory issues, insomnia, fear and anxiety, depression, and trouble learning, which impacts quality of life.
Key Facts And Statistics About Epilepsy
Here are some key facts and statistics about epilepsy[3][4][5]:
- In 2015, 1.2% of the total US population had active epilepsy, which is about 3.4 million people nationwide, including 3 million adults and 470,000 children.
- Globally, an estimated 5 million people are diagnosed with epilepsy each year, with around 50 million people affected worldwide.
- At least 1 million people in the United States have uncontrolled epilepsy, and approximately 1 out of every 1,000 people with epilepsy die from sudden unexpected death in epilepsy (SUDEP) each year.
- Epilepsy is not rare and can occur as a single condition or may be seen with other conditions such as cerebral palsy, intellectual disability, autism, Alzheimer's disease, and traumatic brain injury.
- Up to 10% of people worldwide will have a one-off seizure at some point in their lives, and over 600,000 people in the UK have epilepsy, which is about one in every 100 people.
These statistics highlight the significant impact of epilepsy on individuals and communities, emphasizing the need for continued research, better treatments, and increased awareness.
Causes and Risk Factors
Epilepsy is often referred to as a spectrum disorder because of the diverse factors that predispose people to developing recurrent seizures. These include[6]:
- Genetics: Many genes have been linked to epilepsy, but most genetic links are complex.
- Head trauma and stroke: Head injuries that cause brain bleeding, swelling, or scarring can trigger epilepsy. Strokes restrict oxygen supply causing brain cell death and increasing seizure risk.
- Infections: Infections like meningitis, AIDS, and viral encephalitis can cause brain inflammation and injury that leads to seizures.
- Brain tumors: Brain tumors take up space in the skull and can interrupt normal electrical brain function.
- During development,: Risk factors like trauma during birth leading to oxygen deprivation, low birth weight, etc. can contribute to epilepsy development later.
Other key risk factors are vascular diseases, alcohol or drug use, dementias like Alzheimer's disease, etc. Many people may also develop epilepsy from unknown causes.
National Cross-Sectional Study For Epilepsy Risk Factors
Here is a summary of the key points from the study[6]:
This study used data from the National Health and Nutrition Examination Survey (NHANES) between 2013-2018 to investigate risk factors for epilepsy. Over 14,000 participants aged 20-80 were included in the analysis. 120 participants were identified as having epilepsy based on self-reported medication use.
The results showed that older age, specifically 40-59 years old, was associated with a higher risk of epilepsy. Those who had never been married had around 3 times higher risk compared to those married or living with a partner. Having good or very good general health was linked to lower epilepsy risk. Additionally, not having sleep disorders was found to be a protective factor, with around half the risk of those experiencing disorders.
So in summary, this large national study identified older age, not being married, and having sleep disorders as risk factors for epilepsy. Meanwhile, reporting good general health without sleep issues was protective against the condition. The findings provide insights that could help efforts to improve the quality of life for those with epilepsy.
Getting Diagnosed
Since the main symptom of epilepsy is seizures, doctors often start with enquiring about the onset, type, frequency, and triggers of seizures along with accompanying symptoms or issues. The key diagnostic steps include[7][9]:
- Medical history: Thorough details about health events leading to the first seizure episode.
- Neurological exam: Checks reflexes, motor skills, memory, and vision.
- Blood tests: To rule out infections, genetic conditions, etc.
- EEG test: Records electrical patterns during seizure to identify epilepsy type
- MRI/CT scans: Views brain structure to detect tumors, scar tissue, or bleeding
- Genetic testing: For young children to check epilepsy linked to genetic mutations
These tests help determine epilepsy type - focal, generalized, or unknown cause. Accurate classification guides the treatment approach.
Treating Epilepsy
While there is no cure yet for epilepsy, almost 75% of all cases can be well-controlled with adequate treatment[3]. The main treatment avenues include[7]:
- Anti-seizure medication: Broad range exists eg levetiracetam, valproate, etc. Dosage is titrated up slowly and adjusted based on tolerability and seizure control. Most people use one anti-seizure drug and more can be tried sequentially or in combo if needed.
- Vagus nerve stimulation: Electrical pulses to vagus nerve via implanted device, approved for difficult-to-treat cases
- Ketogenic diet: High fat, low carb diet that mimics fasting shown to reduce seizures in some children
- Surgery: Removal of seizure-causing brain tissue in focal epilepsy. Success rate of around 60-70% for well-selected surgical cases
Treatment aims to maximize seizure control while minimizing side effects to enable normal day-to-day functioning. But only around 50% of cases achieve full seizure control highlighting the need for better therapies.
Life with Epilepsy: Coping and Support
Living with uncontrolled epilepsy can be extremely challenging given the unpredictability of seizures, medication side effects, injury risks, anxiety about the next episode, etc. However, several positive lifestyle changes and support resources can improve quality of life[8]:
- Self-management education: Understanding epilepsy specifics, seizure triggers, first aid, safety issues, and treatment options helps patients actively participate in care.
- Handling triggers: Stress, sleep deprivation, alcohol use, and visual stimuli like flashing lights can trigger seizures so managing these areas helps.
- Adhering to treatment: Taking medicines regularly, maintaining treatment records, monitoring side effects, and reporting to doctor is key. Alternative therapies should only be taken under medical guidance.
- Safety practices: Precautions like wearing a helmet, placing cushioning mats on the floor, swimming with supervision, etc. reduces accident risks.
- Support groups: Support groups and talking to others with epilepsy facilitates coping, reduces isolation, and give practical advice.
- Work accommodations: For people struggling with work, vocational rehab programs train in skills suited to their condition, and aids like modified work schedules, rest breaks, etc. can support continued employment.
While knowledge and research on epilepsy treatment continues to expand all the time, tackling stigma and misunderstanding is equally important to ensure patient rights, and inclusion and improve access to care globally.
The Global Fight Against Epilepsy
As per WHO estimates, nearly 80% of people with epilepsy live in low and middle-income countries, which also sees higher rates of preventable epilepsy deaths due to suboptimal care[3].
Limited trained healthcare staff, cost of treatment, cultural beliefs that increase stigma, and inadequate healthcare infrastructure for chronic conditions are some key barriers faced in developing countries. Epilepsy also remains poorly prioritized in health policy planning and awareness is lacking across societal levels - from school teachers to employers.
Global initiatives by organizations like ILAE, IBE, and WHO aim to address these gaps by[10]:
- Raising public understanding: Campaigns like Purple Day that encourage open conversations about epilepsy to dispel myths and reduce stigma
- Capacity building programs: Training healthcare workers in developing countries on epilepsy diagnosis and evidence-based treatment
- Advocating increased policy focus: Encouraging governments to recognize epilepsy as a health priority and allot resources for tackling gaps in care
- Supporting research: Global research collaborations to better understand biological causes, identify cost-effective diagnostic tools for resource-limited settings, and advance therapy development
These worldwide efforts aligned with the 2030 UN Sustainable Development Goals collectively work towards ensuring healthier lives and promoting well-being for all people living with epilepsy globally.
So this International Epilepsy Day, let us renew our commitment to drive these initiatives forward through awareness and action - because millions are depending on us gaining a better understanding of this condition to unlock their full potential.
References:
[1] “Epilepsy – Seizure Types, Symptoms and Treatment Options.” Aans.org, 2024, www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Epilepsy.
[2] “Understanding Epilepsy | Brain Institute | OHSU.” Ohsu.edu, 2015,
www.ohsu.edu/brain-institute/understanding-epilepsy.
[3] World. “Epilepsy.” Who.int, World Health Organization: WHO, 9 Feb. 2023, www.who.int/news-room/fact-sheets/detail/epilepsy.
[4] Epilepsy Fast Facts. 2024, www.cdc.gov/epilepsy/about/fast-facts.htm.
[5] Epilepsy Data and Statistics. 2024, www.cdc.gov/epilepsy/data/index.html.
[6] Yang, Lixiang et al. “Risk Factors for Epilepsy: A National Cross-Sectional Study from National Health and Nutrition Examination Survey 2013 to 2018.” International journal of general medicine vol. 14 4405-4411. 11 Aug. 2021, doi:10.2147/IJGM.S323209
[7] Oguni, Hirokazu. "Diagnosis and treatment of epilepsy." Epilepsia 45 (2004): 13-16.
[8] NHS Choices. Living with - Epilepsy. 2024, www.nhs.uk/conditions/epilepsy/living-with/.
[9] Frequently Asked Questions about Epilepsy. 2024, www.cdc.gov/epilepsy/about/faq.htm.
[10] “ILAE-IBE-WHO Global Campaign against Epilepsy // International League against Epilepsy.” Ilae.org, 2021,
