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  • Dr Ashleigh Bhanjan

Shedding Light on Epilepsy Treatment, latest advances and limitations

Epilepsy is a neurological disorder characterized by recurring, unprovoked seizures. It affects approximately 1.2% of the population in the United States, with no gender, race, or ethnicity being exempt from the condition. Seizures are caused by surges of electrical activity in the brain, which can lead to a variety of symptoms depending on the affected brain regions.

The epidemiology of epilepsy in Africa varies widely across different countries and populations, with prevalence rates ranging from 0.5% to 10%

Some of the specific causes of epilepsy in sub-Saharan Africa include family history of seizures, previous febrile seizures, perinatal trauma, head injury, and central nervous system (CNS) infections.

Neurocysticercosis and ischemic strokes are common causes of epilepsy in Eastern Africa.

The stigma associated with epilepsy in Africa is a significant challenge, leading to limited access to healthcare and treatment.

The management of epilepsy in Africa is often inadequate due to a lack of awareness and education, limited access to diagnostic tools and treatments, inadequate coordination of care, and the stigma associated with the condition.

International Epilepsy Day is observed on the second Monday of February each year.
In 2024, it falls on February 12th. It's a day for individuals, organizations, and communities to come together and make a difference in the lives of those affected by epilepsy.

Types of Epilepsy

Epilepsy can be classified into 2 main types: generalized and focal (previously known as partial)

Generalized Epilepsy

This type involves seizures that begin in both hemispheres of the brain simultaneously. Examples include absence seizures (formerly called "petit mal" seizures) and generalized tonic-clonic seizures (formerly called "grand mal" seizures)

Focal Epilepsy

Seizures in this type begin in a specific area of the brain. They can be further classified as focal impaired awareness seizures (formerly called "complex partial" seizures) and focal motor seizures (formerly called "simple partial" seizures)

Latest Advances in Epilepsy Treatment

Epilepsy treatment has advanced significantly in recent years, with new techniques and devices offering hope for better seizure control and improved quality of life for patients.

Medications : Antiseizure medications (also known as antiepileptic drugs or AEDs) are the most common treatment for epilepsy. They can help control seizures in approximately 70% of patients.

Surgery : Epilepsy surgery, such as resective surgery, disconnection surgery, and deep brain stimulation, can be effective for patients with refractory epilepsy.

Transcranial Magnetic Stimulation (TMS): TMS is a non-invasive technique that uses magnetic fields to stimulate the brain and has shown promise in treating epilepsy.

Vagus Nerve Stimulation (VNS): VNS is a device that has been approved for epilepsy since 1997 and can help reduce the number and intensity of seizures.

Brain Mapping : Advanced brain mapping techniques help surgeons preserve critical areas of the brain, such as memory and language, during epilepsy surgery

Photobiomodulation Therapy (PBM, aka Low Level Laser Therapy)

Photobiomodulation therapy (PBM) offers several potential benefits over other non-pharmacological treatments for epilepsy.

Firstly, PBM is non-invasive and has an excellent safety record with little or no evidence of side effects.

Secondly, PBM targets mitochondrial dysfunction, which is a key factor in epilepsy, and has been shown to improve many of the hallmarks of the disorder, such as abnormal neuronal activity and death.

Thirdly, PBM is a relatively safe and non-pharmacological treatment option for patients with epilepsy, particularly for those who are unresponsive to drug therapy or for whom surgical intervention is not suitable

Compared to other non-pharmacological treatments, such as the ketogenic diet or neuromodulation, PBM offers the advantage of being non-invasive and having an excellent safety record with little or no evidence of side effects

Additionally, PBM targets the underlying mechanisms of epilepsy, making it a promising treatment option for patients who do not respond well to other non-pharmacological interventions.In summary, PBM offers several potential benefits over other non-pharmacological treatments for epilepsy, including its non-invasiveness, excellent safety record, and ability to target the underlying mechanisms of the disorder.

Ongoing research and clinical trials continue to explore its effectiveness and safety in the management of epilepsy.

Limitations and Challenges

Despite these advances, epilepsy remains a complex disorder with limitations and challenges.

Diagnosis : In some cases, it can be difficult to determine whether seizures are focal or generalized, especially if the patient was alone during the seizure. The Electroencephalogram [EEG], is our gold standard to diagnose seizure activity, in the brain.

Normal EEG recording

Treatment Resistance : Some patients with epilepsy do not respond well to medications, and their seizures may be refractory to medical therapy

Stigma : Misconceptions and stigma surrounding epilepsy can lead to social isolation and reduced access to educational and employment opportunities.

Access to Care: Many patients with epilepsy live in low- and middle-income countries, where access to healthcare and epilepsy medications may be limited.

In conclusion, epilepsy is a complex neurological disorder characterized by recurring seizures. It can be classified into generalized and focal types, and recent advances in treatment have led to improved seizure control and quality of life for many patients.

However, challenges remain in diagnosis, treatment resistance, stigma, and access to care. Newer therapeutic forms of neuromodulation should be considered for patients, in additional to usual therapeutic modalities, for better seizure control, quality of life and outcomes.



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