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Epilepsy is one of the most common neurological diseases. Nearly 1 percent of the human population suffer from epilepsy. There are approximately 400 patients in Poland.
One in ten of us may experience one seizure in our lifetime. The greatest number of new cases occurs in the first year of life and after the age of 60, but it is possible at any age.
Prof. Joanna Jędrzejczak, president of the Polish Society of Epileptology, wrote a very accessible guide called You too can get epilepsy. The title emphasizes the prevalence of this disease and encourages learning about it. The guide is supplemented with authentic stories of people of all ages struggling with epilepsy. As you read these statements, you will find that there is no one typical history of epilepsy, because every story is different. But, as prof. Jędrzejczak, they all have one thing in common: They talk about an extremely difficult, chronic disease that must be dealt with sometimes for a few years, sometimes for a dozen or so years, and sometimes for the entire life. The disease may have long periods of remission (seizure-free period). This does not mean, however, that the epilepsy has resolved, because we do not know if and when, even after a long break, the seizure will reappear. This can happen to a sick person at any time, during an exam, on vacation, or even on their wedding day. People suffering from epilepsy live in uncertainty, in fear because they do not know when to expect a seizure. Insecurity is perhaps the most difficult part of living with epilepsy.
History of epilepsy
Epilepsy is one of the oldest diseases in the world. The word epilepsy is 2500 years old and comes from the Greek verb epilambanein – to attack, take, attack. The oldest document describing a seizure is from Mesopotamia in 1050 BC. For a long time, epilepsy was considered a sacred disease, sent by a god or a devil. The Romans, for example, believed that the sick, who were possessed by evil demons, infect others through their breath and kept epileptics out of the community. The breakthrough in understanding the essence of this disease came thanks to Hippocrates, who said in AD 400 that epilepsy is a brain disease that must be treated with diet and medication, not with spells or witchcraft. Epilepsy has its patron. It is Saint Valentine, a priest and doctor who died a martyr’s death in 268. His relics were supposed to free people from attacks, so thousands of sick people made pilgrimages to the temples under his call, to the Italian basilica in Termi, or to Passau in Germany. One of the names for epilepsy was St. Valentine’s impotence.
However, the treatment of epilepsy, understood as seizure prevention, did not begin until the 1920th century, and in XNUMX Hans Berger, a German psychiatrist, invented an electroencephalograph that allows the study of the electrical activity of the brain (EEG). In the case of epilepsy, it is one of the most important diagnostic tests.
The causes and types of epilepsy
According to modern medicine, epilepsy is a primary brain disease that occurs when certain nerve cells function suddenly in the brain, accompanied by electrical activity triggered by these cells. The disease is manifested by the occurrence of repeated seizures. Any short-term sudden disturbance in the nervous system can trigger a seizure. Medicine calls the starting point of this attack in the brain an epileptic focus.
There are many different causes of epilepsy. In terms of etiology, medicine divides epilepsy into three groups: idiopathic, symptomatic and cryptogenic.
Idiopathic epilepsy accompanies some genetic diseases, is one of the symptoms of these diseases. There may also be a genetic predisposition for seizures. Idiopathic epilepsy most often manifests itself in childhood.
Cryptogenic epilepsy is diagnosed when the root cause of the disease cannot be identified. These are probably microscopic structural changes in the brain that, despite the diagnostic progress, we are unable to detect. The etiology of epilepsy is not recognized in 65-75%.
Symptomatic epilepsy have a known cause. It can be diagnosed in 1/3 of patients. These are most often the effects of various types of random events, injuries, and diseases related to aging.
The most commonly recognized causes of epilepsy:
• head injuries, including perinatal injury (brain damage caused during childbirth), are among the most common causes of epilepsy; Even before birth, the fetal brain may be damaged as a result of certain maternal diseases (e.g. rubella), certain chemicals (nicotine, drugs), and any other injuries or conditions leading to fetal hypoxia,
• vascular diseases of the brain (strokes, subarachnoid haemorrhage, vascular anomalies), especially in the elderly,
• degenerative diseases (Alzheimer’s disease) and demyelinating diseases (multiple sclerosis),
• tumors and metastases to the brain – another factor whose proportion is age dependent and increases with age; the first attack in life after the age of 30 is always suspected of tumor etiology,
• inflammation of the brain and meninges,
• toxic-metabolic causes (chronic alcohol abuse).
Types of epileptic seizures
Depending on the place in the brain where nerve cell function is disturbed, the picture of an epileptic seizure can be very diverse. Epilepsy is not only a seizure with loss of consciousness. About 40 forms of seizures are diagnosed. Some occur frequently, others much less frequently. Description of symptoms and EEG testing are the basis of seizure classification.
Focal seizures – it is the most common form of epilepsy. They start in a well-defined region of the brain, can occur at any age, and last from a few seconds to a minute. The patient may be aware of what is happening to him. The symptoms of focal disorders depend on the location of the epileptic focus in the brain. These can be, for example, hand convulsions, a feeling of numbness or pain, visual (sparks, flashes), auditory (whistling), taste and olfactory disorders involving the perception of strange unpleasant tastes or smells. The patient may experience some upper abdominal or chest ailments, sweat, drool, or have an increased heart rate. He may experience the feeling that he is observing his body from the outside, or that he is experiencing a given situation again, or that he may perceive a distorted image of his surroundings. For many patients, this is the aura that foreshadows an attack.
Another form are seizures with disturbances of consciousness, e.g. immobility, interruption of the activity performed, with repetition of activities such as moving the lips, chewing, nibbling, folding hands. These movements are called automatisms.
Absence seizures they mainly occur in children and adolescents. They last up to 30 seconds and involve sudden loss of consciousness and immobility. After the attack, the patient immediately resumes the interrupted activity.
Atonic seizures – there is a sudden loss of muscle tone which may result in a sudden fall and severe head injury.
Myoclonic seizures – they occur mainly in children and adolescents and consist of short jerks (jerks) of the muscles. It usually happens in the morning after a sleepless night. They do not cause loss of consciousness.
Generalized seizures – in this type of seizures, epileptic discharges occur in both hemispheres of the brain simultaneously.
Tonic-clonic seizures – occur at all ages. They last from 1-3 minutes and are accompanied by loss of consciousness. The seizure begins with a scream, the patient stiffens and stretches. The torso and head are tilted and the limbs point inward. The hands are clenched (tonic phase), the eyeballs are pointing upwards. It is accompanied by apnea and cyanosis. After 30 seconds, you breathe in deeply and the clonic phase (convulsions) begins. During an attack, the pupils are wide and do not respond to light, the blood pressure rises and the heart beats faster. Drooling occurs. The 2-minute clinical phase is followed by deep sleep. Sometimes you bite your tongue and urinate.
These concepts should be distinguished:
| Awareness | Loss of consciousness | Swoon |
|---|---|---|
| The mental state of being aware of the existence of oneself and the environment. | A state of impaired consciousness, combined with a loss of response to external stimuli. Loss of consciousness can vary in depth. | Short-term, profound loss of consciousness, caused by a decrease in blood flow through the brain as a result of heart disorders, a drop in blood pressure, or cardiovascular reflexes. Fainting is not characteristic of an epileptic seizure. |
The triggers for seizures may include: lack of sleep, anxiety, women’s peri-menstrual period, alcohol, sleep (in some patients, seizures occur only during sleep), television, flashing disco lights.
Diagnosis and treatment of epilepsy
The diagnosis of epilepsy is based on a careful interview with the patient and family about the circumstances of the seizures. Additional tests are also recommended: electroencephalogram – EEG recording allows the assessment of changes in brain function in a patient with epilepsy. It also allows you to recognize the type of epilepsy and the type of seizure. Your doctor may also order brain structure tests to find the cause of your epilepsy. These are computed tomography and magnetic resonance imaging.
The mainstay of treatment for epilepsy is antiepileptic drugs. The drug should be adapted to the type of seizure. If seizure control is not achieved with one drug, a second drug is introduced gradually. Antiepileptic drugs must be taken in a certain number of daily doses at fixed times. The patient treated pharmacologically should undergo blood tests (complete blood counts and liver tests) every 6 months.
About 5-10 percent of patients do not respond to drug treatment and require neurosurgical treatment. The treatment of the brain tissue is designed to reduce the frequency of epileptic seizures or change their character to a less burdensome one. It cannot be assumed that surgical treatment will completely free the patient from epileptic seizures. Vagus nerve stimulation is a new treatment for epilepsy. Below the left clavicle, a vagus nerve stimulator is implanted to inhibit the seizure activity of the brain. This device resembles a pacemaker. The vagus nerve stimulator is used primarily in patients with the so-called aura, where the patient, sensing that a seizure is approaching, can prevent seizures by actuating the pacemaker magnet. Implanting a pacemaker is very costly. In Poland, this method is not reimbursed and therefore its availability is low.
The good tolerance of drugs and the absence of seizures during their use enables epilepsy patients to lead a normal professional and private life. However, they cannot perform all professions. They should not drive public means of transport, operate heavy machinery, work with hazardous materials. They should also not work at heights and in shifts at night.
Prof. Joanna Jędrzejczak ends the guide for patients with an optimistic statement that epilepsy can be overcome and can be lived with. However, the condition for the availability of the latest diagnostic and treatment methods must be met.
Drug treatment of epilepsy
The organization of the epilepsy care system in Poland does not keep up with the possibilities of medical knowledge. Existing regulations prevent doctors from personalizing treatment. Reimbursement of epilepsy treatment with so-called the first line is limited to only four classic substances with many side effects. All other drugs used in the pharmacotherapy of epilepsy belong to the newer generation and as such are reimbursed only after the diagnosis of drug-resistant epilepsy. Due to the lack of reimbursement, in many clinically difficult cases, modern therapy becomes unavailable for patients by restricting the use of newer generation drugs only to drug-resistant epilepsy. In order to create uniform procedures in the treatment of epilepsy, the Polish Society of Epileptology in cooperation with the National Consultant in the field of Neurology developed guidelines for pharmacological management in patients with epilepsy in Poland. They assume the introduction of a division, functioning in other European countries, into first-, second- and third-choice drugs, which would allow for a more precise and effective adjustment of the drug to the type of seizures or epilepsy syndromes. It is therefore necessary to expand the list of reimbursed drugs and to create specialized reference centers that would have appropriate diagnostic equipment and employ all the necessary specialists: neurophysiologists, neuropsychologists, technicians, nurses and social workers.
This is being sought by the Agreement for People Suffering from Epilepsy, established by the Polish Society of Epileptology and the Polish Association of People Suffering from Epilepsy, i.e. organizations grouping patients and doctors. In January, an application was made to the Minister of Health to modify the current record of drug-resistant epilepsy in the Regulation of the Minister of Health by removing the term drug-resistant and changing the indications specified in the reimbursement decisions from drug-resistant epilepsy to epilepsy in all treatment lines (I, II, III in accordance with the guidelines of the Polish Society of Epileptology).
The European Parliament also noticed the need to improve care for patients with epilepsy. In September 2011, the Written Declaration on this disease was signed, initiating an important project aimed at improving the prevention, care and quality of life of people suffering from epilepsy in Europe. We hope that Poland, as a member state of the European Union, will support this initiative
More information on the websites of the Polish Society of Epileptology (www.epilepsy.org.pl) and the Polish Association of People suffering from Epilepsy (http://padaczka.2n.pl).