Epilepsy is a brain disease that causes repeated episodes of brain dysfunction. There are different types of seizures and the cause is sometimes known and sometimes not. It is not a rare disease as it appears to have a prevalence of around 1% and affects people of all ages, genders and ethnicities.

How do seizures occur?

Seizures manifest themselves in a variety of ways: the patient may experience convulsions (generalized or in a limited area of ​​the body), fixation of the gaze, loss of urine, aesthetic disturbances, disturbance of the senses, such as that time is running at the wrong rate, that they smell something ugly and more. During the epileptic crisis, the patient may lose consciousness or show confusion, while in others he may remain fully awake. The usual duration of a seizure is between a few seconds and two minutes.

Seizures may occur after a stroke, brain injury, meningoencephalitis, hypoglycemia, alcohol and substance abuse, etc.

A seizure is a symptom, therefore its appearance does not mean that the patient suffers from epilepsy. A diagnosis of epilepsy requires at least two episodes more than 24 hours apart. In general, epilepsy patients tend to have the same type of seizures every time.

How is epilepsy diagnosed?

Epilepsy investigation includes brain MRI with special imaging protocol and electroencephalogram. As part of a more general check-up and to rule out other conditions, blood tests, electrocardiogram, recall test and possibly a psychiatric assessment are carried out on a case-by-case basis.

EEG: a test of choice

The electroencephalogram is the test of choice for the diagnosis of epilepsy. It is a simple, safe and painless test that records the electrical activity of the brain’s surface. It is one of the most common paraclinical examinations of clinical neurophysiology

Brain cells communicate with electrical impulses. This activity is continuous, even during sleep, and is what is recorded on the EEG. During an epileptic seizure, the normal function of these cells is disturbed and pathological electrical discharges are recorded in the form of an electrical storm (like a “short circuit”). In most cases the EEG is performed between seizures, although abnormal activity may be recorded. This is an important diagnostic aid, as it can identify the area of ​​pathology as well as the type of seizures.

The electroencephalogram is a simple routine examination and is performed by attaching simple, metal disk-shaped electrodes to the skull, in predetermined positions. The patient sits calmly in a chair or may be prone. Simultaneous camera recording is done so that any clinical manifestations (such as movement) can be combined with the electroencephalographic image. During the recording, techniques are applied, such as hyperpnea and intermittent light stimuli, which aim to activate any pathological activity.

In special cases, an electroencephalogram can be performed after sleep deprivation (mainly in younger patients), or a long-term video-electroencephalogram, eg 24 hours or more. The latter allows a more complete investigation of nocturnal seizures as well as the distinction between seizures and other types of disorders, e.g. episodes of loss of consciousness of cardiac etiology that may be difficult to differentially diagnose

Pregnancy in patients with epilepsy

Pregnancy is of particular interest in patients with epilepsy. In general, pregnancy can increase the frequency of seizures in 25-30% of cases. Conversely, epilepsy affects pregnancy. Pregnant women with epilepsy have higher rates of preeclampsia, miscarriage, premature birth, vaginal bleeding, etc. relative to the general population. If we also take into account the potentially toxic effect of antiepileptic drugs on the fetus, it becomes clear that the pregnancy is at high risk.
Nevertheless, a woman suffering from epilepsy can become pregnant, with exceptions, provided that the pregnancy is planned so that appropriate interventions are made in the medication before conception. Close monitoring is required during pregnancy.

Is there a cure for epilepsy?

The treatment of epilepsy is primarily pharmaceutical. After a complete investigation, each patient is given as monotherapy an antiepileptic drug that is considered suitable for the specific type of seizures. In some cases this is not enough and a combination of more than one drug is required. If the seizures are not controlled satisfactorily with medication, i.e. it is drug-resistant epilepsy, then, in selected patients, surgical treatment of epilepsy may be recommended.

Epilepsy is a chronic disease that requires careful investigation and monitoring. With appropriate interventions, patients with epilepsy can have satisfactory seizure control and minimal burden on their quality of life.