Epilepsy
Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures.[10] An epileptic seizure is the clinical manifestation of an abnormal, excessive, and synchronized electrical discharge in the neurons.[1] The occurrence of two or more unprovoked seizures defines epilepsy.[11] The occurrence of just one seizure may warrant the definition (set out by the International League Against Epilepsy) in a more clinical usage where recurrence may be able to be prejudged.[10] Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrical activity in the brain.[1] These episodes can result in physical injuries, either directly such as broken bones or through causing accidents.[1] In epilepsy, seizures tend to recur and may have no detectable underlying cause.[11] Isolated seizures that are provoked by a specific cause such as poisoning are not deemed to represent epilepsy.[12] People with epilepsy may be treated differently in various areas of the world and experience varying degrees of social stigma due to the alarming nature of their symptoms.[11]
"Epilepsia" and "Epileptic" redirect here. For the journal, see Epilepsia (journal). For the comics, see Epileptic (comics).Epilepsy
Seizure disorder Neurological disability
Periods of loss of consciousness, abnormal shaking, staring, change in vision, mood changes and/or other cognitive disturbances [1]
Long term[1]
Unknown, brain injury, stroke, brain tumors, infections of the brain, birth defects[1][2][3]
Electroencephalogram, ruling out other possible causes[4]
Medication, surgery, neurostimulation, dietary changes[5][6]
Controllable in 69%[7]
39 million/0.5% (2015)[8]
125,000 (2015)[9]
The underlying mechanism of an epileptic seizure is excessive and abnormal neuronal activity in the cortex of the brain[12] which can be observed in the electroencephalogram (EEG) of an individual. The reason this occurs in most cases of epilepsy is unknown (cryptogenic);[1] some cases occur as the result of brain injury, stroke, brain tumors, infections of the brain, or birth defects through a process known as epileptogenesis.[1][2][3] Known genetic mutations are directly linked to a small proportion of cases.[4][13] The diagnosis involves ruling out other conditions that might cause similar symptoms, such as fainting, and determining if another cause of seizures is present, such as alcohol withdrawal or electrolyte problems.[4] This may be partly done by imaging the brain and performing blood tests.[4] Epilepsy can often be confirmed with an EEG, but a normal reading does not rule out the condition.[4]
Epilepsy that occurs as a result of other issues may be preventable.[1] Seizures are controllable with medication in about 69% of cases;[7] inexpensive anti-seizure medications are often available.[1] In those whose seizures do not respond to medication; surgery, neurostimulation or dietary changes may then be considered.[5][6] Not all cases of epilepsy are lifelong, and many people improve to the point that treatment is no longer needed.[1]
As of 2020, about 50 million people have epilepsy. Nearly 80% of cases occur in the developing world.[1] In 2015, it resulted in 125,000 deaths, an increase from 112,000 in 1990.[9][14] Epilepsy is more common in children and older people.[15][16] In the developed world, onset of new cases occurs most frequently in babies and the elderly.[17] In the developing world, onset is more common at the extremes of age – in younger children and in older children and young adults due to differences in the frequency of the underlying causes.[18] About 5–10% of people will have an unprovoked seizure by the age of 80.[19] The chance of experiencing a second seizure within two years after the first is around 40%.[20][21] In many areas of the world, those with epilepsy either have restrictions placed on their ability to drive or are not permitted to drive until they are free of seizures for a specific length of time.[22] The word epilepsy is from Ancient Greek ἐπιλαμβάνειν, 'to seize, possess, or afflict'.[23]
Prevention[edit]
While many cases are not preventable, efforts to reduce head injuries,[7] provide good care around the time of birth, and reduce environmental parasites such as the pork tapeworm may be effective.[30] Efforts in one part of Central America to decrease rates of pork tapeworm resulted in a 50% decrease in new cases of epilepsy.[18] Yoga-based Nadi Shodhana Pranayama, also known as Alternate Nostril Breathing, may positively impact the nervous system and help manage seizure disorders. Regular exercise helps balance brain function by providing the body with oxygen and removing carbon dioxide and toxins from the blood.[140]
Complications[edit]
Epilepsy can be dangerous when seizure occurs at certain times. The risk of drowning or being involved in a motor vehicle collision is higher. It is also found that people with epilepsy are more likely to have psychological problems.[141] Other complications include aspiration pneumonia and difficulty learning.[142]
Epidemiology[edit]
Epilepsy is one of the most common serious neurological disorders[196] affecting about 39 million people as of 2015.[8] It affects 1% of the population by age 20 and 3% of the population by age 75.[16] It is more common in males than females with the overall difference being small.[18][68] Most of those with the disorder (80%) are in low income populations[197] or the developing world.[30]
The estimated prevalence of active epilepsy (as of 2012) is in the range 3–10 per 1,000, with active epilepsy defined as someone with epilepsy who has had a least one unprovoked seizure in the last five years.[68][198] Epilepsy begins each year in 40–70 per 100,000 in developed countries and 80–140 per 100,000 in developing countries.[30] Poverty is a risk and includes both being from a poor country and being poor relative to others within one's country.[18] In the developed world epilepsy most commonly starts either in the young or in the old.[18] In the developing world its onset is more common in older children and young adults due to the higher rates of trauma and infectious diseases.[18] In developed countries the number of cases a year has decreased in children and increased among the elderly between the 1970s and 2003.[198] This has been attributed partly to better survival following strokes in the elderly.[68]