Epilepsy overview
Epilepsy, which is a type of seizure disorder, is a medical condition in which the brain produces brief intense bursts of electrical energy.¹ These bursts result in seizures which affect a variety of mental and physical functions, such as consciousness, body movements, and sensations.^1,2

Epilepsy can be caused by thousands of medical conditions, from genetic mutations to traumatic brain injury.³ More often than not, no cause can be identified.¹

Epilepsy is the third most common neurological disorder in the U.S. after Alzheimer's disease and stroke. Its prevalence is greater than cerebral palsy, multiple sclerosis and Parkinson's disease combined.²

Classifying Epilepsies and Seizures
A person is considered to have epilepsy when they have experienced two or more unprovoked seizures.²  There are many types of seizures, varying from brief disruptions of the senses, to short periods of unconsciousness, to convulsions.³

It is important to note that all people with epilepsy will have seizures, but not all people with seizures will necessarily be diagnosed with epilepsy.⁴

More than one-third of all patients with epilepsy have a seizure type called Complex Partial Seizures (CPS), making it the most frequently occurring type of seizure.⁵ A majority of people will experience an aura, often described as a strange sensation, immediately before the seizure. The first indication of this type of seizure may be a blank stare or arrest of motion. During a seizure, people with CPS may make repetitive and purposeless movements called “automatisms,” which include chewing, lip-smacking and picking at the air, for example. Impaired consciousness can occur during the seizure, resulting in an inability to respond to commands or interact with one’s surroundings. The average duration of the seizure is 30 to 90 seconds and after the seizure, people may be confused or fatigued.⁶

Epilepsy is also grouped into epileptic syndromes according to a set of common characteristics, like patient age, seizure type(s), and cause (etiology).⁷

Difficult-to-Manage Epilepsies
Approximately one-third of people with all types of epilepsy are refractory, meaning their seizures are not completely controlled by multiple therapies.⁸ About half of patients with CPS do not achieve seizure control and are considered to have refractory CPS.⁹

There are many different types of epilepsy syndromes. Among particularly severe forms of epilepsy are Lennox-Gastaut syndrome (LGS) and Infantile Spasms (IS).

LGS is a rare and severe form of epilepsy that is typically diagnosed in childhood and often persists into adulthood.^10,11 LGS is associated with multiple types of seizures with periods of frequent seizures, and daily seizures are common.12 Some of these seizures may cause falls, or “drop attacks”, which may result in injury.^11,13 By the age of six, most children with LGS have some degree of mental retardation.¹⁴

IS is a difficult-to-manage syndrome that usually starts in the first year of life, and onset is typically between four and eight months. Children with IS can experience hundreds of spasms per day. Many infants have neurological impairment prior to the onset of spasms. While spasms usually cease by age five, more than half of children with IS develop other types of seizures, and approximately one-fifth of children with IS develop LGS.^15,16

Statistics
It is estimated that 1% of people by 20 years of age and 3% of people by 75 years of age have epilepsy. Ten percent of people will have at least one seizure in their lifetime. According to the Epilepsy Foundation of America, almost 3 million Americans have experienced epilepsy and seizures.¹⁷ Worldwide, 40 million people have epilepsy.¹⁸

Epilepsy can occur in people of all ages and races.¹ Approximately 200,000 new cases of epilepsy are diagnosed each year, and diagnosis is most common in the age groups of under 2 years and over 65 years.¹⁷

Seeking diagnosis and care
Epilepsy can be diagnosed and managed by many types of doctors, including neurologists, pediatric neurologists, pediatricians, neurosurgeons, internists and family physicians.¹ If possible, patients and their caregivers should seek out a neurologists with a special expertise in epilepsy – these epilepsy specialists are often referred to as “epileptologists.”

Diagnosis is a multi-step process that includes a review of the medical history, a physical examination, and tests to analyze blood and other bodily fluids.¹⁹ Several additional diagnostic tools can be used, including an electroencephalogram (EEG), and brain imaging techniques.²⁰ The precise tests and diagnostic tools that are used will vary.¹⁹

Following the diagnosis of epilepsy, the next step is to develop an appropriate management plan. There are multiple options, and sometimes a combination of these may be required to help manage the specific epilepsy type. Options include surgery, a special diet, medicines, complementary therapy or stimulation of the vagus nerve. Surgery can prevent seizures that are caused by an underlying correctable brain condition.²⁰

It is essential that people with epilepsy seek comprehensive care from healthcare professionals.

Sources
1. Epilepsy Foundation. Frequently asked questions. www.epilepsyfoundation.org/aboutepilepsy/faq.cfm. Accessed 9/27/11.

2. Epilepsy Foundation. About epilepsy. www.epilepsyfoundation.org/aboutepilepsy/index.cfm. Accessed 9/27/11.

3. Rogers SJ, Cavazos JE. Epilepsy. In: DiPiro JT, Talbert RL, Yee GC, et al., eds. Pharmacotherapy: A pathophysiologic approach. 7th edition. New York, NY: McGraw-Hill; 2008: p927.

4. Lowenstein DH. Seizures and epilepsy. In: Fauci AS, Braunwald E, Kasper DL, et al., eds. Harrison’s Principles of Internal Medicine. 17th edition. Philadelphia, PA: McGraw Hill; 2010: p1.
5. Carroll, Elizabeth. EMedicine.com. Complex Partial Seizures.

http://emedicine.medscape.com/article/1183962-overview. Last accessed 9/27/11.

6. Seizures and Epilepsy Syndromes. In: Course #8042. CME Resource (2010). 1-58.

7. University of Maryland. Introduction to Epilepsy.
http://www.umm.edu/patiented/articles/what_epilepsy_000044_1.htm

8. Wheless J. Intractable epilepsy: A Survey of Patients and Caregivers. Epilepsy & Behavior. 8 (2006) 756-764.

9. Treiman, David M. Management of refractory complex partial seizures: current state of the art
In: Neuropsychiatric Disease and Treatment:6. Phoenix, AZ; 2010. 297-308

10. Van Rijckevorsel, Kenou et al. Treatment of Lennox-Gastaut syndrome: overview and recent findings.  Neuropsychiatric Disease and Treatment. 2008: 4(6) 1001-1019].

 11. Arzimanoglou, Alexis et al. Lennox-Gastaut syndrome: a consensus approach on diagnosis, assessment, management, and trial methodology. The Lancet. 2009: 8(1) 82-93.

12. Borggraefe I, Noachtar S. Pharmacotherapy of Seizures Associated with Lennox-Gastaut Syndrome. Clinical Medicine Insights: Therapeutics. 2010; 2:15–24.

13. Dulac, Olivier. Lennox-Gastaut Syndrome. International League against Epilepsy
http://www.ilae-epilepsy.org/Visitors/Centre/ctf/lennox_gastaut.cfm. Last accessed 9/16/11.

14. Epilepsy Foundation. Lennox-Gastaut Syndrome. http://www.epilepsyfoundation.org/aboutepilepsy/syndromes/lennoxgaustaut/index.cfm. Accessed 10/13/11.

15. National Institute of Neurological Disorders and Stroke. NINDS Infantile Spasms Information Page.
http://www.ninds.nih.gov/disorders/infantilespasms/infantilespasms.htm. Last accessed 9/27/11.

16. Holmes, Gregory. Epilepsy.com. Infantile Spasms.  http://www.epilepsy.com/epilepsy/epilepsy_infantilespasms.html. Last accessed 9/27/11.

17. Epilepsy Foundation. Incidence and prevalence.
www.epilepsyfoundation.org/aboutepilepsy/whatisepilepsy/statistics.cfm. Accessed 10/13/11

18. World Health Organization. The global burden of disease. 2004 update. www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html. Accessed 9/27/11.

19. Epilepsy Foundation. Diagnosis. www.epilepsyfoundation.org/aboutepilepsy/Diagnosis/index.cfm. Accessed 9/27/11.

20. Epilepsy Foundation. Treatment. www.epilepsyfoundation.org/aboutepilepsy/treatment/index.cfm. Accessed 9/27/11.