Every second Monday in February, International Epilepsy Day is commemorated with the aim of raising awareness and educating society about this neuronal pathology suffered by around 50 million people in the world and some 400,000 in Spain, which makes it a one of the most common neurological disorders and, at the same time, the most discriminated
Epilepsy is a chronic disease of the nervous system that produces epileptic seizures and for which there is still no cure.
This disease can be suffered by anyone, but there are two moments in life when it is more common to suffer from it: the childhood (first months of life) and old age (From the age of 50 the risk increases, especially from the age of 70).
This pathology can be triggered by many causes, such as genetics, being a hereditary disease that can be transmitted to offspring.
EFEsalud has interviewed the president of the Spanish Epilepsy Society (SEEP), the Dr. Maria del Mar Carreno Martinezto learn more about this disease on its International Day.
“The main problem with epileptic seizures is that they are unpredictable, they can occur at any time and that limits the patient’s life. The most serious crises are generalized seizures (the ones we all associate with epilepsy), but there are crises in which the patient does not have jerks, but remains absent»
Reports the president of the SEEP.
Your risk of death is three times higher in the general population and in many places around the world patients and their families are victims of stigmatization and discrimination.
In this way, epilepsy becomes a chronic disease that can cause not only physical and neuronal problems, but also a stigma that entails social, work and family difficulties that are fought against on February 14.
“I think it would be essential for the entire population to know how to act in the event of witnessing a generalized crisis,”
claims Dr. Carreño.
Stigma and discrimination towards epilepsy
The discrimination and social stigma that surround epilepsy in some places are a big part of the fight against the disease, as in some cases the stigma is more difficult to control than the epileptic seizures themselves.
The stigmatization of the pathology can prevent patients from seeking help and treatment in order to avoid being recognized as epileptic.
“Despite the fact that we have made great progress in understanding the disease and in disseminating truthful medical information, epilepsy continues to have a great stigma, largely due to ignorance,” shares the expert.
How to act against an epileptic crisis?
In order for the patient’s day-to-day life to have the best possible quality, it is important to observe the crises and then describe them and provide information that helps the choice of treatment.
epilepsy can manifest in various wayssuch as involuntary muscle spasms, absences, seizures or sensory sensations, among others, being able to lose consciousness during a crisis.
It is advisable to know its onset, the part of the body in which it suffers, the duration, if it loses consciousness from the beginning, if the gaze is diverted, foam is perceived at the mouth, if there is loss of sphincter control, if it requires medication and how subsequent recovery occurs.
However, there are cases and patients in which it is difficult to prevent a crisis.
“There are patients who, for example, have had brain hemorrhages or other injuries. These patients must be evaluated periodically and undergo tests such as the electroencephalogram. It is not entirely clear that it is appropriate to treat them preventively, “
explains the doctor.
Pandemic and epilepsy
During the pandemic, medical care for chronic diseases was reduced by the global health emergency.
According to a study carried out by the Epilepsy Unit of the Neurology Service of the Vall d’Hebron Hospital in Barcelona, 10% of patients worsened the control of their epilepsy due to confinement.
Face-to-face visits were reduced and new consultation possibilities were opened. The telephone attention and video visits allowed to continue with the control of the diseases without putting the patient at risk.
“In general, patients were able to contact us whenever they needed to. Some patients have found virtual visits very convenient and we continue to do them in specific cases or when the pandemic situation is bad, “
informs the president of the SEEP.
Drugs, surgery and robots for its treatment
As in any disease, pharmacological treatment is essential for a good quality of life for the patient. “Most epilepsies (70%) are adequately controlled with drugs,” says the expert.
Among the variety of antiepileptic drugs, of which there are currently 20, There is also the use of medical cannabis without THC.
«In Spain we have cannabidiol in pharmacies. This can be used as an add-on treatment to treat severe epilepsies such as Dravet syndrome or Lennox-Gastaut syndrome.”
emphasizes Dr. Carreño.
Each of the drugs is intended for a type of patient according to their age, type of epilepsy, electroencephalographic pattern, etc. Always monitoring the possible appearance of side effects that leads to the abandonment of treatment in some cases.
“You have to work with the patient to convince him of the importance of taking the drugs regularly to avoid the occurrence of crises. And change the drug if you don’t tolerate it well, because we currently have many options, “
expresses the doctor.
But nevertheless, there are patients with drug-resistant epilepsya problem that leads to the continuation of the seizures despite having taken the anti-seizure drug correctly.
For these cases It is possible to use surgery, «especially if there is an injurysays the expert. With this method, the epilethogenic area or area of the brain where the crises originate is removed.
In these surgeries, it is increasingly common to use robots since “they represent additional help to place, for example, intracranial electrodes. However, they are never a substitute for an experienced neurosurgeon.”
Diet and stimulation
It is also possible to use a ketogenic diet in cases of add-on therapy in childhood epilepsy refractory to antiepileptic drugs (AED).
In it, carbohydrates in the diet are replaced by lipids (fats), which become the main energy source, thus metabolizing fatty acids instead of carbohydrates, which are what cause a state of ketosis.
On the other hand, there is the possibility of stimulating the vagus nerve to reduce crises. In this case, a programmable generator similar in size to a cardiac pacemaker is placed in the chest wall.
This regularly sends electrical signals to the vagus nerve, and the patient and family can use a magnet to stop the stimulation or activate it outside of the programmed cycle.
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