Epilepsy is a type of neurologic condition that is described by occurrence of the seizures involving the nervous system affecting people of all races, ages, and ethnic backgrounds. Abnormal electrical activity in the brain leads to epilepsy. Often, the exact cause for epilepsy is not known. There are numerous factors that contribute to development of this condition which include brain conditions such as brain tumors, strokes, or traumatic brain injuries, genetic mutations, infections like meningitis and encephalitis and defects in prenatal development. 

Epilepsy is widespread across the globe. As per WHO, approximately 50 million people suffer from epilepsy globally with prevalence ranging from 4 to 10 people per every 1000 persons.  

Epilepsy is a condition that is marked by imbalance in terms of neuronal excitation as well as inhibition, ion channel dysfunction, net neurotransmitter imbalances, network dysfunction and structural abnormalities. It can result from these disparities that there happens abnormal neuronal excitability, seizures whereby there is disturbance on how neural networks function. The chance of getting epilepsy may be increased by structural abnormalities like cortical malformations, tumors, strokes, or head trauma. 

Genetic mutations are a significant factor in the development of epilepsy, along with developmental disorders and physical brain trauma. A mutation can involve a change in passage of ions, enzymes that metabolize substances or molecules involved with signaling. Seizures are more likely to happen when there is also an autism spectrum disorder or cerebral palsy present as part of a person’s medical history. 

Prognosis is affected by the kind of seizures experienced by an individual and their frequency. In most cases, people who have focal (partial) seizures are more likely to get well than those with general ones. Generally, those who get it during childhood show signs of improvement as compared to adults. Developing epilepsy at a young age often results into remission in adolescents. 

Epilepsy can appear in babies, kids, teenagers, and adults. Common symptoms include movements of the limbs or body as well as episodes of staring, unresponsiveness or lack of awareness coupled with repetitive motions such as hand wringing or grunting noises made during sleep. 

ination can include, abnormalities of eye movements, nyst. The examination of the nervous system includes assessment of motor function, sensory function, reflex action, coordination, and balance. 

The examination of the head and neck can reveal structural abnormalities associated with epilepsy such as: abnormalities of head circumference, facial asymmetry, deformities of the skull, stiffness in the neck muscles or signs suggesting trauma (e.g., scars). 

Inspection of the skin may show hypopigmented macules typical for tuberous sclerosis or cafe au lair macules seen in neurofibromatosis type 1; less frequently. 

Abnormalities found upon ocular exam 

1. Neurodevelopmental Disorders 
2. Mental Health Disorders 
3. Physical or Cognitive Impairments 

Epilepsy may start suddenly with many seizures being acute, usually due to brain injuries, strokes, or brain infections. It involves repeated seizures over a long time, some being isolated while others are frequent enough to result into disability. z

The treatment for epilepsy involves antiepileptic drugs (AEDs), the ketogenic diet, vagus nerve stimulation (VNS), responsive neurostimulation (RNS), and epilepsy surgeries. Brain abnormality is reduced by AEDs while the ketogenic diet causes ketosis leading to decreased seizures. Vagal nerve stimulators work by stimulating the vagus nerve while responsive neurostimulators sense abnormal activities and provide targeted stimulation. RNS is used for focal seizures that are not well controlled by medication or are unsuitable for surgery. The purpose of epilepsy surgery is to eliminate or minimize seizure activity.   

Neurology

Neurosurgery

Psychiatry/Mental Health

For people with epilepsy, cognitive behavioral therapy (CBT) may be able to assist in managing stress and anxiety, while practising hygienic sleep can play a role in seizure control. Additionally, meditation and deep breathing exercises are useful stress reducing activities that facilitate short-term seizure. Eliminating most carbohydrate-rich foods helps reduce seizures. This is because according to the theory behind it, dependence on ketone bodies has anticonvulsant effects which are thought to help with the reduction of brain excitability. 

Neurology

Antiseizure medications, also known as antiepileptic drugs (AEDs), are crucial in managing epilepsy.

• Seizure Control: The primary goal of antiseizure medication therapy is to control seizures and prevent their recurrence. AEDs work by suppressing abnormal electrical activity in the brain, stabilizing neurons, and reducing the likelihood of seizures.
• Prevention of Seizure Spread: AEDs help control the primary seizure focus and prevent the spread of seizures to other brain parts.
• Reduction of Seizure Burden: AEDs aim to reduce the overall burden of seizures in individuals with epilepsy by minimizing the frequency, duration, and intensity of seizures.
• Epilepsy Syndrome Management: Antiseizure medications are selected based on the specific epilepsy syndrome and seizure type. Different AEDs have varying efficacy for different types of seizures and epilepsy syndromes.
• Prophylaxis for Seizure Triggers: Some individuals with epilepsy have known triggers that can precipitate seizures, such as stress, sleep deprivation, or flashing lights. In such cases, AEDs may be prescribed as prophylaxis to prevent seizures triggered by these specific factors.

Antiepileptic drugs (AEDs)

• carbamazepine: It is used to treat focal seizures, generalized tonic-clonic seizures, and trigeminal neuralgia. It works by reducing excessive electrical activity in the brain.
• phenytoin: This medication is effective against focal seizures and generalized tonic-clonic seizures. phenytoin stabilizes neuronal membranes and inhibits the spread of seizure activity.
• valproic acid: valproic acid is used for various seizure types, including focal seizures, absence seizures, and generalized tonic-clonic seizures. It increases gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the brain.
• lamotrigine: It is prescribed for focal seizures, generalized tonic-clonic seizures, and Lennox-Gastaut syndrome. lamotrigine inhibits the release of excitatory neurotransmitters and stabilizes neuronal membranes.
• levetiracetam: levetiracetam is effective for focal seizures and myoclonic seizures. Its mechanism of action has yet to be fully understood, but it is thought to modulate neurotransmitter release and reduce neuronal excitability.

Anesthesiology

Neurology

Neurosurgery

Intervention with a procedure is often considered a treatment option for epilepsy when medications fail to provide adequate seizure control. 

Resective Epilepsy Surgery: This process involves removing or cutting out the part of the brain that causes seizures to begin. It is used for people with focal epilepsy. This is when the seizures start in one specific area of the brain. This area can be found by doing imaging studies and EEG monitoring. 

Corpus Callosotomy: Severing the corpus callosum is involved. The corpus callosum is a band of nerve fibers that connects the two halves of the brain. This is usually done in patients with severe types of epilepsy like Lennox-Gastaut syndrome. 

Vagus Nerve Stimulation (VNS): It consists of implanting a tool which supplies electrical stimulation to the vagus nerve located in the neck. The tool is attached to a generator that is positioned beneath the skin. This treatment targets at changing abnormal mind activity and decreasing the number of seizures. 

Laser Interstitial Thermal Therapy (LITT): LITT is a minimally invasive technique for precisely destroying or ablating the brain tissue that causes seizures using laser energy.  

Anesthesiology

Neurology

Neurosurgery

The treatment of epilepsy involves several steps such as diagnosis, selection of appropriate anticonvulsants, initiation and titration of drugs, assessment of seizure control. The goal in choosing or adjusting an antiseizure drug is to achieve maximum seizure management. The effectiveness of drugs is monitored by regular checkups and keeping records of seizures. Education and support for people with epilepsy as well as their families should be done regularly.