Epilepsy
"Epilepsy can affect different aspects of patients' lives. Therefore, it requires a comprehensive and multidisciplinary care by specialized personnel".
DR. ASIER GÓMEZ IBAÑEZ
SPECIALIST. NEUROLOGY DEPARTMENT
Epilepsy is a group of diseases affecting the central nervous system whose usual clinical manifestation is epileptic seizures. These are the result of an abnormal electrical discharge of neurons in the cerebral cortex. Approximately 70% of them are well controlled with antiepileptic drugs.
This pathology affects individuals of all ages, although the incidence is higher in the early years of life and in the elderly. It is estimated that it affects about 1 in every 100 people, with about 500,000 people affected in Spain according to recent studies.
The Clínica Universidad de Navarra has a specialized Epilepsy Unit composed of specialists from different areas and with the most specific, modern, and precise diagnostic methods: electroencephalogram (EEG), video-EEG monitoring unit, high field (3T) brain magnetic resonance (MRI), and other tests such as PET or SPECT.
The pharmacological treatment of epilepsy can last several years and may require adjustments to achieve maximum therapeutic benefit with minimal adverse effects. For this reason, it should be supervised by an epilepsy specialist.
If the epilepsy is shown to be rebellious or refractory to drugs, there are other complementary alternatives such as surgical treatment by resection of the brain area that produces the crisis (resective surgery), placement of electronic devices (functional surgery) or administration of ketogenic diet.
What are the symptoms of epilepsy?
Epilepsy usually manifests itself with spontaneous epileptic seizures.
The clinic is very variable, from loss of consciousness with seizures (the best known and dangerous), to motor symptoms, sensory, visual or psychic without altering the level of consciousness. The approximate duration is between 1-5 minutes.
According to the location of the neurons that produce seizures, we can classify epilepsy in focal (a delimited group of neurons) or generalized (simultaneous involvement of all neurons).
Do you have any of these symptoms?
You may have epilepsy
What are the causes of epilepsy?
The most decisive factor for the prognosis and control of epilepsy is the cause that produces it. The three main groups in which we divide them are:
1. Genetic cause (known or presumed), also called "idiopathic". They are produced by genetic alterations and it is common that there are other family members affected.
2. Structural cause. Epilepsy appears as a result of a lesion identified in the brain: trauma, stroke and other vascular lesions, tumor, infection, inflammation, congenital malformations of the cerebral cortex, neurodegenerative diseases, etc.
3. Unknown cause. In these cases the cause of epilepsy is not determined, usually microscopic structural lesions.
Some causes are particularly important at specific ages:
- The epilepsies of genetic cause usually appear in the first two periods of life.
- Trauma affects mostly young adults.
- Brain tumors can manifest as epilepsy at any age, with predominance in adults between 40-50 years.
- Brain vascular diseases and neurodegenerative diseases are common causes of epilepsy in the elderly.
What is the prognosis of epilepsy?
Overall, 70% of people diagnosed with epilepsy are well controlled. However, this percentage will depend on the type of epilepsy.
The widespread epilepsies of presumed genetic origin, such as child absence or tonic-clonic seizures of awakening have a very good prognosis, virtually disappearing in adulthood, allowing in some cases the withdrawal of medication.
Focal epilepsies can also come to control properly. While it is less likely to withdraw medication completely, can be controlled with minimal doses of drugs and no side effects.
How is epilepsy diagnosed?
The basis for the diagnosis of epilepsy is a thorough medical history taken from both patients and witnesses of seizures.
In addition, we rely on several complementary explorations:
1. Electroencephalogram (EEG). It is a specific test for diagnosis, since it allows us to analyze the brain activity of the person in real time. It is useful to confirm the suspected diagnosis of epilepsy, but a normal EEG does not exclude the diagnosis.
A more complex and very useful variant is the monitoring with continuous video-EEG. This system records the image of the patient in synchrony with the digital recording of electroencephalographic activity, allowing differentiation of epileptic seizures from other types of non-epileptic episodes, as well as locating the area of the brain that causes epileptic seizures. For this purpose, patients are admitted for several days in a specially prepared room. This study is indicated for the diagnosis and classification of seizures and pre-surgical study in patients susceptible to surgery.
2. Magnetic Resonance Imaging (MRI) of the brain. It is a radiological test that does not emit radiation and allows the identification of brain lesions causing epilepsy.
3. PET/SPECT. These are Nuclear Medicine tests used in complex epilepsies that help locate the brain areas that cause the crisis.
Also, in many cases people with epilepsy have other problems added as cognitive dysfunction, especially memory loss. To identify and address this issue, it is important to perform a neuropsychological evaluation by specialists
How is epilepsy treated?
The first step is always the pharmacological treatment, once the diagnosis is confirmed. This must be associated with appropriate lifestyle guidelines, mainly maintaining proper sleep hygiene and avoiding toxic substances.
Antiepileptic treatment should be administered for a more or less prolonged time and is not exempt from adverse effects. Some forms of epilepsy respond favorably to early surgical treatment, which avoids years of unsuccessful trials with multiple drugs.
There are many effective antiepileptic drugs. The choice depends on the type of epilepsy and the balance between maximum efficacy and minimum adverse effects.
Treatment should be monitored regularly. Its duration will depend on the various factors that can reduce or increase the risk of relapse when the medication is withdrawn. Therefore, any change should always be made under the control of the specialist.
The development of surgical techniques has opened up new possibilities for curing some of the cases that do not respond well to medication.
Surgery is considered when epilepsy does not respond to drug treatments. This occurs in approximately 30% of people with epilepsy, of which 5-10% are susceptible to surgery.
This treatment requires a highly specialized hospital, since it is necessary interdepartmental collaboration of neurologists, neurophysiologists, neurosurgeons, etc.
There are basically two types of surgery:
Resective surgery
It consists of removing the part of the brain tissue that causes epileptic seizures. This can only be done in focal epilepsies. If the indication is adequate after the completion of the pre-surgical study, the expectation of improvement and even freedom from crisis is high.
Functional Surgery
This type of surgery can be performed when resective surgery is not possible. It consists of either surgically disconnecting the brain areas involved in the origin and spread of the crisis by the brain (callosotomy, hemispherectomy) or placing electronic devices that emit electrical impulses to the brain to reduce epileptiform activity (vagus nerve stimulator).
In case the surgical option is not considered, there are other forms of treatment in addition to drugs, such as the ketogenic diet. This consists of giving patients a diet high in fat and low in protein and carbohydrates, which has proven effective in some patients resistant to drugs. This is done by a team of nutritionists who guide patients and families at all times on the foods to be eaten, as well as ensuring that the person receives the necessary nutrients.
Finally, there is the possibility of participating in a clinical trial with novel drugs that are in the development phase.
Where do we treat it?
IN NAVARRE AND MADRID
The Department of Neurology
of the Clínica Universidad de Navarra
The Neurology Department has extensive experience in the diagnosis and multidisciplinary treatment of neurological diseases.
We offer a diagnosis in less than 72 hours, along with a proposal for personalized treatment and post-consultation follow-up of the patient by our specialized nursing team.
We have the most advanced technology for an accurate diagnosis with cutting-edge equipment such as HIFU, deep brain stimulation devices, video EEG, PET and epilepsy surgery, among others.
Why at the Clinica?
- State-of-the-art diagnostic assistance with great work in research and teaching.
- Specialized nursing team.
- We work together with the Sleep Unit.
Our team of professionals
