In Spain there are between 25,000 and 30,000 new epileptics every year. This figure is similar to other developed countries in Europe or the USA, where new patients are measured taking into account the incidence and prevalence of the disease.
It is not possible to define a specific profile of patients affected by epilepsy, since it can appear at any age in life and be due to different causes, according to the latest classification of the International League Against Epilepsy (ILAE):
- Genetic
- Structural and malformative
- Metabolic
- Immunological
- Infectious
- Unknown origin
What are the symptoms of epilepsy?
Initially this brain disorder begins in the form of epileptic episodes, varied and divided into focal seizures, generalized seizures or both.
It is possible that the manifestations can be confused with other pathologies, either isolated or concomitant, such as migraine, non-epileptic psychogenic, vascular, toxic, among others.
How is epilepsy diagnosed?
The clinical history taken by specialists in Neurology experts in epilepsy to the patient and the family as witness is still the first step to clinically define that the patient has the pathology and has had seizures by anamnesis. Then the syndrome and the cause of its development are diagnosed by means of tests such as video EEG, which helps the neurologist to classify the type of seizures and to know the epileptogenic zone, high resolution resonance imaging (MRI) and, in complex cases, PET-CT, Spect, among others.
What types of treatment are available for epilepsy?
In 90% of cases, the main and most frequent approach is pharmacological. About 15 different drugs are available on the market.
In cases where patients are drug-resistant, there is the option of epilepsy surgery. These cases should be studied in specialized units.
Other options are:
- Ketogenic diet: Stimulates the vagus nerve. This option is rather palliative, not curative.
- Deep brain electrical stimulation
- Radiosurgery
- Neuronavigation
- Other drugs such as immunomodulators, steroids, immunoglobulins, plasmapheresis, rituzimab, among others. In addition, to improve the results of the treatment it is advisable to avoid factors that can precipitate crises, such as lack of sleep, alcohol and other toxics, stress, among others.
In which cases is a surgical indication necessary?
In cases in which patients are drug-resistant, the suitability for surgical treatment is studied. Normally only 20% of patients with refractory epilepsy will be amenable to presurgical study, of which only 30% will be finally operable.
The aim of the pre-surgical studies is to locate the epileptogenic focus to be resected, i.e. the brain area where the lesion is located and from where the seizures emanate, in order to eliminate epileptic activity.
The most suitable cases for surgery are:
- Mesial temporal sclerosis with hippocampal atrophy.
- Malformations of cortical development
- Dysplasias
- Single neortical lesions
What types of surgery are there?
There are two types of surgery:
- Resective surgery: aimed at removing the focus of the brain producing the epileptic activity, which, in many cases, is curative. Usually patients who undergo this surgery have the focus in the temporal lobe and up to two thirds of these patients are free of seizures after the intervention.
- Palliative surgery: includes different techniques and is intended to reduce the frequency and/or intensity of seizures. With this type of surgery, the intensity or frequency of seizure occurrence is reduced by 50% in half of the patients treated.