The drugs used for epilepsy, to date are so-called anti-crisis drugs, i.e., they suppress or decrease the number of epileptic seizures, but do not prevent epileptogenesis, i.e., the neuronal process by which an epileptogenic focus develops in the brain and leads to the development of epilepsy.
Social and emotional impact of epilepsy.
People with uncontrolled seizures experience greater physical and psychological comorbidities than patients who respond to treatment, adversely affecting their quality of life.
The choice of drug should be completely individualized taking into account the type of epilepsy, age, cause, possible side effects and concomitant diseases the patient has if any.
But who is easier to treat: children, adults, women…?
For the neurologist, “it is not a question of one population group being easier to treat than another. It is a matter of having the necessary knowledge to manage the different population groups and their peculiarities. With respect to the child population, there are age-dependent epilepsy syndromes, that is, epilepsy that manifests with similar symptoms, such as childhood epilepsy-absence, which we know has a good prognosis, and there are childhood epilepsies that are accompanied by alterations in brain development and present crises that do not respond well to drugs and have a worse prognosis, and they must be identified and treated as soon as possible, with the most appropriate medication”.
Epilepsy in women has special implications. The influence of sex hormones on the evolution of epilepsy is known, as well as the effects of both the disease and antiepileptic drugs on fertility, contraception, pregnancy, the consequences on the fetus during the intrauterine period and lactation.
Nevertheless, a woman with epilepsy can have a safe pregnancy by following up closely with her neurologist and gynecologist.
A complex age group is also the elderly, as it is sometimes more difficult to identify the symptoms of epilepsy and the causes are very varied. In fact, it is important to know how to make the right choice of drugs, as these are people who are often polymedicated and have other associated diseases.
The quality of life in a person with epilepsy clearly relates to the number and intensity of seizures he or she presents, so that a patient with epilepsy controlled with the appropriate dose of treatment, without side effects, can develop a normal life at work and social level, with certain precautions. Fortunately, most patients with epilepsy are in this situation.
However, there is a group of patients with an epilepsy that is difficult to control, which has an impact on their daily life activities (school, work, social), limiting it and significantly reducing the quality of life.
It should also be taken into account that, sometimes, despite having a controlled epilepsy, the fear of presenting seizures can generate anxiety and alterations in the mood of patients, so psychological support is often necessary.
Approximately 40% of patients with epilepsy do not respond to antiseizure medications. Poor seizure control results in increased physical risk and has a negative impact on psychosocial and occupational aspects, leading to a poorer quality of life.
Early identification of these patients is therefore essential, both to optimize pharmacological treatment, where possible, and to consider surgical treatment or other non-pharmacological therapeutic alternatives, thus avoiding the negative consequences derived from poorly controlled epilepsy.
The improvement in treatments
In recent years, new antiseizure drugs with novel mechanisms of action have been developed, which have improved the reduction in number and intensity of seizures, improving the quality of life of many patients with difficult-to-control epilepsies.
For neurologist Ascensión Castillo, “the option of surgical treatment should be considered early in patients with drug-resistant focal epilepsy. To this end, patients should be properly evaluated in Epilepsy Units where a pre-surgical evaluation can be performed to locate the area of the brain where the epilepsy originates and perform resection of the area where the seizures are triggered without producing deficits in the patient. In the event that surgery is not possible, other types of treatment may be used, such as vagus nerve stimulation or the application of a ketogenic diet”.
In recent years, important research and new advances are being developed to achieve a better quality of life for people with uncontrolled seizures.