-Written by Dr. Manasi Rege, JR1, Dept of Pharmacology, L.T.M.M.C. and G.H., Mumbai.

They could feel it coming even before it actually showed up. And when it did show up, the nightmare would begin. It would begin as an involuntary cry and twitching that would later convert into jerky movements. They would lose their balance, sometimes their consciousness, sometimes their bladder would give way. For some, it was just periods of blank stares. But the worst part was that it was way beyond their control. They didn’t know who caused it. Was it witchcraft, or anything that they consumed? They didn’t know how or when it would stop. For some, it deterred them from carrying out their daily activities. Anxiety, depression, all came as part and parcel of the disease. It manifested in various forms. But ultimately, this condition had one name… Epilepsy.

Epilepsy is a neurological disorder characterised by recurrent unprovoked seizures. Seizures are paroxysmal events that result from abnormal, involuntary, rhythmic neuronal discharges in the brain. Unlike the previous terminologies like grand mal and petit mal, epilepsy, now, is broadly classified into focal, generalised, combined generalised and focal, and unknown as per the ILAE (International League Against Epilepsy) 2017 classification.

Epilepsy has existed throughout the history of mankind, but the first detailed description of the disease is in a 3,000-year-old medical text called the Sakikku written sometime around 1,050 BC by the Babylonians (an ancient civilization in modern-day Iraq). The Charaka Samhita, an Indian medical text written in 400 B.C., accurately described convulsions with blackouts and loss of consciousness, attributing the cause of seizures to be within the brain. The Greeks, however, thought of epilepsy to be a sacred disease. In fact, the word epilepsy arises from the Greek work for ‘to seize’ as it was thought to occur due to demons seizing people. John Hughlings Jackson laid the scientific foundation for epileptology, as well as studied the localization of lesions which could produce seizures.

This group of disorders can occur due to a variety of reasons such as prenatal and perinatal injury causing brain damage, stroke and brain tumours, high fever leading to febrile convulsions, etc. Most epilepsies are a combination of acquired and genetic factors while predominantly genetic epilepsies are responsible for only a minority of seizure disorders. Dysfunction of mutated ligand gated or voltage gated ion channels is the major cause of such epilepsies.

A patient is clinically diagnosed to have epilepsy on having 2 or more unprovoked seizures. EEG (Electroencephalogram) reveals characteristic findings in various epilepsy syndromes.

No effective treatment existed until 1857, when salts of bromide were first used. In 1912, Alfred Hauptmann discovered the anticonvulsant properties of phenobarbital. Numerous AEDs were introduced in the following decades including ethosuximide, carbamazepine, valproate, and several benzodiazepines. Today, AEDs are usually the first-line treatment for epilepsy and selected based on the type of seizure one has as well as the patient’s other pertinent medical history.

However, not all epilepsies can be controlled by medications which brings in the role of surgical treatment. The roots of surgical treatment for epilepsy can be traced back to when doctors in England conducted brain surgery as early as 1831. It is carried out in refractory, drug resistant epilepsy. Resective surgery is the most common type performed which often involves temporal lobectomy. Some other procedures involve Laser Interstitial Thermal Therapy, Deep brain stimulation, Corpus Callostomy, Hemispherectomy, etc.

Other modes of managing this condition involve the ketogenic diet (strict reduction of carbohydrates) that was introduced in 1911. It mimics the fasting state altering the metabolism to generate ketone bodies which have antioxidant effects on the brain and lead to neurotransmitter modulation. Vagus nerve stimulators came in 1997. It involves the placement of helical electrodes on the left cervical vagus nerve, with intermittent stimulation provided by a neurocybernetic prosthesis implanted subcutaneously in the upper chest with stimuli given periodically at 20-30 Hz.

According to WHO, around 50 million people suffer from this disorder of which 80% live in low and middle income countries. Immediate diagnosis and early medications can make help keep this disease in check. Hence, awareness about epilepsy is the need of the hour and celebrating National Epilepsy Day on 17th November surely contributes to this purpose. Advances in medicine have reduced a lot of deadly diseases to mere stories in the pages of history. We can hope that, someday, epilepsy too can be an easily managed disease so that this disease of ‘fits’ need not fit anymore in the lives of humans.

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