From the Guidelines
Epilepsy is a chronic non-communicable disease of the brain characterized by recurrent seizures due to abnormal electrical activity, affecting over 50 million people worldwide with an annual incidence of two million, as reported in the most recent study 1.
Definition and Classification
Epilepsy is classified into focal, generalized, combined focal and generalized, or unknown, with focal epilepsy being the most frequent form 1. The disease has various aetiologic groups, including genetic, infectious, metabolic, immune, or unknown, which may have implications for treatment 1.
Key Characteristics
Some key characteristics of epilepsy include:
- Affects people of all ages
- One of the most frequent neurological conditions
- Estimated prevalence of more than 50 million people worldwide
- Annual incidence of two million
- Classified into different types, including focal, generalized, and unknown
Treatment and Management
Treatment typically involves pharmacotherapy with anti-seizure medications (ASMs), with approximately 30% of patients not responding to two ASMs and considered drug-resistant 1. In patients with drug-resistant focal epilepsy, epilepsy surgery is a promising treatment option, with approximately 65% of patients becoming seizure-free 1.
Diagnostic Tools
Diagnostic tools, such as scalp video/EEG telemetry, structural MRI, and molecular neuroimaging using PET and SPECT, play a crucial role in the diagnostic work-up and therapy management of epilepsy patients 1.
Recent Guidelines
Recent guidelines, such as those published by the European Association of Nuclear Medicine (EANM), aim to promote optimal epilepsy imaging, especially in the presurgical setting, and provide practical information for performing different molecular imaging procedures for epilepsy 1.
From the Research
Definition of Epilepsy
Epilepsy is a common neurological condition with a worldwide prevalence of around 1% 2, 3. It is characterized by recurrent unprovoked seizures, which are caused by abnormal electrical discharges from the brain. According to the International League Against Epilepsy (ILAE), epilepsy can be diagnosed even after the first seizure, if the risk of seizure recurrence is high 4.
Key Facts About Epilepsy
- Approximately 60% to 70% of people with epilepsy will achieve a longer-term remission from seizures, and most achieve that remission shortly after starting antiepileptic drug treatment 2, 3.
- Most people with epilepsy are treated with a single antiepileptic drug (monotherapy) 2, 3.
- The correct choice of first-line antiepileptic drug (AED) for individuals with newly diagnosed seizures is of great importance 5.
- About two in three adults with new onset epilepsy will achieve lasting seizure remission on or off these drugs, although around half will experience mild to moderately severe adverse effects 6.
Treatment of Epilepsy
- Current guidelines from the National Institute for Health and Care Excellence (NICE) in the United Kingdom recommend carbamazepine or lamotrigine as first-line treatment for partial onset seizures and sodium valproate for generalised onset seizures 2, 3.
- Other antiepileptic drugs, such as levetiracetam, zonisamide, and phenytoin, are also available and may be suitable alternatives for certain individuals 4, 2, 3.
- The development of antiepileptic drugs urgently needs to be revitalized to discover more effective antiseizure drugs for the treatment of drug-resistant epilepsy 6.
Risk Factors for Epilepsy
- The presence of epileptiform discharges on the EEG, focal neurological signs, and the presence of epileptogenic lesion on the MRI are risk factors for a second seizure (such as for the development of epilepsy) 4.
- Without these risk factors, the chance of a second seizure is about 25-30%, while the presence of these risk factors can predict >70% seizure recurrence 4.