Epilepsy & Disorders of consciousness

Epilepsy is a common condition. It is estimated that 0.5% to 1% of the population have active epilepsy, while 1 in 26 people will develop it during their lifetime. It can appear at any age. However, it is more prevalent among children and adults over 60 years old.

The term "epilepsy" is often subject to various misconceptions. Epilepsy is a disorder characterised by the tendency to experience repeated, unprovoked seizures. Therefore, an isolated seizure isn't always a manifestation of epilepsy.

Epileptic seizures have a sudden onset, usually last seconds to minutes and subsequently resolve spontaneously on their own. Their frequency varies considerably among affected individuals. Without treatment, they may appear daily, monthly or less than once per year.

Seizures originate from the cortex of the brain (surface grey matter). During a seizure, the electrical activity of cortical neurons becomes excessively synchronized. This activity may start either from a small area of the cortex or diffusely from both hemispheres. In the former case, seizures are categorized as partial, while in the latter as generalised. Therefore, seizures can present with a variety of different clinical manifestations, depending on the part of the brain that is involved: convulsions, sensory symptoms, loss of consciousness, psychic symptoms, etc.

The underlying causes that lead to the apparent cortical hyperexcitability in epilepsy are revealed through medical investigations in about 50% to 60% of cases. The culprits are often stroke, space-occupying lesions, traumatic brain injury and lesions due to prolonged cerebral hypoxia. For the remaining 40% to 50%, causes remain elusive. These types of epilepsy often appear at a younger age and a significant proportion of them are considered to have a genetic contribution to their etiopathogenesis.

With currently available treatments, about 80% of people with epilepsy achieve control of their seizures. Duration of treatment varies: in many instances, medication is taken for a period of time and then successfully tapered without seizure recurrence; sometimes, treatment needs to be lifelong. Living with epilepsy however, means much more than having to take antiepileptic medication. For many people, the psychosocial impact of epilepsy leads to more issues than the seizures themselves.