Epilepsy unveiled: Advances in diagnosis and treatment

Epilepsy is a complex neurological disorder characterised by recurrent seizures that requires a comprehensive approach to diagnosis and treatment.

A renowned consultant neurologist, provides an expert insight into epilepsy, discussing diagnosis, treatment, and the advancements that have been made in the field.

What is epilepsy?

Epilepsy is a neurological disorder that results in a tendency to experience recurrent seizures. Seizures occur when there is a sudden and abnormal electrical discharge in the brain.

Seizures can vary widely in type and severity. They are categorised into two main types:

• Focal seizures: These seizures originate in a specific area of the brain and can cause localised symptoms, such as twitching or alterations in sensation. Focal seizures can further be divided into simple focal seizures (where consciousness is retained) and complex focal seizures (where consciousness is lost).
• Generalised seizures: These seizures impact both sides of the brain from the beginning. There are various types, such as tonic-clonic seizures, absence seizures, and myoclonic seizures.

How is epilepsy diagnosed?

A detailed medical history is taken first to understand the patient's symptoms, seizure types, and family history of epilepsy or other neurological disorders. A complete neurological examination then helps assess the patient's reflexes, coordination, and cognitive function.

As well as this, various diagnostic tests are conducted, including:

• Electroencephalogram (EEG): An EEG is the primary test for diagnosing epilepsy. It measures the brain's electrical activity and can detect abnormal patterns indicative of epilepsy.
• Imaging studies: MRI or CT scans can be performed to visualise brain structures and identify any potential lesions or abnormalities.
• Blood tests: Blood tests can help rule out other medical conditions that may mimic seizures, such as infections or metabolic disorders.

What are the current treatment options for epilepsy?

The following are the main treatment options available for epilepsy:

• Anti-epileptic drugs

The initial treatment for epilepsy involves medication with anti-epileptic drugs. These help to stabilise electrical activity in the brain. There are many different anti-epileptic drugs available, and the exact choice of medication depends on the type of seizures, the patient's health, and the drug’s potential side effects.

• Surgery

For refractory epilepsy (that doesn’t respond to anti-epileptic drugs), epilepsy surgery may be considered. This can involve removing the area of the brain where seizures originate or employing neurosurgical techniques to prevent seizures from originating in a different part of the brain.

What advancements have been made in the treatment of epilepsy?

There have been significant advancements in both diagnosis and treatment in recent years, leading to improved outcomes. Some notable key developments include:

• Precision medicine

There is a growing emphasis on tailoring treatment plans to individual patients using precision medicine, based on their genetic, metabolic, and environmental factors. This precision approach enhances the effectiveness of treatment and minimises potential side effects.

• Diagnostic techniques

Innovations in diagnostic techniques, including high-density EEG and wearable EEG monitors, allows for continuous monitoring of brain activity, providing better insights into seizure patterns and potential triggers.

• Neuromodulation

Clinical research is ongoing to improve the efficacy of neuromodulation therapies and explore new devices. This includes investigating closed-loop systems that respond to brain activity in real time to prevent seizures.

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