Few medical conditions have attracted so much attention and generated so much debate as epilepsy. Observations on epilepsy can be traced to ancient writings dating back to 2000 years B.C. Epilepsy is one of the most common neurological disorders, affecting about 50 million people worldwide. Nearly 3 million Americans suffer from epilepsy, and at least 2.2 percent of Kentuckians have the diagnosis.
Historically, epilepsy has been misunderstood and stigmatized. People with epilepsy continue to suffer from physical insults and injuries related to their seizures. They also must deal with the social stigma of the disease. Our modern understanding of epilepsy was begun in the 19th century by two British physicians, John Hughlings Jackson and Sir William Richard Gowers. Jackson thought seizures were "the result of sudden brief electro-chemical discharges of energy in the brain."
By modern standards, early treatments for epilepsy were ineffective and unusual, if not bizarre. Treatments included medicinal herbs, religious interventions, gladiator blood or liver consumption, and burring a hole in the skull. The first anti-seizure medicine was introduced in the mid-1800s. However, the first major breakthrough in epilepsy therapy came more than 50 years later. About then, there also was an important development, allowing physicians to monitor brain activity and capture seizures in the investigation of epilepsy with the use of the electroencephalogram, which records brain activity, including seizures.
The electrical disruption that causes epileptic seizures can occur anywhere in the brain. Therefore, seizures can manifest very differently from one person to the next. Accurate differentiation between generalized and focal in onset seizures is especially important, because their treatments are vastly different.
More than 18 anti-seizure or anti-epileptic drugs are available in the United States. Despite advances in the past 20 years, about 30 percent of patients with epilepsy suffer from enduring seizures or side effects from epilepsy medicines. In such cases, epilepsy surgery might be an option but it warrants a detailed pre-surgical evaluation. Selected cases might require recording seizures directly from the brain surface and brain mapping before removal of the area that causes seizures.
In some patients, seizures can be reduced with placement of a device that stimulates the vagus nerve in the neck. Some patients' seizures might benefit from dietary changes under medical supervision, such as the ketogenic diet.
In recent years, our understanding of the disorder has grown exponentially. New drugs and less-invasive surgery, such as gamma knife radiosurgery or implantation of responsive neurostimulators or deep brain stimulators, are being investigated as an alternative to traditional open brain surgery in patients with medically resistant epilepsy.
Dr. Meriem K. Bensalem-Owen is director of the UK HealthCare Epilepsy Program and an associate professor of neurology at the UK College of Medicine.