Epilepsy

Epilepsy is not a single condition but a large group of highly heterogeneous disorders, which in common has an abnormally increased predisposition to seizures (1).

• it is defined as a neurological condition characterised by recurrent epileptic seizures unprovoked by any immediately identifiable cause (2)
• the International League Against Epilepsy (ILAE) defines epilepsy as a “a disorder of the brain characterised by an enduring predisposition to generate epileptic seizures and by the neurobiological, cognitive, psychological and social consequences of this condition”. The definition of epilepsy requires the occurrence of at least one epileptic seizure (1).

Epilepsy should be considered as a symptom caused by an underlying neurological disorder and not as a single disease entity (2).

It is a diagnosis which sadly and unnecessarily carries physical, psychosocial and economic implications for the patient. As such, it ought to not be applied without thorough consideration.

• epilepsy has been estimated to affect between 362,000 and 415,000 people in England (3)
  • also, there will be further individuals, estimated to be 5-30%, so amounting to up to another 124,500 people, who have been diagnosed with epilepsy, but in whom the diagnosis is incorrect
  • incidence is estimated to be 50 per 100,000 per year and the prevalence of active epilepsy in the UK is estimated to be 5-10 cases per 1000
    
    
• two-thirds of people with active epilepsy have their epilepsy controlled satisfactorily with anti-epileptic drugs (AEDs) (3)
  • other approaches may include surgery. Optimal management improves health outcomes and can also help to minimise other, often detrimental, impacts on social, educational and employment activity
    
    
• a large multicentre trial (the SANAD trial) evaluating newer drugs in newly diagnosed epilepsy (accepting some limitations) suggested that sodium valproate should be the drug of choice in generalised and unclassifiable epilepsies, and lamotrigine in focal epilepsies (3)

Note that there is confusion between the terms epilepsy and seizure, and they are often used interchangeably. The confusion is not helped by the term status epilepticus, which need not have anything to do with epilepsy. The two are separated here.

People with epilepsy (PWE) have a higher mortality rate than the general population (4)

In a UK based study (4) number of deaths within the database increased by 69% between the first and last year of the study (2014 compared with 2004)

UK Biobank study (n=329,432; 2699 with epilepsy) found pts with epilepsy had an increased risk of all cardiac arrhythmias (HR 1.36; 95% CI 1.21-1.53), atrial fibrillation (AF) (1.26) & other cardiac arrhythmias (1.56) especially in those using carbamazepine and valproic acid vs pts without epilepsy (5)

Reference:

• (1) Fisher RS et al. Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia. 2005;46(4):470-2.
• (2) National Clinical Guideline Centre (NCGC) 2012. The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care.
• (3) NICE (April 2018). Epilepsies: diagnosis and management
• (4) Wojewodka G, Gulliford MC, Ashworth M, et al. Epilepsy and mortality: a retrospective cohort analysis with a nested case-control study identifying causes and risk factors from primary care and linkage-derived data.BMJ Open 2021;11:e052841. doi: 10.1136/bmjopen-2021-052841
• (5) Wang J and others, Epilepsy and long-term risk of arrhythmias, European Heart Journal, 2023;, ehad523, https://doi.org/10.1093/eurheartj/ehad523