Epilepsy

Introduction to Epilepsy

Definition and Overview of Epilepsy

Epilepsy is a chronic noncommunicable disease of the brain that affects people of all ages. It is characterized by recurrent seizures, which are brief episodes of involuntary movement that may involve a part of the body (partial) or the entire body (generalized) and are sometimes accompanied by loss of consciousness and control of bowel or bladder function. 

Seizure episodes are a result of excessive electrical discharges in a group of brain cells. Different parts of the brain can be the site of such discharges. Seizures can vary from the briefest lapses of attention or muscle jerks to severe and prolonged convulsions. Seizures can also vary in frequency, from less than one per year to several per day.

Prevalence and Impact of Epilepsy

Around 50 million people worldwide have epilepsy, making it one of the most common neurological diseases globally. Nearly 80% of people with epilepsy live in low- and middle-income countries. It is estimated that up to 70% of people living with epilepsy could live seizure-free if properly diagnosed and treated. 

The risk of premature death in people with epilepsy is up to three times higher than in the general population. Three-quarters of people with epilepsy living in low-income countries do not get the treatment they need. In many parts of the world, people with epilepsy and their families suffer from stigma and discrimination.

Understanding Epilepsy

The Biology of Epilepsy

Epilepsy is a disorder of the brain’s electrical system. Abnormal electrical impulses cause brief changes in movement, behavior, sensation, or awareness. These physical changes are called epileptic seizures. Epilepsy can affect various parts of the brain and is categorized into generalized, focal, and unknown depending on the area of the brain affected.

Types and Subtypes of Epilepsy

There are many types of epilepsy, each with different causes, symptoms, and treatments. Some of the common types include Generalized Epilepsies (like Absence Epilepsy, Juvenile Myoclonic Epilepsy), Focal Epilepsies (like Temporal Lobe Epilepsy), and Epilepsy Syndromes (like Lennox-Gastaut Syndrome, Dravet Syndrome).

Causes and Risk Factors

The exact cause of epilepsy is not known, but it can be linked to various factors such as brain damage, serious illness, or abnormal brain development. Risk factors can include a family history of epilepsy, head injuries, stroke, brain tumors, and infectious diseases such as AIDS.

Symptoms and Diagnostic Criteria

The main symptom of epilepsy is repeated seizures. These can manifest in many ways, from dramatic convulsions to brief moments of unconsciousness. Other symptoms can include temporary confusion, staring spells, uncontrollable jerking movements, and loss of consciousness or awareness. Diagnosis is typically made through a combination of symptom analysis, neurological examination, and tools like Electroencephalogram (EEG) and brain scans.

The Impact of Epilepsy

Physical Health Consequences

Epilepsy can have various physical health consequences. The seizures themselves can lead to injuries, including head injuries and fractures, due to falls or lack of body control during an episode. Prolonged seizures, known as status epilepticus, can be life-threatening. Moreover, people with epilepsy have a higher risk of sudden unexpected death in epilepsy (SUDEP).

Mental and Emotional Impact

Epilepsy can also have significant mental and emotional impacts. People with epilepsy have higher rates of psychological conditions, including depression, anxiety, and suicidal ideation. The fear of having a seizure can lead to stress and worry, impacting overall emotional well-being.

Social and Economic Impact

Socially, epilepsy can lead to stigma, discrimination, and social isolation. It can affect a person’s ability to drive, work, and participate in various activities, leading to reduced quality of life. Economically, the costs of long-term treatment, potential loss of employment, and related health issues can be substantiated.

Treatment and Management of Epilepsy

Medications and Therapies

The primary treatment for epilepsy involves the use of anti-epileptic drugs (AEDs). These medications help to reduce the frequency and severity of seizures. It’s important to note that the effectiveness of these drugs can vary from person to person, and it may take some time to find the right medication and dosage for each individual. Some of the commonly used AEDs include Levetiracetam, Lamotrigine, Topiramate, and Carbamazepine.

Lifestyle Modifications

In addition to medication, certain lifestyle changes can also help manage epilepsy. This includes maintaining a regular sleep schedule, eating a healthy diet, regular exercise, and avoiding triggers that may induce seizures, such as stress and alcohol.

Self-Care and Coping Strategies

Living with epilepsy can be challenging, but adopting effective self-care and coping strategies can significantly improve the quality of life. This can involve learning stress management techniques, joining a support group, staying active, and taking time for relaxation and leisure activities.

Support for Individuals with Epilepsy

Support for individuals with epilepsy is crucial. This can come in the form of professional healthcare services, community resources, and personal networks of family and friends. In the UK, organizations like Epilepsy Action provide a range of support services, including a helpline and information resources.

Epilepsy and Medical Marijuana

Role of Medical Marijuana in Managing Epilepsy Symptoms

Medical marijuana, specifically its component cannabidiol (CBD), has been studied for its potential role in managing epilepsy symptoms. The U.S. Food & Drug Administration (FDA) approved EPIDIOLEX® (cannabidiol, CBD) oral solution on June 25, 2018, for the treatment of seizures associated with two epilepsy syndromes – Lennox-Gastaut syndrome and Dravet syndrome – in people two years of age or older. This is the first-ever FDA-approved medication to treat seizures in Dravet syndrome.

Cannabidiol, or CBD, does not cause psychoactive effects but has shown some positive effects on certain body systems. This is the part that has been effective in reducing seizures in some people with epilepsy.

Research and Evidence on Medical Marijuana for Epilepsy

Early evidence from laboratory studies, anecdotal reports, and small clinical studies over a number of years suggest that cannabidiol (CBD) could potentially help control seizures. In recent years, a number of studies have shown the benefit of specific plant-based CBD products in treating specific groups of people with epilepsy who have not responded to traditional therapies.

In controlled clinical trials, Epidiolex (a plant-based CBD formulation) has been studied for a number of years. Data from these studies have helped provide evidence that led to the FDA approval of this product.

Risks and Considerations

While CBD has shown promise in managing epilepsy symptoms, it’s important to note that it can have side effects. The most common side effects reported in people taking cannabidiol were sleepiness, decreased appetite, and diarrhea. There are also potential drug interactions, particularly with anti-seizure medication valproic acid and clobazam.

Before considering CBD or any other form of medical marijuana, it’s crucial to discuss it with a healthcare provider to understand the potential benefits and risks.

Navigating Epilepsy in New York

State Resources and Support for Individuals with Epilepsy

New York State provides various resources and support for individuals with epilepsy. The New York State Department of Health has a dedicated page for epilepsy, providing a wealth of information about the disorder, including a fact sheet available in both English and Spanish. This resource can be particularly beneficial for individuals newly diagnosed with epilepsy, their caregivers, and anyone seeking to understand the disorder better.

Legal and Regulatory Framework for Epilepsy Treatment

The treatment of epilepsy in New York is governed by the state’s health regulations. These regulations ensure that individuals with epilepsy receive the necessary care and support. They also guide healthcare providers in delivering appropriate and effective treatments.

Accessing Medical Marijuana for Epilepsy in New York

In New York, medical marijuana is legal and can be accessed by individuals with specific conditions, including epilepsy. The Office of Cannabis Management oversees the licensure, cultivation, production, distribution, sale, and taxation of medical cannabis within the state. 

Registered patients can buy medical cannabis products from dispensing facilities operated by registered organizations across New York State. This provides an additional treatment option for individuals with epilepsy, particularly for those who have not responded well to traditional epilepsy medications.

Conclusion

Epilepsy is a complex neurological disorder that affects millions of people worldwide. It is characterized by recurrent seizures, which are the result of excessive and abnormal neuronal activity in the brain. The impact of epilepsy extends beyond the physical health consequences, affecting mental and emotional health, as well as social and economic aspects of life.

The management of epilepsy involves medications and therapies, lifestyle modifications, self-care strategies, and support systems. In recent years, medical marijuana has emerged as a potential treatment option, with research indicating its efficacy in managing epilepsy symptoms.

In New York, individuals with epilepsy have access to various state resources and support. The legal and regulatory framework ensures they receive the necessary care and support. Furthermore, the legalization of medical marijuana provides an additional treatment option, particularly for those who have not responded well to traditional epilepsy medications.

Understanding epilepsy, its impact, and the available treatment options is crucial for individuals with epilepsy, their caregivers, and healthcare providers. This knowledge empowers them to make informed decisions about managing the disorder and improving the quality of life for those affected.