Prevalence and Etiology of Epilepsy - Essay Example

Epilepsy Introduction Epilepsy is one of the most common brain and central nervous system related disease that is characterised by persistent seizures and convulsion. This condition has caused a lot of suffering to number of people across the world partly due to the lack of proper medication or complete research on its mechanism. The transmission of wrong signals or false alarm to the section of the brain responsible for initiating seizures by a cluster of nerve cells is responsible for the occurrence of the condition (Theodore & Spencer, 2006). The transmission of such pulses results into funny and uncharacteristic behaviours accompanied by strange sensations and loss of emotional control. The occurrence of the violent muscle spasm result into loss of unconsciousness and the formation of form in the mouth of the patients. A number of techniques have been adopted to detect the condition in children and even adults as early diagnosis helps in proper management and control. Though no cure have been so far discovered for the condition, proper management, surgical procedures and the use of implants such as nerve stimulators can control it (Bazhenov & Timofeev, 2008). A number of pharmacological drugs have also been discovered that have produced positive results with the condition. This translates to over 65 million people, a number that have prompted a number of pharmaceutical companies to research on the condition and develop therapeutic medications. In this paper, epilepsy will be discussed in line with its symptoms, the causes so far discovered, aetiology and epidemiology across the globe and the current medications used (Sridharan, 2002). Prevalence and aetiology of epilepsy Epilepsy occurs in individuals of all ages irrespective of their social status, sex or even religion with after birth cases more prevalent in advanced age individuals. A number of neurological conditions exist but epilepsy is considered as one of the most common in Europe, the United States and in the developing world. Epilepsy prevalence is differentiated by the differences in seizures, specific syndrome and the extent of spasm according to the epilepsy foundation. Globally, 20% of those diagnosed with the condition experience clonic seizures while 20% are exposed to partially complex seizures. Others however have mixed and partial seizures, forming roughly 12% of all the seizures experienced globally. The sensitivity to light also varies with only 3% of the total diagnosed patients having photosensitivity and seizures created by photic stimuli (McCormick, 2001). Prevalence of a condition provides a rough estimate that enables epidemiologists to determine the possibility of an individual to have a certain condition. Prevalence thus provides the total number of cases of a specific condition, in this case epilepsy, that is believed to exist globally among geographically and socially diverse group of individuals. In the United Kingdom, it is estimated that roughly 600,000 people have epilepsy and have been introduced into different epileptic medications. This is based on the information that was released by the 2010 population census in different parts of the country. Based on the census, 469,000 out of the over 52 million Britons have epilepsy and this represent 0.095% of the entire population translating into 1 in every 150 individuals having the condition. The northern Ireland had a higher proportion of its citizens having the condition at 1.11%, which meant a total of 20,000 people out of the total population of 1,800,000 people (Theodore & Spencer, 2006). In every 509 children aged below 4 years old, one was diagnosed with the condition while those aged 16 years and below had the condition after every 240 children sampled. The number however increased as the ages of the citizens advanced with those aged 28 and below presenting the disease in 1 after every 220 people. Epilepsy is therefore prevalent among the aged as compared with the younger population and this means that most of the cases are associated with physical brain injury. Social deprivation also increases the prevalence of the condition with 25% of socially derived citizens having the condition as compared to those that are not exposed to such conditions (McCormick, 2001). Though the ability to develop the condition remains at 1% globally, certain groups are at a higher risk of contracting the disease. Out of the children that showed symptoms of mental retardation and sickness, 25.8% of them were suffering from epileptic conditions. Cerebral palsy also increases the prevalence of the condition due to the impacts it produces on the CNS (Bharucha, 2003). As a result of the association between cerebral palsy and epilepsy, 13% of cerebral palsy patients experiences seizures characteristic of epilepsy. Children with other physical disabilities which expose them to brain injury and cerebral palsy are at a 50% chance of developing epileptic diseases. Other conditions that the world health organization report associate with increased prevalence of epilepsy include Alzheimer and stroke with 10% of Alzheimer and 22% of stroke of patients experiencing the condition. Worldwide, epilepsy affects over 60 million people, which is roughly 1% of the total world population distributed discriminatively across countries and dependent upon the diagnostic abilities. Approximately 80% of all the reported cases are found in developing countries due to the fact that such countries lack proper diagnostic and management approaches as compared to the developed nations (McCormick, 2001). Though generally caused by false sensation of the brain by a cluster of neurons, epilepsy has more complex foundation and this makes understanding of the main cause essential. The causes of epilepsy are however categorized into three main categories depending on the category of epilepsy. The three categories of epilepsy vary in their causation, the symptoms and even the medical approach that can be effectively adopted to eliminate them (Bharucha, 2003). Symptomatic epilepsy is associated with conditions that results into structural impacts on the brain. Such conditions or experiences results into significant effects on the functions of brain palsy which increases the exposure of the brain to impulsive neuron messages. Excessive use of drugs and alcohol also increases brain damage which results into the development of symptomatic epilepsy in people. Other birth defects that could have developed as a result of difficulties associated with giving birth also increases the chances of developing symptomatic epilepsy in people (McCormick, 2001). Other problems during birth can result into oxygen deprivation to the embryo as a result of twisted umbilical code which damages the brain. Other causes of symptomatic causes include general injuries to the head from accidents, strokes or even the development of brain tumours. Idiopathic epilepsy is at times treated as mild epilepsy due to its asymptomatic nature which results into lack of any visible symptoms and signs that can be associated with the condition. However, the lack of visible sign has been associated with lack of advanced medical equipment that can be able to detect the presence of the condition as opposed to its mild nature. Though the causes of idiopathic epilepsy have not been strongly conceived through medical research, genetic mutation has been associated with its prevalence in individuals. Cryptogenic epilepsy is category of epilepsy that has been diagnosed but no physical, genetic or medical reason can be used to explain its presence. However, independent researchers have associated the presence of the category of epilepsy to brain damage or disruption in the brain function which create room for impulsive transmission of pulses. However, other signs and symptoms exist that have been used by doctors and brain specialist to diagnose the condition and categories it accordingly. The signs associated with the condition are currently divided into motor signs, sensory signs, psychic signs and autonomic or involuntary signs. Motor signs are the most common signs which are visible in the patient due to the physical manifestation of the wrong signals sent to the brain (Remy & Beck, 2006). The rapid alternated spasm one of the most visible motor signs of the conditions and this is directly responsible for seizures. Stiff and focused eye movements and movement of the head towards one particular direction characterize this. Due to the contractions and relaxations that occur, the stability of the limbs is affected and this results into asymmetrical posturing of the limbs. The speech and vocal muscles are also affected and this results into the impairment of the vocal abilities of the patient (Bharucha, 2003). While these signs associated with uncoordinated contraction and relaxation of the muscles occurs, other signs, which are associated with loss of sensory abilities, are also visible. Most patients see flashes of lights and sharp colours, which create an illusion of this or people leading to persistent hallucination. Funny and discomforting sounds like humming, buzzing and hissing sounds further complicates the comforts of the patients and reduces their stability. The tasting and smelling senses are also affected by such movements and these results into experiencing of unpleasant odours and smell which creates the need for funny nose movements (Dekker, 2002). Other signs and symptoms associated with epilepsy include the presence of flushes, nausea and vomiting, the development of goose bumps and profuse sweating. Tachycardia or increase pulse rate also occurs in the patients which results into overworking of the heart tissues. Psychic symptoms include the development of a strong feeling to detach from others around the patient. Most patients also experience persistent dreamy states especially after experiencing the seizure and spasms. Memory losses also occur associated with flashbacks and false déjà vu, which increases hallucination in the patients and affects their psychological stability (Remy & Beck, 2006). Cellular and molecular basis of epilepsy The development of seizures and epilepsy in some individuals has been associated with their cellular or molecular properties, which increases their chances of sending false alarm to the brain. Based on the epidemiological information in the United Kingdom, 3% of the total population are prone to epilepsy and seizures and may therefore develop the condition in their lifetime. It is also estimated that approximately two thirds of epilepsy patients who developed the condition without experiencing physical injury to the brain have a genetic explanation and reason. This makes it essential to identify and understand both the cellular and molecular basis of the condition to assist in the process of developing therapeutic measures (Lossin & Wang, 2002). The human brain is considered as one of the most complex organs in the body with over 500 billion neurons having trillions of connection with each other to enhance the communication process. The regulation is believed to begin immediately the cellular form the brain is achieved during foetal development, a process that occurs during the second trimester (Schmidt, 2009). The brain cells therefore require large amount of proteins, which are a product of different genes in the brain. They also assist in the cell-to-cell communication as neurotransmitters and in the removal of cellular toxins which increases brain damage. Other categories of proteins known as the ion channels are specialized in the flow of ionic substances across the cell plasma. Such ions, which are critical for the brain function, include sodium and calcium, which are moved into the cell and potassium, which is transported out of the cells (Remy & Beck, 2006). Seizures, which are prevalent in epileptic individuals, are associated with abnormal electrical activity occurring within a network or cluster of neurons. This result into the development of repeated seizures, which are not associated with toxins, drugs or even metabolic malfunctions as, are commonly found in other seizure cases. Cryptogenic and idiopathic epilepsy occurs due to the genetic causes occurring as a result of damage in the cellular makeup of the brain tissues. This result into a condition that is not easily identifiable using imaging techniques as is common in other epileptic conditions (Schmidt, 2009). Seizure disorders including epilepsy have been associated with a string of polygenic changes, which affects different genes and are brought together by chance. However, the slightly different mix of genes that are inherited by siblings in a family makes it impossible for all of them to inherit the variations and experience seizures. Mutations on genes that result into epilepsy also occur within different positions in a chromosome or gene and these results into different categories of epilepsy. Monogenetic epilepsy occurs when a single point mutation occurs in the gene resulting into abnormalities in the normal functioning of the brain. This condition is rare but has been reported in about 1% of all the genetic cases reported worldwide. Mutations that affect the normal functioning of the brain occur in genes that responsible for ion transport including the voltage gated ions channels and the ligand gated ion channels. Different research activities funded by the European epileptic association have helped in the development of therapeutic approaches that target the genetic changes that occur in such individuals (Lossin & Wang, 2002). Current treatments of epilepsy ` Despite lacking a universal treatment approach, research in epilepsy and seizure has resulted into the development of a number of therapeutic and non-therapeutic approaches. These approaches aim at reducing the occurrence of seizures in such patients without causing further damage to the brain that may escalate the situation. This goal has been accomplished in approximately 60% of the cases that it has been used and this demonstrates its effectiveness in the management of epilepsy. However, the decision to initiate treatment cannot be taken unless a full diagnostic report has indicated the presence of the condition in the patient (Schmidt, 2009). ` In children, antiepileptic drugs (AEDs) have been used with varying success and the reduction in the occurrence of the seizures. Epilepsy medication in children aim at reducing the recurrence of the seizure to enable the children lives a normal life especially in school. However, the choice of AED take depends upon complete diagnostic examination and the prescription of the drugs by qualified physicians. These drugs come in the form of capsules and have been successfully used to control seizures in patients after first attempt (McCorry & Marson, 2004). Anticonvulsant therapies have also enabled patients to live a normal life without having to depend on prescription drugs like antiepileptic drugs. Different anticonvulsant drugs are available in the United Kingdom and in other parts of the world and their use differ due to the variations in pathophysiological mechanisms that may exist in different patients. The mechanism of action of the anticonvulsants differ with some such as the lamotrigine, topiramate and valproic acid exhibiting varied modes of action with others such as phenytoin and carbamazepine exhibiting single action mode (Costello & Cole, 2006). Phenytoin and carbamazepine act by blocking the repetitive activation of sodium channels, which is known to increase the influx of sodium ions into the brain. Lacosamide and rufinamide act by slowing the process of sodium channel activation and this reduces the overall sodium transport into the brain. In the case of an epileptic condition with absent seizure, ethosuximide has been successfully used in the treatment and this has enabled such patients to live a normal life. Other management approaches have adopted non-pharmacologic approaches and this has been helpful in reducing the side effects associated with the continued use of neurological medications like phenobarbital and phenytoin. Ketogenic diets are nutritional alternatives which heavily rely on the use of fats such as hydrogenated vegetable oils and have been used in the management of epilepsy in children. A number of observational studies have demonstrated the benefits of ketogenic diet in the control of seizure among children. However, the difficulty in maintaining the diet makes it less likely to help in most cases as nutritional discipline is needed for it completely control the recurrence of the seizures (McCorry & Marson, 2004). The use of vagal nerve stimulation as a non-pharmacological option in the maintenance of epilepsy has also increased due to the positive reviews it has received from researches conducted by the American academy of neurology. The food and drugs agency have approved the use of VNS in the treatment of refractory focal onset epilepsy especially in patients who are older than 12 years old. Implantable neurotransmitters have also been used in the process of epilepsy management through their implantation in the cranium. These neurotransmitters are used in the processes of recording and transmitting patterns which helps in the interruption of the ictal discharges to the brain. The device was adopted after the FDA concluded that it was a safer antiepileptic treatment with benefits which outweigh the risks it exposes the patient to (Costello & Cole, 2006). Care for unmet medical need Unmet medical conditional conditions are those that the available therapeutic measures, management approaches or research concerns have continued to ignore. Though epilepsy has attracted massive attention from the medical fraternity across the world, unmet medical cases still exist that affects specific individuals. According to the board members of the epilepsy therapy project, a number of epileptic medical cases have continuously been ignored and this qualifies them under the unmet medical conditions. Epilepsy is a condition that affects people of all walks of life in the society but this has not reduced the level of stigmatization that patient with the condition have been exposed to. The lack of proper mechanism for conducting awareness and public education on the condition has been cited as one major factor that affects the social and medical aspects of individuals living with this condition. As the patients experience repeated seizures, the society and the public are not well trained on how to handle these people whenever they are attacked especially in public places. Most of the time, the occurrence of the seizure increases their social exclusion and stigmatization as people developed varied views towards their medical conditions. Epilepsy affects the stability of relationships and families and this makes it essential for public awareness to be increased to help them learn how to cope with the condition whenever it emerges (Bazhenov & Timofeev, 2008). Conclusion Epilepsy is one of the prevalent neurological diseases that affect a large number of people across the globe irrespective of social classes. The disease currently affects 1% of the total world population with its prevalence increasing with age which means that it is caused by physical injury to the brain in most cases. However, genetic factors also contribute to the prevalence of the condition and research shows that families with the condition are more likely to pass it to the next generation. However, a number of therapeutic and non-therapeutic management approaches have been developed to help in the management of the condition and ensure that the patients live a normal life. References Dekker, P 2002, Epilepsy: A manual for medical and clinical officers in Africa, World health organization. Sridharan, R 2002, Epidemiology of epilepsy, recent advances in epilepsy, 82(6). Theodore, W. & Spencer, S 2006, epilepsy in north America; a report prepared under the auspice of global campaign against epilepsy, New Jersey: Blackwell publishing Inc.. 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