Know how to deal with seizures, stress due to this chronic condition

If you have epilepsy, you may face challenges in day-to-day life. The fear of those seizures or those nasty falls can be disturbing. Not only this, the constant anxiety and stress can be overwhelming too. Here, we brief you everything you need to know about the condition plus, the treatment and prevention as well.

Epilepsy is a chronic, non-progressive condition of the central nervous system that can affect individuals of any age, globally. The major burden of the condition is due to premature mortality and residual disability arising due to seizures and their consequences. Globally, epilepsy of unknown cause ranks fifth among neurological diseases after stroke, migraine, dementia and meningitis. A total of 70 million persons suffer from the condition, worldwide. Out of this number, 12 million persons with epilepsy are expected to reside in India, making us contribute to nearly one-sixth of the global burden. The figures are staggering in our country with an overall incidence and prevalence of 0.2-0.6 and 3.0-11.9 per 1000 population/year, respectively. Dr Pradeep Mahajan Regenerative Medicine Researcher gives a better understanding of epilepsy.

The causes of epilepsy

What exactly causes the idiopathic form of epilepsy remains unknown in close to 50 per cent of global cases? Secondary epilepsy may be associated with conditions such as stroke, head/traumatic brain injury, neurodegenerative diseases, inflammatory brain disorders, tumours, congenital anomalies, etc.

The cardinal manifestation of epilepsy is seizures, which occur due to altered electrical activity in the brain. There can be excessive electrical discharges in a group of cells, in any region of the brain. Such discharges cause brief lapses of attention or muscle jerks or even prolonged convulsions. The frequency can vary from less than one seizure per year to several episodes per day.

What happens when one gets seizures?

During a seizure, a person can experience abnormal behaviour, symptoms, and sensations, sometimes including loss of consciousness. Patients may not remember what happened during the seizure or may not even realize that they had a seizure. Occasionally, seizures may be preceded by warning signs (like aura before migraine attack); however, this is not consistent. A seizure ends when the abnormal electrical activity in the brain stops and brain activity begins to return to normal. However, because seizures can occur repeatedly and cause physical injury as well as psychological consequences, epilepsy becomes a burdensome neurological disorder impairing the quality of life of an individual.

Prevention and Treatment

It is not always possible to identify triggers of the condition. Some patients report common triggers such as:

• Lack of sleep
• Illness or fever
• Stress
• Bright lights, flashing lights, or patterns
• Caffeine, alcohol, medicines, or drugs
• Skipping meals, overeating, or specific food ingredients

However, these triggers cannot be considered the standard-in fact, they may not occur consistently in the same individual during each episode. Nonetheless, maintaining a diary to keep track of seizure-inducing factors is advisable to avoid the same or be prepared in the future.

We often end to be overprotective of a person with Epilepsy and advise them against participating in sports and exercise. However, research suggests that physical exercise and active participation in sports may result in seizure control, in addition to producing broader health and psycho-social benefits.

Conventionally, treatment of epilepsy predominantly symptomatically comprises of seizure suppressing anti-epileptic medications. In extreme cases, surgical therapy is indicated to eliminate seizure generating neuronal impulses. However, there is no effective therapy to prevent epileptogenesis (generation of abnormal electrical activity).

Role of cell-based therapy in epilepsy

Regenerative Medicine and Cell-Based Therapy is garnering attention in the treatment of various conditions that were previously thought to be untreatable. It is known that epilepsy is associated with underlying factors such as loss in specific cells in the brain. Mesenchymal cells in the human body are capable of self-renewal and differentiation into other cell types. This property aids in the maintenance of tissue homeostasis and can also be utilized to regenerate lost neurons and repair tissue damage. Paracrine property of mesenchymal cells can enhance the function of neighbouring cells of the nervous system and provide endogenous factors (trophic factors and cytokines) to prevent epileptogenesis.

The advantage of cell-based therapy lies in its minimally invasive nature, being autologous; therefore safe, and effective. Mesenchymal cells are known to selectively migrate to areas of damage (area of epileptic foci) and regenerate cells and tissues. Studies have shown the differentiation of mesenchymal cells into mature neurons, which replaced lost neurons and ameliorated seizure activity. Additionally, these cells arouse neuroprotective properties by releasing neurotrophic factors and can modulate the immune system that can attenuate seizures and cognitive dysfunction in epileptic patients.

Results achieved through cell-based therapy are maintained for long periods of time as they bring about the regeneration of affected structures and not just symptomatic relief. With a better understanding of molecular mechanisms, we can personalise cell-based treatment strategies using cells, peptides and growth factors to achieve more effective outcomes in various conditions.

Take-home message: The need of the hour is targeted programs and a stronger public health approach aiming towards prevention, control, and management of epilepsy.