Epilepsy is a neurological disorder in which the electrical activity of neurons becomes altered, leading to a predisposition to epileptic seizures. Although it can occur at any age, it is more common in children and older adults.

CausasCausasCauses

Causes

  • Neurotransmitters: An increased level of excitatory neurotransmitters or a decreased level of inhibitory neurotransmitters can cause neuronal hyperactivity, leading to epileptic seizures.
  • Genetic factors: Many genes are involved in neuronal activity. Some are associated with specific types of epilepsy.
  • Abnormal brain development: During pregnancy, various problems may affect the normal development of the baby’s brain, such as oxygen deprivation during delivery or maternal infectious diseases.
  • Diseases causing secondary epilepsy: Central nervous system infections, brain tumors, cerebrovascular diseases (strokes or hemorrhages), and degenerative diseases, among others.
  • Head trauma
SíntomasSíntomasSymptoms

Symptoms

Epileptic seizures are not the same in all individuals, and symptoms depend on the area of the brain affected. There are:

  • Generalized seizures, which affect the entire brain and cause loss of consciousness or altered awareness.
  • Partial or focal seizures, which affect a specific area of the brain and produce symptoms depending on the region involved.

During a seizure, several of the following symptoms may appear, typically with sudden onset and stereotyped patterns:

  • Loss of consciousness
  • Uncontrolled movements of the limbs
  • Muscle stiffness
  • Deviation of the gaze
  • Emotional and cognitive changes
DiagnósticoDiagnósticoDiagnosis

Diagnosis

To diagnose epilepsy and choose the appropriate treatment, a neurological evaluation is required, including:

  • Medical history: Including the characteristics of the seizures and their initial symptoms (such as warning sensations, presence or absence of loss of consciousness, body movements, speech content, duration, and other features).
  • Electroencephalogram (EEG): Records the brain’s electrical activity. It helps detect areas of abnormal electrical activity and classify the type of epilepsy. Prolonged video-EEG monitoring (12–24 hours) is more useful than a short 20–30 minute EEG, which may appear normal in a high percentage of people with epilepsy.
  • Computed Tomography (CT scan): Produces a series of X-ray images of the head processed by computer to obtain a three-dimensional view. It has limited usefulness in epilepsy due to its lower resolution.
  • Magnetic Resonance Imaging (MRI): Uses magnetic fields and radiofrequency waves to produce three-dimensional images. Compared to CT, it provides better visualization and is the best imaging test to identify structural causes of epilepsy. High-resolution MRI with an epilepsy-specific protocol and thin slices is recommended, guided by the patient’s seizure type.
  • Laboratory tests: Blood tests may be necessary to confirm or rule out certain causes of epilepsy or to monitor adverse effects of antiepileptic drugs. In some cases, cerebrospinal fluid (CSF) analysis obtained by lumbar puncture may be required.
  • Other tests: Depending on clinical features, personal and family history, and results of previous studies, additional tests may be necessary (e.g., cardiac studies, genetic testing, metabolic studies).
tratamientos245x120tratamientos245x120Treatment

Treatment

The first step in epilepsy treatment is to avoid, as much as possible, seizure triggers, which vary depending on the type of epilepsy (e.g., sleep deprivation, alcohol).

  • Medications: There are many antiepileptic drugs available, chosen according to the type of epilepsy and the individual patient. Age, coexisting conditions, and potential drug interactions must be considered. Some patients require treatments directed at the underlying cause, such as immunotherapy in autoimmune epilepsies. There are also numerous clinical trials currently focused on specific genetic epilepsies.
  • Ketogenic diet: A diet that significantly reduces carbohydrates and increases fats. It must be supervised by a nutritionist and is used only in drug-resistant epilepsies.
  • Epilepsy surgery: In some cases, surgery may be performed to remove the area of the brain responsible for seizures. Minimally invasive techniques are now available, such as thermal ablation (thermocoagulation using deep electrodes) or Gamma Knife radiosurgery.
  • Vagus nerve stimulation: This involves implanting a generator in the chest wall connected to the vagus nerve. The device sends regular electrical impulses to the brain, helping to reduce seizure frequency.