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\nWhen you hear the word epilepsy, you might think of intense seizures with muscle spasms and loss of consciousness. But most epilepsy seizures are surprisingly subtle and may be hard to recognize. These little spells can be an early warning sign of epilepsy, a brain disorder that strikes an estimated 1 in 26 Americans at some point in their lives. The sooner epilepsy is recognized, the sooner it can be treated and seizures prevented.
\nMost people know surprisingly little about epilepsy, even though it\u2019s the nation\u2019s 4th most common neurological disorder, after migraine, stroke, and Alzheimer\u2019s disease. Epilepsy is marked by repeated, unpredictable seizures that may last for seconds or minutes. Seizures arise from abnormal bursts of electrical activity in the brain that trigger jerky movements, strange emotions or sensations, falls, or passing out.
\n\u201cEpilepsy can strike people of all ages, from the moment of birth\u2014even in the delivery room\u2014up to older ages,\u201d says Dr. Jeffrey Noebels, an epilepsy expert at Baylor College of Medicine. The condition is most likely to first arise in children and in adults over age 60. \u201cMost types of epilepsy last a lifetime, but some are self-limited, meaning they can go away on their own,\u201d Noebels adds.
\nThe causes of epilepsy are varied. \u201cDefects in genes are probably responsible for the largest fraction of epilepsy cases,\u201d Noebels says. Scientists so far have linked more than 150 genes to epilepsy. \u201cOther types of epilepsy can be acquired through trauma (such as head injury or stroke), infections, brain tumors, or other factors.\u201d
\nAnything that disrupts the normal pattern of brain activity\u2014from illness to brain damage to faulty brain development\u2014can lead to seizures. But for up to half of people with epilepsy, the underlying cause is simply not known.
\nTypes of seizures can also vary widely, which is why epilepsy is sometimes called a \u201cspectrum disorder.\u201d In some people, seizures may appear only occasionally. At the other end of the spectrum, a person may have hundreds of seizures a day. The seizures can be severe, with convulsions, loss of consciousness, or even sudden death in rare cases. Or seizures may be barely noticeable.
\nSuch subtle seizures\u2014sometimes called partial or focal seizures\u2014can cause feelings of d\u00e9j\u00e0 vu (feeling that something has happened before); hallucinations (seeing, smelling, or hearing things that aren\u2019t there); or other seemingly mild symptoms. During some seizures, a person may stop what they\u2019re doing and stare off into space for a few seconds without being aware of it.
\n\u201cThese little spells or seizures can sometimes occur for years before they\u2019re recognized as a problem and diagnosed as epilepsy,\u201d says Dr. Jacqueline French, who specializes in epilepsy treatment at the New York University Langone Medical Center. \u201cThey can be little spells of confusion, little spells of panic, or feeling like the world doesn\u2019t look real to you.\u201d
\nThe symptoms of these small seizures generally depend on which brain regions are affected. Over time, these types of seizures can give rise to more severe seizures that affect the whole brain. That\u2019s why it\u2019s important to get diagnosed and begin epilepsy treatment as soon as possible. \u201cIf you notice a repeating pattern of unusual behaviors or strange sensations that last anywhere from a few seconds to a few minutes, be sure to mention it to your doctor or pediatrician,\u201d French says.
\nOver the past few decades, NIH-funded scientists have been working to develop better approaches for diagnosing, treating, and understanding epilepsy. The condition can now be diagnosed through imaging tools like MRI or CT scans, by testing blood for defective genes, or by measuring the brain\u2019s electrical activity. Seizures can often be controlled with medications, special diets, surgery, or implanted devices. But there\u2019s still a need for improved care.
\n\u201cTraditional medications for treating epilepsy are effective but problematic,\u201d says Dr. Ivan Soltesz, who studies epilepsy at Stanford University. \u201cAbout 1 in 3 patients has drug-resistant epilepsy, meaning that available drugs can\u2019t control the seizures. In these cases, surgical removal of brain tissue may be the best option.\u201d When the drugs do work, he explains, they can also cause numerous side effects, including fatigue, abnormal liver function, and thinking problems.
\nOne issue with today\u2019s medicines is they aren\u2019t targeted to the malfunctioning brain cells. Rather, they tend to affect the whole brain. \u201cThe drugs are also not specific in terms of the timing of treatment,\u201d Soltesz says. \u201cThe medications are always in the body, even when the seizures are not occurring.\u201d
\nHe and other researchers are working to create highly targeted epilepsy therapies that are delivered only to malfunctioning brain regions and only when needed to block a seizure. So far, they\u2019ve developed an experimental approach that can stop epilepsy-like seizures as they begin to occur in a mouse. The scientists hope to eventually translate those findings for use in people who have epilepsy.
\nIn another line of NIH-funded research, a team of scientists is studying a deadly and poorly understood condition called SUDEP (for sudden unexpected death in epilepsy). \u201cMost people with epilepsy live long and happy lives. But SUDEP is the most common cause of the shorter lifespan that can occur with epilepsy,\u201d says Noebels. \u201cIt\u2019s been a real mystery. We haven\u2019t known who\u2019s at greatest risk for this premature death. It can happen to different people who have epilepsy, from all walks of life.\u201d
\nNoebels and his colleagues have identified several mouse genes that seem related to both sudden-death seizures and heart rhythm problems. The researchers are now searching for similar human genes that may help predict who\u2019s most at risk for SUDEP. \u201cWe believe that SUDEP doesn\u2019t have to happen\u2014that we can learn about it, predict it, and eventually find better ways to prevent it in every patient,\u201d Noebels says.
\nYou can take steps to reduce some risk factors for epilepsy. Prevent head injuries by wearing seatbelts and bicycle helmets, and make sure kids are properly secured in car seats. Get proper treatment for disorders that can affect the brain as you age, such as cardiovascular disease or high blood pressure. And during pregnancy, good prenatal care can help prevent brain problems in the developing fetus that could lead to epilepsy and other problems later in life.
\n\u201cWe\u2019ve made exciting advances to date in our understanding of epilepsy, its prevention, and treatment,\u201d says French. \u201cBut there\u2019s still much we have to learn, and much we\u2019re actively working to improve.\u201d
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References:
The evolution of epilepsy surgery between 1991 and 2011 in nine major epilepsy centers across the United States, Germany, and Australia. Jehi L, Friedman D, Carlson C, Cascino G, et al. Epilepsia. 2015 Oct;56(10):1526-33. doi: 10.1111/epi.13116. Epub 2015 Aug 7. PMID: 26250432.
On-demand optogenetic control of spontaneous seizures in temporal lobe epilepsy. Krook-Magnuson E, Armstrong C, Oijala M, Soltesz I. Nat Commun. 2013;4:1376. doi: 10.1038/ncomms2376. PMID: 23340416.
Sudden unexpected death in epilepsy: Identifying risk and preventing mortality. Lhatoo S, Noebels J, Whittemore V; NINDS Center for SUDEP Research. Epilepsia. 2015 Nov;56(11):1700-6. doi: 10.1111/epi.13134. Epub 2015 Oct 23. PMID: 26494436.
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