EPILEPSY- A Neurological Disorder

What is Epilepsy?

Epilepsy is a neurological disorder which mainly affects the central nervous system. It is a chronic and non-communicable disorder associated with unpredictable seizures which affect the body and can result in injuries hence is a physical condition too.

Anyone can develop Epilepsy at any age, at any point of time and anywhere. It usually affects people of all ages and races.

What Causes Epilepsy?

Epilepsy has no identifiable cause. Some with no clear cause can blame their genetic profile. Sometimes the triggers run in families. It can be caused due to the way some genes have been manipulated to work. Brain infections or Brain injuries can change the way how neurons work. Thus, leading to seizures. Brain malformations, lack of oxygen during birth, maternal drug use, and low blood sugar level at the time of birth can lead to Epilepsy in newborns. In adults and children, brain injuries, fever, brain tumour, progressive genetic disorder, and other genetic factors can cause onset of Seizures. Stroke and Alzheimer’s disease during old age.

Epilepsy is affecting 3.4 million people worldwide,  and over 150,000 new cases are diagnosed each year accounting for 0.6% of the global burden of disease.

Looking at the numbers, the severity of the disorder is self-explanatory. It is likely to affect 1 in 26 people in their lifetime. Approximately 2.2 million Americans and roughly 1 million people in Japan are living with Epilepsy. Over 6, 00,000 people in the UK have Epilepsy. In Europe, at least 6 million people have epilepsy, and 15 million Europeans will have one seizure at some time in their lives. Moreover, 80% of people living with it are from low- or middle-income countries. Out of which 70% of them if diagnosed properly can live a seizure free-life.

Now, what exactly is a seizure?

A SEIZURE is a sudden alteration of behavior, a sudden surge in the brain activity that affects how a person acts or behaves. There present cells in the brain which are either responsible for exciting or stopping the chemical produced in the brain. During a Seizure there is either too much of excitation or too little inhibition, creating an imbalance. It itself isn’t a disease but a symptom which can last for up to a minute. Although the sign of any seizure depends on the size of it but sometimes it is hard to even notice if a person is going through it.
There are different types of Seizures.
Generalized onset Seizures affect both sides of the brain cells simultaneously. It results in an epileptic person to stare aimlessly, jerking movements, limp or tense muscles, repeated spasms or continuous eye twitching. 
Focal onset Seizures affect one side of the brain. And if a person is completely aware of the happenings around during a seizure it is Focal Onset Awake Seizure. If a person loses awareness then it is referred to as Focal onset Impaired Seizure. It includes lip-smacking, running or chewing, continuous rubbing of hands or clapping or behavioral and emotional changes.
There exist phases of Seizures.
Seizures have a beginning, a middle and an end. Although not everyone going through a Seizure may feel or go through each of the phase listed above but some are aware of the upcoming attack hours or even days before. During a BEGINNING, a person can feel different smells, unfamiliar sounds, Déjà vu, Jamais vu, visual loss, fear or light-headedness. The MIDDLE of a seizure includes a person to black out, lose consciousness daydream, distractedness, unusual strange tastes or sounds, numbness, panic, repeated movements of body parts, uncontrollable shaking called fits, rigid body parts, drooling, racing heart or losing control over excretion. The Ending results in a slow response, dizziness, confusion, frustration, embarrassment, memory loss, injuries, thirst, or nausea. 

Stay Safe during a SEIZURE

• Maintain composure and Stay Calm.
• Stay with the person until the seizure is over and the person is fully alert.
• Ease the person to the floor.
• Get rid of any sharp objects, any neck or wrist bands, and eyeglasses to prevent any injuries. Protect the head.
• Do not try to give CPR or try to feed the person any kind of food. Do not try to hold the person.
• Look for help if the seizure lasts for more than 5 minutes.
• What causes Epilepsy?
• Head trauma or any type of brain injury can result in Epilepsy.

Diagnosis

Diagnostic methods for Epilepsy ranges from Blood testing to Brain Imaging. Electroencephalogram (EEG) is the most common method to diagnose Epilepsy. This method includes placing electrodes on the brain to study the changes in brain electrical waves. Then there is High-density EEG as well in which the placement of electrodes is way more compact. Computerised-Tomography (CT) Scan which uses x-Rays, MRI uses powerful radio magnets to make a detailed view of the brain.

Seizures can be controlled.
Medications can help people live a seizure-free life. The current market for Epilepsy is dominated by the use of several Anti-epileptic drugs (AEDs). They have the potential to treat the seizures completely in almost 70% of the cases. Antiepileptic Drugs (AEDs) which can be broadly classified as per their mechanism of action, these are Gamma-Aminobutyric Acid  (GABA) Enhancers/ Inhibitors, Calcium Channel Blockers, Sodium (Na) Channel Blockers, medication inhibiting both Ca and Na Channel Blockers, AMPA Receptor Blockade, the new AEDs falling under the category of Synaptic vesicle protein 2a (SV2a) vesicle inhibition, the plant-based approved cannabidiol, Epidiolex, which is the only approved therapy in this category. These medications do have the side effects- mild ones include skin rashes, fatigue, dizziness, and the severe ones include suicidal thoughts, depression and severe rashes. Finding the right dosage is critical for the patient as well as the Doctor. Because the right medication in the right amounts can change the lives of the epileptic-patients.
When the medications fail, surgery is opted. Doctors try to remove the specific part of the brain that is causing seizures keeping in mind that it doesn’t affect any vital functions of the brain like motor function, speech, vision or hearing.
There are dietary options as well which have shown benefits to 70% of the patients. Ketogenic Diet is a special high fat, adequate protein, and low carbohydrate diet, and a modified Atkins diet is although a similar one but less restrictive.

Socio-Economic Impacts

Epilepsy poses an economic burden to health care systems and the affected ones. The impact may vary depending upon the severity, duration and the income group of the country. Even if the economic impact doesn’t affect much the social stigma associated can cause much more harm than expected. Social acceptance matters the most.

The Road Ahead

Delveinsight believes that the current market of Epilepsy will slightly increase in the upcoming years with the emergence of several new Antiepileptic Drugs while few of them with a novel mechanism of action in the market. Among all these upcoming years, NRL-1(Neurelis), Cannabidiol (INSYS Therapeutics) and Fintepla (Zogenix) are expected to hold the largest market share after their launch in the market in 2020 followed by the USL-261 (UCB Pharma) and ZYN-002 (Zynerba) with expected launch in 2019 and 2024 respectively as ZYN-002 is still in Mid Stage of development in the clinical trials for Epilepsy.