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Epilepsy is a state of the brain with a predisposition to epileptic seizures (ES). ES are sudden temporal dysfunctions of the central nervous system characterised by highly synchronic and high-frequency excitations of groups of neurons of variable localisation, size and extension. This explains the highly variable phenomenology ranging from second long Absences to involuntary convulsions of one extremity, to impaired consciousness and to the classical tonic-clonic seizure.
Epilepsies have different causes such as family disposition (mutations of ion channels or receptors), metabolic defects, connate malformations, inflammation, traumas, tumours or vascular lesions. With a prevalence of about 0,8% Epilepsy is a very frequent neurological disorder. Its incidence is 46/100000 per year with peaks in childhood and old age.
ES need to be distinguished from non-epileptic psychogenic seizures, convulsive syncopes and REM sleep behaviour disorder. ES are characterised by open, gazing, unseeing or twisted eyes, a duration of less than two minutes, consistent phenomenology of seizures, variable, often elongated reorientation and sore muscles one day after a tonic-clonic seizure.
The differentiation of ES in terms of extension, namely focal versus generalised, is crucial for the choice of therapeutics. There are more than 20 drugs available, all of them reduce the likeliness of seizures by elevating the threshold but none aims at the underlying causes of epilepsy. Therefore, a medication is not curative and in most cases it is lifelong. About 50-70% of all patients under medication stop having seizures. In case of pharmacoresistance, assumed after the third failing drug but at the latest after five years of insufficient therapy, an operation should be considered.
Medical Treatment by Mechanism of Action