One seizure does not signify epilepsy (up to 10% of people worldwide have one seizure during their lifetime). Epilepsy is defined as having two or more unprovoked seizures. Epilepsy is one of the world’s oldest recognized conditions, with written records dating back to 4000 BC.
Fear, misunderstanding, discrimination and social stigma have surrounded epilepsy for centuries. This stigma continues in many countries today and can impact on the quality of life for people with the disease and their families. Characteristics of seizures vary and depend on where in the brain the disturbance first starts, and how far it spreads. Temporary symptoms occur, such as loss of awareness or consciousness, and disturbances of movement, sensation (including vision, hearing and taste), mood, or other cognitive functions. People with epilepsy tend to have more physical problems (such as fractures and bruising from injuries related to seizures), as well as higher rates of psychological conditions, including anxiety and depression. Similarly, the risk of premature death in people with epilepsy is up to three times higher than in the general population, with the highest rates of premature mortality found in low- and middle-income countries and in rural areas. A great proportion of the causes of death related to epilepsy, especially in low- and middle-income countries are potentially preventable, such as falls, drowning, burns and prolonged seizures.
Epilepsy accounts for a significant proportion of the world’s disease burden, affecting around 50 million people worldwide. The estimated proportion of the general population with active epilepsy (i.e. continuing seizures or with the need for treatment) at a given time is between 4 and 10 per 1000 people. Globally, an estimated five million people are diagnosed with epilepsy each year. In high-income countries, there are estimated to be 49 per 100 000 people diagnosed with epilepsy each year. In low- and middle-income countries, this figure can be as high as 139 per 100 000. This is likely due to the increased risk of endemic conditions such as malaria or neurocysticercosis; the higher incidence of road traffic injuries; birth-related injuries; and variations in medical infrastructure, the availability of preventive health programmes and accessible care. Close to 80% of people with epilepsy live in low- and middle-income countries. Although many underlying disease mechanisms can lead to epilepsy, the cause of the disease is still unknown in about 50% of cases globally. The causes of epilepsy are divided into the following categories: structural, genetic, infectious, metabolic, immune and unknown. Examples include: brain damage from prenatal or perinatal causes (e.g. a loss of oxygen or trauma during birth, low birth weight); congenital abnormalities or genetic conditions with associated brain malformations; a severe head injury; a stroke that restricts the amount of oxygen to the brain; an infection of the brain such as meningitis, encephalitis or neurocysticercosis, certain genetic syndromes; and a brain tumour. Up to 70% of people living with epilepsy could become seizure free with appropriate use of antiseizure medicines. Low-cost treatment is available, with daily medication that costs as little as US$ 5 per year. Discontinuing anti-seizure medicine can be considered after 2 years without seizures and should take into account relevant clinical, social and personal factors. A documented etiology of the seizure and an abnormal electroencephalography (EEG) pattern are the two most consistent predictors of seizure recurrence. In low-income countries, about three quarters of people with epilepsy may not receive the treatment they need. In many low- and middle-income countries, there is low availability of antiseizure medication. A recent study found the average availability of generic antiseizure medicines in the public sector of low- and middle-income countries to be less than 50%. It is possible to diagnose and treat most people with epilepsy at the primary health-care level without the use of sophisticated equipment. WHO pilot projects have indicated that training primary health-care providers to diagnose and treat epilepsy can effectively reduce the epilepsy treatment gap. Surgery might be beneficial to patients who respond poorly to drug treatments. An estimated 25% of epilepsy cases are preventable. Preventing head injury is the most effective way to prevent post-traumatic epilepsy. Adequate perinatal care can reduce new cases of epilepsy caused by birth injury.
The use of drugs and other methods to lower the body temperature of a feverish child can reduce the chance of febrile seizures.
The prevention of epilepsy associated with stroke is focused on cardiovascular risk factor reduction, e.g.