Epilepsy causes seizures in patients and is a serious health problem, if not treated well then it can be fatal. The illness is characterized by aberrant neuron discharges or hyperexcitability of neurons with synchronization. Three subtypes comprise the pathology-focal ie starting from one part of the brain, generalized when the whole brain starts firing and unclassified when the sparking point is not clear.

There are various brain chemicals- neurotransmitters such as glutamate, GABA, and acetylcholoine involved in normal brain functioning. Some of them are excitatory and some are inhibitory in nature.  Normally there is a balance in these chemicals. Seizures happen when there is an imbalance with excessive  excitation or reduced inhibition 

What is Epilepsy?

Epilepsy affects a person’s brain and causes recurrent seizures at random times. There are different kinds of epilepsy, and its causes are sometimes unknown, but that is not the case for most epileptic individuals. One seizure does not indicate that one has epilepsy; however, when two unprovoked seizures occur at least a day apart, epilepsy is diagnosed by a doctor.

All parts of your body transmit and receive messages to and from the brain's cells, and a constant electrical impulse that moves from cell to cell transmits these messages. This periodic electrical impulse pattern is disturbed by epilepsy in one or more regions of your brain, and there are also electrical energy bursts between cells that resemble an erratic lightning storm. Your awareness, emotions, and muscular actions are all altered by this electrical disturbance.

People of various ages and genders are affected by epilepsy, and the epilepsy symptoms might differ greatly depending on the individual. While some people do not lose consciousness during a seizure, many patients do. Some people may have convulsions, which are characterised by jerky movements of the arms or legs.

Pathophysiology of Epilepsy 

The complex pathophysiology of epilepsy and seizures can explain the wide variety of seizure disorders. When you have epilepsy, a disturbed balance between excitatory and inhibitory happens at the synaptic level, which can lead to seizure activity and is a commonality across all types of epilepsy. 

Early pharmacological research showed that normal people might experience seizures when exposed to GABA-receptor and glutamate-receptor agonists, and subsequent research shows that the interictal spikes that are frequently seen on EEG recordings from individuals with epilepsy are linked to a significant depolarization and subsequent burst of impulses in individual neurons. 

When scientists explain the pathophysiology of epilepsy, they mention that the cortical tissue's highly ordered structure, which includes layers of laminar cells, promotes proper neuronal processing. Still, it is particularly vulnerable to aberrant synchronous activity, which can cause seizures. 

Normally, inhibitory interneurons closely regulate excitatory synaptic activity. However, various stressors, including genetic mutation, trauma, and others, can upset this regulation, making cortical networks hyperexcitable. Approximately sixty percent of epileptic patients have partial epilepsies, which manifest clinically as any partial episode.  

Partial epilepsies have a wide range of etiologies, such as acute cerebral injury from trauma, tumors, and cortical lesions. As medical advancements enable people to survive more severe injuries that would have been deadly in past generations, trauma-induced epilepsy is becoming a bigger problem. Tumor formation or partial epilepsies causing cortical abnormalities may also be influenced by genetics, and that is explained in the pathophysiology.

Seizure Phases 

There can be three phases of seizures- the onset, middle, and end phase. 

• Prodrome: Prodrome is not a part of the seizure itself but is the first indication that one may happen. People may get an indescribable impression that a seizure could occur during the prodrome, and they could also exhibit behavioral changes. This may occur in the few hours or days preceding a seizure, and there may be an aura during the prodrome period. 
• Aura-An aura may manifest as symptoms such as deja vu or the sensation that a person or location is familiar, or it may manifest as an unfamiliar experience. Alternatively, people might sometimes experience odd sensations, like dread, panic, or even positive emotions. Other possible symptoms include stomach discomfort, abnormal throat sensation, fear, hearing noises, distorted vision, racing thinking, headache, tingling, numbness, or dizziness.
• Ictal: The ictal phase is called the middle part of a seizure, and the period from the start of the seizure to its conclusion is described by the ictal phase.  
• Postictal: This is the recovery time following a seizure, and hours might pass during the postictal period. While some people heal fast, others need more time, and the kind of seizure and the area of the brain that causes the seizure determine how long the postictal period lasts. People may experience memory problems, be sluggish to react, have difficulty speaking during this phase, and they might also have drowsiness, confusion, vertigo, fear, weakness, and anxiety.

Types of Seizures

Doctors routinely reclassify seizure categories due to the wide variation in seizures, but they often fall into one of two main categories- partial (or focal) seizures and generalized seizures. A massive electrical discharge affecting both sides of the brain simultaneously is the first sign of generalized seizures, and an electrical discharge in a single, constrained region of the brain causes partial seizures. 

Generalized epilepsy is the term used to describe epilepsy in which seizures start simultaneously on both sides of the brain. Compared to partial epilepsy, where seizures originate from a specific area of the brain, generalized epilepsy is more likely to involve genetic elements, meaning that hereditary factors play a significant role. Though the etiology of most partial seizures is unclear, some can be linked to tumors, brain infections, and head injuries.  

Epilepsy Treatment  

Antiepileptic drugs, nutrition therapy, and surgery are available for epilepsy treatment. Almost all patients with multiple seizures begin therapy with medications. Still, medication may not be necessary for certain people who have just had one seizure, and testing does not show a high probability of a seizure recurrence. Instead of treating the underlying cause of epilepsy, the drugs address its seizure symptoms. Patients with certain types of epilepsy may also benefit from diet treatment, and the modified Atkins diet and the ketogenic diet are the two most popular diets.

If the epilepsy treatment with medication fails, the best chance of total seizure control is with surgery, but it is not a good option for every patient with refractory epilepsy. The epilepsy-causing area needs to be located in a section of the brain that is unlikely to cause serious neurological problems if removed during surgery. Extensive testing is used to identify whether or not patients may benefit from surgery and whether it is safe for them. 

Final Remarks

Epilepsy is a neurological condition that affects around sixty million individuals globally and is mostly brought on by an imbalance in excitatory and inhibitory neurotransmission, which results in abnormally synchronized firing of neural populations. Chronic epilepsy is a long-term condition characterized by recurrent seizures brought on by aberrant electrical impulses generated by damaged brain cells. A seizure may cause modifications to your consciousness, sensations, behaviour, and motor control, but for the majority of epileptics, treatment with medications or occasionally surgery may manage seizures. For some people, therapy must last a lifetime; however, for others, the seizures can be stopped