Epilepsy ranks among the primary disorders of the brain, along with Alzheimer’s disease and depression. In 2017, an estimated 3 million adults and 470,000 children in the United States were diagnosed with epilepsy.
Globally, an estimated five million people are diagnosed with epilepsy each year. According to the World Health Organization (WHO), the clinical definition of epilepsy requires a patient to have recurrent seizures at least 24 hours apart.
The seizures experienced may involve a partial area of the brain (focal) to the entire body (generalized). Based on studies, people with epilepsy have poorer overall health status, impaired intellectual and physical functioning, a greater risk for accidents and injuries, and higher rates of psychological conditions, including anxiety and depression.
The intermittent clinical features of seizures are often dramatic and alarming, and frequently induces fear, misunderstanding, and social stigma. This in turn has led to profound social consequences for sufferers, which has greatly added to the burden of this disease.
Epilepsy is such an “ancient disorder”. In fact, ancient people believed that epileptic attacks were manifestations of evil and supernatural possession over the human body. Back then, it is thought that exorcism and other religious mechanisms can drive away the evil spirits causing epileptic attacks. Fortunately, remarkable progress was made in epilepsy diagnostic facilities and treatment through structural and functional neuroimaging.
Managing and treating epilepsy can be challenging for both patients and caregivers. For many patients, the initial challenge to optimizing care includes having a correct diagnosis, and gaining access to skilled neurologists and equipped hospitals. It is important to keep in mind that the treatment plan designed by neurologists and specialists is in the ultimate goal of having a normal lifestyle.
For the majority of patients, the administration of anti-epileptic drugs (AEDs) therapy is the mainstay of treatment. Patients newly diagnosed with epilepsy are often given a single AED e.g clobazam which can control their seizures up to 60%. Pharmacists can contribute to tailoring the AED to the patient’s health conditions.
In some instances, medical experts and parents resort to using cannabidiol (CBD) oil, an FDA-approved product for the treatment of seizures associated with Lennox-Gastaut syndrome or Dravet syndrome. CBD oil is derived from cannabidiol, one of the active cannabinoids found in cannabis plants. Unlike the other components, CBD does not have cannabinoid receptor-independent mechanisms associated with psychoactive properties and therefore has minimal psychoactive properties.
Holistic care of epilepsy patients should be provided by a multidisciplinary team. The primary care doctor is responsible for initial evaluation of all patients presenting with a suspected seizure and for subsequent follow-up. A specialist consultation is generally required to make the qualified diagnosis, to identify seizures and syndromes, and to formulate a management plan.
An epilepsy nurse specialist offers the patient warm counselling and health education. If the epilepsy is not controlled with the first two or three AED regimens, patients should be referred to a specialist center for assessment of their suitability for alternative treatment modalities, such as epilepsy surgery. Non-pharmacological strategies are primarily reserved for drug-resistant epilepsy.