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Chapter 13. Epilepsy

The term “epilepsy” (from the Greek “epilepsia” — a contraction, a convulsion, a seizure) was introduced by an ancient Greek doctor Hippocrates (460–370 BC) in 400 BC as a designation of a special brain disease characterized by seizures (attacks).

Epilepsy is a chronic brain disease that occurs with repeated, two unprovoked epileptic seizures. The main symptom of epilepsy is considered to be epileptic seizures (paroxysms). Symptoms of epilepsy are unprovoked seizures, but most people can have provoked seizures (febrile seizures, alcohol-dependent seizures, etc.) without a predominant pathology of the CNS.

In December 2013, the Executive Committee of the International League Against Epilepsy (ILAE) adopted the official position of the ILAE regarding the working definition of epilepsy for clinical diagnosis. According to this definition, epilepsy is considered a brain disease that meets the following criteria:

  • at least two unprovoked (or reflex) epileptic seizures with an interval of more than 24 hours;
  • one unprovoked (or reflex) seizure and the probability of recurrence of seizures close to the overall risk of relapse (≥60%) after two spontaneous seizures in the next 10 years;
  • diagnosis of epileptic syndrome.

Epileptic seizure is the clinical manifestation of paroxysmal discharges in the neurons of the brain, which occur as a result of excessive neural activity; they are accompanied by various clinical and paraclinical manifestations, that is this condition predisposes to repeated seizures due to CNS dysfunction.

Seizure is a sudden involuntary, short-term change in behavior, including changes in motor activity, autonomic functions, consciousness or sensitivity, accompanied by abnormal electrical activity of the brain.

An epileptic seizure is a clinical manifestation of abnormal excessive neuronal activity of the brain in the form of paroxysms (events), which may significantly vary by their clinical presentation.

It is important to note that the appearance of “provoked” or situationally conditioned epileptic seizures (for example, in the acute period of TBI, stroke) is regarded as provoked and is not considered epilepsy as such.

Epilepsy is one of the most common diseases of the nervous system. The incidence is 50–70 per 100,000 population per year, the prevalence is 5–10 per 1000 population. The incidence is highest in children and the elderly. Approximately 5% of the population suffers one seizure or more during their lifetime.

According to the results of population studies conducted in industrialized countries, the incidence of epilepsy in different age groups ranges from 28.1 to 53.1 per 100,000 population. In developing countries, the prevalence of epilepsy varies from 3.6 per 1000 people in Bombay to 40 per 1000 in rural Nigeria. In different countries of the world, there are significant differences in the quality of medical care for patients with epilepsy. That is why the ILAE Commission on European Affairs has formulated uniform requirements for the level of medical care for all European countries. According to the World Health Organization, the lack of proper epidemiological information in many countries causes significant shortcomings in the organization of medical care. Thus, more than 75% of 40 million patients with epilepsy in the world receive no adequate treatment.

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