The World Health Organization (WHO) has recently updated its fact sheet on epilepsy.

Background Information:

Epilepsy is a chronic noncommunicable disease of the brain that is characterized by recurrent seizures, which are brief episodes of involuntary movement that may involve a part of the body (partial) or the entire body (generalized) and are sometimes accompanied by loss of consciousness and control of bowel or bladder function.

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.

Causes:

Epilepsy is not contagious. 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.

Prevention:

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. measures to prevent or control high blood pressure, diabetes and obesity, and the avoidance of tobacco and excessive alcohol use.
• Central nervous system infections are common causes of epilepsy in tropical areas, where many low- and middle-income countries are concentrated. Elimination of parasites in these environments and education on how to avoid infections can be effective ways to reduce epilepsy worldwide, for example those cases due to neurocysticercosis.

Key Messages:

Around 50 million people worldwide have epilepsy, making it one of the most common neurological diseases globally.

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 5 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. Nearly 80% of people with epilepsy live in low- and middle-income countries.

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.

Three quarters of people with epilepsy living in low-income countries do not get the treatment they need.

It is estimated that up to 70% of people living with epilepsy could live seizure- free if properly diagnosed and treated. Discontinuing anti-seizure medicine can be considered after 2 years without seizures and should take into account relevant clinical, social and personal factors.

In many parts of the world, people with epilepsy and their families suffer from stigma and discrimination. People with epilepsy can experience reduced access to educational opportunities, a withholding of the opportunity to obtain a driving licence, barriers to enter particular occupations, and reduced access to health and life insurance. In many countries legislation reflects centuries of misunderstanding about epilepsy, for example, laws which permit the annulment of a marriage on the grounds of epilepsy and laws that deny people with seizures access to restaurants, theatres, recreational centres and other public buildings.

Useful Links:

Link to the updated WHO fact sheet:

https://www.who.int/news-room/fact-sheets/detail/epilepsy

Link to WHO video on epilepsy:

https://youtu.be/SshVn6MUGxA