Epilepsy is a neurological condition characterised by a history of two or more seizures. Seizures are acute episodes during which there is a surge of uncontrolled electrical activity in the brain.
Epilepsy affects approximately 50 million people across the globe, with 2.4 million new cases being diagnosed each year1.
Many types of Epilepsy are associated with cognitive impairment2. In addition, Epilepsy can severely affect an individual’s quality of life and ability to function. People with seizures are at increased risk of psychological conditions such as depression and can experience physical consequences such as bruising and bone fractures.
The total direct and indirect cost of Epilepsy per year is estimated to be $15.5 billion in the USA3; the equivalent figure for the United Kingdom is in excess of £2 billion per year4.
Pathology and functional impact of Epilepsy
Seizures are due to excessive discharge of electrical activity in groups of brain cells, with the precise symptoms being dependent on the ‘spread’ of inappropriate electrical activity and the regions affected.
In the majority of cases, there is no identifiable cause of Epilepsy and so it is termed ‘idiopathic’ or primary. When causes can be identified, this is referred to as secondary epilepsy.
Secondary epilepsy can be caused by brain damage (e.g. due to stroke, trauma, or perinatal complications), infections of the brain, malignancies of the brain, and certain genetic conditions1.
A meta-analysis has shown there is evidence for cognitive impairments in multiple types of Epilepsy with medium to large effect size2.
Limitations in the existing cognitive research commonly includes overlooking the possible contribution of comorbid conditions (e.g. depression), and failure to use standardised, comprehensive cognitive assessment tools2.
Research and development in Epilepsy
Because Epilepsy exists in many forms, and can be mistaken for other disorders, investigation and treatment should be undertaken by specialists.
Physical investigation should be conducted including mental state, cardiovascular, and neurological examinations. Further investigations are used under particular circumstances, such as the use of electroencephalogram (EEG), brain imaging (magnetic resonance imaging, MRI), and/or a 12-lead electroencephalogram (ECG/EKG). The assessment may also include referral for a neuropsychological assessment especially where cognitive impairment or learning disabilities are suspected.
For confirmed Epilepsy, a comprehensive treatment plan should be formulated, which can include anti-seizure medication. Examples of medications used in some types of Epilepsy include carbamazepine, lamotrigine, and sodium valproate.
The main aims of Epilepsy treatment are to minimise seizure frequency and severity, and to minimise the functional impact of the condition.
Cognitive problems are common in people with several types of Epilepsy. Evidence-based treatments specifically targeting these cognitive problems are needed, and many clinical trials are yet to thoroughly assess the effects of pharmacological interventions on cognition in people with Epilepsy5.
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Loughman A., et al (2014). Cognitive functioning in idiopathic generalised epilepsies: a systematic review and meta-analysis. Neurosci Biobehav Rev.
Cross J.H., (2010). Neurodevelopmental effects of anti-epileptic drugs. Epilepsy Res.
Palade S., and Benga I., (2007). Neuropsychological Impairments on the Cantab Test Battery: Case Reports of Children with Frontal and Temporal Lobe Epilepsy. Cognition, Brain, Behavior.
Gutierrez-Galve L., (2012). Cortical abnormalities and their cognitive correlates in patients with temporal lobe epilepsy and interictal psychosis. Epilepsia.
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- World Health Organization. Epilepsy. Fact Sheet Number 999, May 2015.
- Loughman A, Bowden SC, D'Souza W. Cognitive functioning in idiopathic generalised epilepsies: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2014 Jun;43:20-34.
- Centers for Disease Control and Prevention, USA. Epilepsy Fast Facts, 2015.
- Cockerell OC, Hart YM, Sander JW, Shorvon SD. The cost of epilepsy in the United Kingdom: an estimation based on the results of two population-based studies. Epilepsy Res. 1994 Jul;18(3):249-60.
- Cross JH. Neurodevelopmental effects of anti-epileptic drugs. Epilepsy Res. 2010 Jan;88(1):1-10.
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