THEEpilepsy is a neurological disease that it affects millions of people. Despite its incidence, however, it still carries with it stigma, diagnostic confusion and management challenges, especially for women and in crucial periods such as pregnancy. The February 9th World Epilepsy Day is celebratedan opportunity to inform, dispel prejudices and spread knowledge about one of the most widespread neurological conditions in the world.
Epilepsy: what is it
According to the Italian Epilepsy Federation this disease can be considered as a set of neurological conditions characterized by a permanent predisposition to generate epileptic seizures due to an abnormal electrical discharge of neurons in the brain. Seizures can manifest themselves in very different ways: from generalized convulsions with loss of consciousness to brief lapses in attention or isolated movements. According to theWorld Health Organization (WHO), approx 50 million people in the world live with epilepsymaking it one of the most frequent neurological diseases. In Italy it is estimated that between 500,000 and 600,000 people are affected by epilepsy, with approx 36,000 new cases diagnosed each year. The disease can appear at any agewith a peak onset in the first years of life and another in older ages. The onset of epilepsy is greater in those under 25 and over 65 years of age. This data takes on a significant value and social relevance, as it indicates a greater prevalence in the most delicate and vulnerable age groups.
Prevention and treatment
Contrary to what many still think, epilepsy it is not a psychiatric illness but one neurological condition well defined and diagnosable through clinical and instrumental tests such as the electroencephalogram. «This disease has often been confused with a psychiatric condition, which leads many people to a sense of shame, a legacy that is unfortunately still present. Sometimes prejudice, with its consequences, is stronger than the disease itself. Yet today, in about the 70% of cases, Adequate pharmacological treatment allows seizures to be controlled and ensure a good quality of life. In the 30% of patients with drug-resistant formsthere are more complex therapeutic approaches, including new drugs, brain stimulation, or specific surgeries. Starting the surgical process is difficult because there are few centers in Italy, but it is a precious possibility because it is often decisive, these cases must be identified as soon as possible”, explains the Doctor Vincenzo BelcastroCoordinator of the Epilepsy study group SNO and Director Complex neurology operating unit at the Maggiore Hospital in Lodi.
Epilepsy in women: managing pregnancy
A crucial issue concerns the management of epilepsy in womenparticularly during pregnancy. Seizures and antiepileptic drugs can affect gestational outcomes, but thanks to International registries on pregnancy in women with epilepsy today we have important data to guide clinical choices and reduce risks. «The data deriving from EURAP register have made it possible to identify which antiepileptic drugs (such as valporate) are associated with an increased risk of congenital malformations and therefore their use is evaluated with caution in women of childbearing age. On the contrary, drugs such as lamotrigine and levetiracetam appear to have more favorable risk profiles. Today we prefer that women with epilepsy during pregnancy are followed by a multidisciplinary team which includes neurologist, gynecologist and endocrinologist, to optimize maternal and fetal health. An approach that until a few years ago was not standard of care”, continues Belcastro.
Epilepsy between stigma and prejudice: a still open battle
Despite scientific advances, epilepsy is surrounded by social prejudices which weigh on the daily lives of people affected by it. According to theItalian Epilepsy Association in Italy, investigations have shown that many patients fear discrimination and feel judged or “different” if others discover their condition, a cultural legacy that persists even though knowledge of the disease has grown in recent years. The Global Action Plan on Epilepsy and other neurological disorders adopted by the WHO aims precisely to reduce stigma, improve care and increase public awareness.
Italian centers of excellence and global impact
In Italy they exist specialist neurology centers for epilepsy, for both children and adults, who collaborate nationally and internationally in research and clinical treatment. These structures deal with complex cases, conduct clinical studies and promote multidisciplinary management paths. Several scientific societies are at the forefront for study the pathology, share the results of diagnostic approaches, promote the spread of awareness and reduce prejudice about the disease. Objectives also pursued by SNO Hospital Neurological Sciences, company which also coordinates a dedicated study group and promotes scientific, informative initiatives and guidelines.
Epilepsy: a look into the future
Epilepsy is not a single disease, but a set of very different conditions. This is why today research is increasingly pointing towards personalized therapiesbuilt on the specific characteristics of each person with epilepsy. The scientific landscape is rapidly evolving and in recent years new avenues are opening up that go beyond the traditional pharmacological approach. Looking to the future, Artificial intelligence and machine learning algorithms will play a central role. These tools can analyze large amounts of clinical data, such as electroencephalograms or genetic information, to identify recurring patterns, predict response to treatments, and improve diagnosis. The integration of AI with systems “closed loop” neurostimulationcapable of recognizing a crisis in real time and intervening by modulating brain activity, could significantly improve seizure control and quality of life of people with epilepsy.
«Beyond the tools that science will make available to us, it is important to continue to fight prejudice. A change of pace could take place disseminating information in schools given that epilepsy is very widespread among children. I hope that in the school process we can provide a moment dedicated to illnesses so that from childhood children learn to know them and consider them as part of their life journey, avoiding isolation and stigma”, concludes the Doctor Vincenzo Belcastro.
