Jeannette Y. Wick, RPh, MBA, FASCP
Epilepsy can be extremely challenging, but effective treatments are available and pharmacists can play an important role in counseling patients.
Complex. Neurologic. Recurrent. Amazingly common. Concurrently psychological, social, and biologic.
That’s epilepsy, or seizure disorder, and this is the inaugural post for the Pharmacy Times
Epilepsy Condition Center. Epilepsy is a neurologic disorder that causes sudden bursts of intense electrical activity in the brain, which can result in seizures. Researchers at Columbia University in New York estimate that approximately 12 million Americans—1 in 26—will develop epilepsy in their lifetimes. This is larger than previous estimates, and reflects the increasing number of older Americans, in whom the rate of epilepsy is highest. The very young are also at elevated risk.
“Epilepsy is a common, serious neurologic disorder with a major impact on public health and therefore deserves the best public health response directed by timely high-quality surveillance data,” Edwin Trevathan, MD, MPH, dean of the School of Health at Saint Louis University in Missouri, wrote
last year in Neurology
. “Until we have good national epilepsy surveillance data informing our direction, public health authorities must do their best to help people with epilepsy while flying blind.”
Our goal is to keep you thinking, reading, and learning about epilepsy in its several forms—dictated by the affected brain area. To start, let’s review:
70% of epilepsy patients have the focal variety, which involves damage to a small part of the brain. It may be partial (the patient remains aware during the seizure) or complex (the patient loses consciousness). Most of these patients experience aura before a seizure.
The remaining 30% have primary generalized epilepsy with full brain involvement. This form has several subtypes, including tonic-clonic, tonic, atonic (drop seizures), and absence seizures. These seizures generally occur without warning.
Epilepsy may result from brain damage during birth, head injury, infection (especially meningitis), vascular disease (especially in elders), or genetic brain disorders.
Epilepsy patients have a risk of dying 2 to 3 times higher than the general population. In epilepsy’s early stages, death may be related to the condition’s underlying cause. In chronic epilepsy, death during a seizure, or sudden unexpected death in epilepsy (SUDEP
), is more likely. SUDEP occurs most often in younger patients, in those with higher seizure frequency, and at home. As the name suggests, its cause is unknown. The incidence of SUDEP has been estimated to range from 0.09 per 1000 patient-years in newly diagnosed patients to 9 per 1000 patient-years in candidates for epilepsy surgery.
Adjusting to life with active epilepsy can be difficult, but approximately 70% of patients can become seizure-free with treatment. Epilepsy affects quality of life, with comorbid depression occurring in about two-thirds of patients and social isolation a frequent concern. Many people with epilepsy have trouble connecting with others, engaging with society, and finding meaningful work. Additionally, social isolation increases risk for all types of health problems. Helping patients with epilepsy, particularly those who have recalcitrant seizures, maintain or regain emotional well-being and life satisfaction should be a key focus for pharmacists. Good medication management must be supplemented with coping strategies, non-medical support, and effective community engagement.
Social stigma is another concern for epilepsy patients. The lay population and some clinicians still do not understand seizures, may believe people with epilepsy cannot drive, and may hesitate to offer them work, fearing “convulsions” or erratic behavior in the work place. Consequently, many people with epilepsy choose to conceal their disease, even if it is mild and controlled. It is important to help dispel these myths.
Patients with epilepsy need frequent medication review; regular discussion about possible or real adverse drug reactions; information on safety issues relating to epilepsy; and encouragement to stay adherent to antiepileptic drugs. We hope that this Condition Center will help you understand epilepsy better, and help us bring the stand of care to a higher level.
Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.