EDITORIAL
Epilepsy is a complex circuit disease with a cure
La epilepsia es una enfermedad compleja de circuitos con
cura
1Department of Neurology, National Institute of
Neurology and Neurosurgery, Mexico City, Mexico
According to the World Health Organization, 50 million people were diagnosed with
epilepsy until year 2017. About 90% of these were in under-served communities1. Although the global burden of disease in Latin
America has decreased by 20%, mortality has risen in the past 20 years2. The main factors related to this increase in
mortality and burden (mostly in the elderly) were found to be secondary to alcohol
consumption and under-development. Although epilepsy is quite common, it is not uncommon
that physicians fail to recognize it and promptly treat it. Most importantly, although
its visibility has increased, the possibility of surgery is still thought of as a last
resort3. If anyone needs convincing, the
number of patients needed to treated with surgery for one additional patient to be
seizure free is two4. This finding is a rarity in
neurology practice!
Although classifications in epilepsy have changed a myriad of times over the years,
clinical manifestations have not5. One of the
pitfalls of epilepsy surgery is the complexity of its propagation patterns. For
instance, Jimenez-Ruiz et al. depicts distinct manifestations in epilepsia partialis
continua (continuous focal epilepsy according to new nomenclature)6 associated with a single pathology, stroke, in a case series.
Stroke is strictly anatomical and follows this anatomical location. We know that
stroke-related epilepsy may often lead to mesial temporal sclerosis, even though the
lesional zone is far away anatomically7.
Epilepsy is a complex network disease8. The most
common type of epilepsy, temporal lobe epilepsy, is characterized by a complex
extratemporal network involving not only the mesial and neocortical regions but also
extratemporal regions. Often, the symptomatogenic zone may be farther away from the
epileptogenic zone9. In fact, in temporal lobe
epilepsy, the seizure onset may arise from structures interconnected within the temporal
lobe or other regions simultaneously10.
Understanding this concept is key to achieve seizure freedom.
References
1. ATLAS Country Resources for Neurological Disorders. Available
from:https://www.who.int/publications-detail-redirect/atlas-country-resources-for-neurological-disorders
[Last accessed on 2024 Jan 24].
[ Links ]
2. Pacheco-Barrios K, Navarro-Flores A, Cardenas-Rojas A, de Melo
PS, Uygur-Kucukseymen E, Alva-Diaz C, et al. Burden of epilepsy in Latin America
and The Caribbean:a trend analysis of the global burden of disease study 1990 -
2019. Lancet Reg Health Am. 2022;8:100140.
[ Links ]
3. Berg AT, Langfitt JT, Cascino GD. The changing landscape of
epilepsy surgery:no longer the “last resort.“Neurology.
2018;91:55-6.
[ Links ]
4. Jette N, Reid AY, Wiebe S. Surgical management of epilepsy. CMAJ.
2014;186:997.
[ Links ]
5. Wolf P. History of epilepsy:nosological concepts and
classification. Epileptic Disord. 2014;16:261-9.
[ Links ]
6. Fisher RS, Cross JH, French JA, Higurashi N, Hirsch E, Jansen FE,
et al. Operational classification of seizure types by the International League
Against Epilepsy:position Paper of the ILAE Commission for Classification and
Terminology. Epilepsia. 2017;58:522-30.
[ Links ]
7. Arévalo-Astrada MA, McLachlan RS, Suller-Marti A, Parrent AG,
MacDougall KW, Mirsattari SM, et al. Epilepsy surgery in stroke-related
epilepsy. Seizure. 2021;88:116-24.
[ Links ]
8. Mahoney JM, Mills JD, Muhlebner A, Noebels J, Potschka H,
Simonato M, et al. 2017 WONOEP appraisal:studying epilepsy as a network disease
using systems biology approaches. Epilepsia. 2019;60:1045-53.
[ Links ]
9. Peng SJ, Chou CC, Yu HY, Chen C, Yen DJ, Kwan SY, et al. Ictal
networks of temporal lobe epilepsy:views from high-frequency oscillations in
stereoelectroencephalography. J Neurosurg. 2018;131:1086-94.
[ Links ]
10. González Otárula KA, Schuele S. Networks in temporal lobe
epilepsy. Neurosurg Clin N Am. 2020;31:309-17.
[ Links ]
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