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A epilepsy It is a chronic neurological disease characterized by the occurrence of recurrent epileptic seizures – which leads to neurobiological, cognitive, psychological and social consequences.
It is estimated that it affects 1 to 3% of the world’s population, and that in developing countries this figure can reach 2%. In Brazil, it is believed that between 1.8 and 3.6 million people live with epilepsy.
The cause of the disease is variable, which may be congenital or acquired. In some cases, the origin is unknown.
Epileptic seizures occur due to a excessive electrical discharge of a group of nerve cells (neurons) located in a given region of the brain. These episodes are initially classified as focal or generalized.
As focal crises are those that originate in a limited region of a cerebral hemisphere. They can generate (or not) alteration of consciousness or alertness.
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As generalized crises are those that originate somewhere in the brain and quickly spread, reaching both cerebral hemispheres at the same time.
What happens during the crisis
The clinical manifestations of epileptic seizures are variable, because depend on the region where this discharge is located and propagates.
Thus, they can present themselves in different ways: they can be quick or prolonged; with or without alteration of consciousness; with motor, sensory or sensory symptoms; single or in salvos; exclusively awake or during sleep; preceded or not by aura (sensation reported by the patient).
How epilepsy is treated
The treatment of epilepsy is basically done with medicinesanti-seizure drugs.
The choice of the appropriate medicine depends on many factors, which involve the characteristics of the epileptic seizures and also the patient.
New drugs have been launched recently, leading to the need for constant updates. Are they based on modifying already existing molecules or are they really new molecules.
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Some perform better in terms of efficacy and/or tolerability.
In view of this, the Brazilian Society of Child Neurology, the SBNI, should review this topic in September 2023, at its 230th Congress.
With seizure control, it is expected that the person with epilepsy will have a life with as few restrictions as possible.
However, due to the risk of life offered, some activities should be avoided, especially at the beginning of treatment. In general, extreme sports such as flying, skydiving, hang gliding, mountaineering, diving, surfing and motor sports may be contraindicated.
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Swimming is allowed, especially if epileptic seizures are controlled, and preferably under individual supervision.
When epileptic seizures cannot be controlled with two drugs at maximum doses, epilepsy is considered refractory.
Adults and children with refractory epilepsy should be referred to specialized epilepsy centers to evaluate the possibility of other therapies, including surgical treatment.
*Maria Luiza Manreza is a supervising physician at the Child Neurology Service at Hospital das Clínicas de São Paulo and President of the Brazilian Society of Child Neurology.
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