Epilepsy is a disease that is not only characterized by seizures but also includes aspects of psychiatric and cognitive impairment. It is unfortunate that no treatment exists for treating these serious symptoms. It is not clear what causes seizures and those that are due to processes that are separate and related to ictal activity. The non ictal and ictal changes in epilepsy are influenced by molecular and cellular mechanisms that are responsible for synaptic modulation. Recent development in medicine mainly focuses on identifying and recognizing the extent and nature of ictal activity. It is possible that the underlying patterns of psychiatric and cognitive impairment will soon be identified and dealt with. The paper attempts to show the main causes of epilepsy and its accompanying symptoms. It also deals with other cognitive and psychiatric disorders that are associated with epilepsy and how measures need to be taken to deal with such disorders.
This disease can be compared to autism which is also a spectrum disorder. This is because it is multifaceted and multifactorial in nature whose severity varies from one individual to the other. The field of medicine and psychology has drawn parallels between epilepsy and other behavioral, cognitive, psychiatric, and neurological disorders including sudden death. Medical evidence indicates that the underlying causes of epilepsy directly contribute to psychiatric, cognitive and other impairments that are related to epilepsy. The evidence further shows that seizures are highly responsible to the behavioral and cognitive disorders found in epilepsy.
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The epileptic condition is characterized by a high frequency of seizures even though it exists within the range of other disorders. Clinical care mostly concentrates on seizures but care should be taken to take note of other cognitive and behavioral disorders which might be more serious to the patient and his family. Nearly 50% of all epilepsy patients have some form of psychiatric and or cognitive problems. The best approach of treating and managing epilepsy needs to have a clear understanding of the relationship between epilepsy and the other existing disorders.
Literature Review
Data on epilepsy indicate that the balance between network inhibition and excitation in the nervous system is disrupted which directly or indirectly enhances the excitatory synaptic composition (Rakhade & Jensen, 2009). The glutamate regulator has been identified as the primary regulator that is responsible for memory and learning. This means that a dysregulation of this regulator might have an effect on cognition and learning. Recent findings indicate that ital. activity has the ability to impair learning and cognition (Kleen et al., 2010). One of the most common forms of adult epilepsy is the Temporal Lobe Epilepsy (TLE) which can be worsened by psychiatric disorders and memory deficit. This is the reason patients develop epilepsy attacks when they are depressed (LaFrance et al., 2008). In this instance, depression becomes the most dominant feature in chronic epilepsy. Most antidepressant therapies are mainly focused at regulating the levels of serotonin to body networks which cause depression.
It is also good to note that seizures are also as a result of local serotonin depletion which further contributes to depression. This type of depletion can also cause sudden death to an epileptic patient. It is during the period of brain development that seizures can affect cognitive functions. This is because this is the period when synaptic plasticity is at its peak when the excitatory mechanism becomes dominant (Rakhade & Jensen, 2009). This leads to a situation where there is excessive neuronal activity.
Early life epilepsy has considerable effects on cognition. One can experience infantile spasms to a normally developing child after only a few weeks. This can lead to neurocognitive impairment as well as developmental delay (Goh et al., 2005). This condition can continue in later childhood in the form of mild seizures of benign rolandic epilepsy. This condition leads to higher levels of learning deficits in comparison to the average levels there is a close association between epilepsy and autism such that nearly 40% of patients with autism have epilepsy. Autism, in this case, exhibits a close relationship between epilepsy and cognitive development. Epileptic incidences are at their peak during infancy and early childhood as compared to later stages of life. This age represents a critical period when synaptogenesis and synaptic plasticity are their peak (Rakhade & Jensen, 2009). Autism and epilepsy are as a result of a deregulated synaptic development. When both these conditions occur at the same time, they are thought to a consequence occasioned by the inhibition of synaptic functions caused by gene mutation or injury. Studies have not revealed whether incidences of epilepsy contribute to the autism condition.
Brain development heralds a period when synaptic functions are fluid. When this process is inhibited it can lead to early cognitive problems or epilepsy, in extreme cases. An immature brain registers high prevalence of epilepsy due to an increase in synaptic tone. Epilepsy, autism, and normal brain development are all involved in the same synaptic process and this can be useful in the creation of new therapies. However, it is not obvious that epileptic incidences will necessarily lead to autism. Both of these conditions occur at the same time due to genetic disorders such as tuberculosis sclerosis complex which is caused by genetic mutation. This condition causes functional and structural neuronal deficits which impair network development and function. Nevertheless, there are other autism abnormalities that disrupt plasticity which are modified by seizures.
Patients with epilepsy also experience a high prevalence of a wide range of psychiatric disorders. These include a variety of personality disorders, depression and anxiety as well as mood and effect disorders. Epileptic patients can also be diagnosed with increased cases of schizophrenia and paranoia as compared to other individuals in society. Schizophrenia and epilepsy exhibits signs of hippocampal and temporal lobe atrophy. In addition to that, patients with schizophrenia and TLE also suffer from auditory hallucinations. Recent studies have shown a certain coincidental occurrence of epilepsy in dementia. In addition to that, there have been incidences where patients suffering from Parkinson’s disease and AD have exhibited increased incidences of epilepsy (Palop & Mucke, 2009). Findings from these studies indicate a high prevalence of epilepsy among the elderly (Beghi et al., 2010). Also, patients with AD exhibited higher rates of epileptiform abnormalities which were highly focal and not generalized. However, it is not known whether seizures can increase the likelihood to accelerate the development of neurodegeneration or if anticonvulsants can regulate neurodegenerative processes.
The field associated with epilepsy has been undergoing a comprehensive transformation in the recent past in relation to diagnostic technology. Patients with various forms of epilepsy are currently undergoing a series of surgeries including neuroimaging, neurophysiologic, and other tests. These tests include processes such as EEG, MRI, SPECT, and PET, among others. Nevertheless, these techniques are mainly focused at identifying a certain activity focus but not in assessing cognitive disorders which usually co-occur with epilepsy. The best thing to do for these patients is to ascertain whether there exists biomarkers which are related to these disorders which are associated with epilepsy. It is in this regard that the field of informatics become useful in gathering data from various sources and merging them to examine the patient’s brain “connectome” (Sporns et al., 2005; Hagmann et al., 2010). This technique deals with the evaluation of network connectivity and integrates MRI with Diffusion tensor imaging (DTI) as well as Structural Imaging (Hagmann et al., 2008). Data from neurophysiologic activity can also be superimposed to provide a greater resolution than that produced by MRI. The multidisciplinary data that is produced in this process is able to disclose functional and structural relationships that are found in the network. The data can also produce connectivity maps showing different brain areas which are graphically represented by nodes including their strengths which are displayed by the thickness of the lines representing the nodes. This technique as the ability to assess brain connectivity in a comprehensive manner and also combine and integrate several modalities including clinical observations of neurophysiological, neurobehavioral, and genomics, among others. Moreover, it has the ability to examine and assess neurophysiologic activity at a much higher frequency than was the case in the past. Higher frequency oscillations and its relationship with neuropsychiatric symptoms in epileptic patients has hitherto not been properly investigated. Once this relationship is known, it might have the potential of acting as a biomarker. Its power as a brain functions assessor makes it possible for data to reveal meta- patterns of the functioning and dysfunction of the brain. This has the ability to redefine neurologic disease by showing differences and similarities between various disorders. With respect to epilepsy, this technique can produce new data that is important in analyzing temporal and spatial relationships of network dysfunction to other epileptic conditions.
Discussion
Epilepsy is a condition that has much relevance in the bible. Temporal lobe epilepsy was first recorded in the Bible before it was scientifically diagnosed. The Old Testament recorded the early cases of epilepsy which were first observed on Ezekiel, a prophet of God who saw visions. This particular prophet exhibited signs and symptoms of this condition. A neuroscientist from the University of California in San Diego argues that Bible records reveal that Ezekiel suffered from temporal lobe epilepsy. This is a prophet who lived about 2700 years ago. This shows that epilepsy is a disease that has a long history and should probably be a genetic condition which is greatly influenced by the environment. Individuals with this type of disease suffer from frequent seizures including mental and auditory hallucinations. Sometimes such patients are misdiagnosed as having psychiatric problems. Ezekiel exhibited such symptoms which included difficulties in speaking and also frequent seizure attacks. Ezekiel is a well-known biblical personality who predicted the fall of Jerusalem. He also displayed other symptoms which are widely associated with epilepsy. One such symptoms was his affinity to writing. He was known to be a compulsive writer, a trait that is associated with the condition known as hypergraphia. This is evidenced by the book of Ezekiel which is regarded as the fourth longest in the Bible. No other prophet was as aggressive as prophet Ezekiel in the Bible. Epilepsy is a condition whose symptoms also include aggression, abnormal speech pattern, and delusions. Ezekiel exhibited all these symptoms. The fact that
Ezekiel suffered from epilepsy helps most Christians to have a clear insight of what his writings are all about. It gives Christians a proper perspective of what he experienced and how they can use that knowledge to conduct themselves. This is a clear evidence that epilepsy is a genetic disease that is has something to do with the environment in which we live in. The topic is relevant to the Body of Christ in that it teaches us that God can use anybody irrespective of their station in life or their physical condition to deliver his message. It shows that God does not choose who to serve him based on their present condition (Motluk, 2001).
Other examples about epilepsy abound in the Bible especially in the New Testament. The Book of Mark Chapter 9: 17-23 reads: … And someone from the crowd answered him, “Teacher, I brought my son to you, for he has a spirit that makes him mute. And whenever it seizes him, it throws him down, and he foams and grinds his teeth and becomes rigid. So I asked your disciples to cast it out, and they were not able.” And he answered them, “O faithless generation, how long am I to be with you? How long am I to bear with you? Bring him to me.” And they brought the boy to him. And when the spirit saw him, immediately it convulsed the boy, and he fell on the ground and rolled about, foaming at the mouth. And Jesus asked his father, “How long has this been happening to him?” And he said, “From childhood” (Openbible.info).This story by the Bible brings in a spiritual angle to epilepsy. It states that the spirit that was in Jesus saw the boy’s condition and immediately reacted upon the epileptic spirit inside the boy to make it him whole again. This shows that most diseases that afflict us as Christians are spiritual in nature and can only be countered by the Holy Spirit which is regarded as the healer. The story also shows us that epilepsy is a genetic disease because the boy’s father told Jesus that the boy had had the disease since childhood. This means that he was born with the disease and grew up with it. Is this the reason why there is no appropriate treatment for the disease? Incidences of epilepsy have relevance to the body of Christ in that it teaches them to be spiritually strong. It is only in this way that they can strengthen their faith and be able to overcome challenges in life.
The other example in the New Testament that is related to epilepsy is found in the book of Matthew 17: 14-20 which reads:…And when they came to the crowd, a man came up to him and, kneeling before him, said, “Lord, have mercy on my son, for he is an epileptic and he suffers terribly. For often he falls into the fire, and often into the water. And I brought him to your disciples, and they could not heal him.” And Jesus answered, “O faithless and twisted generation, how long am I to be with you? How long am I to bear with you? Bring him here to me.” And Jesus rebuked the demon, and it came out of him, and the boy was healed instantly. .. (Openbible.info). This story equates epilepsy with the demon which needs to be rebuked. It has relevance to the Christian faith in that most of the illnesses and diseases that afflict us are brought by evil spirits which needs to be cast out. This is the reason Jesus rebuked the demon and cast it out of the boy. Christians can be free from diseases such as epilepsy when they are strong in their faith. The story of epilepsy teaches Christians to beware of the devil ho hides in such ailments like epilepsy and consistently torment Christians who are weak in sprit and those whose faith is not well grounded.
Conclusion
In the modern age of technological advancement, epilepsy is experiencing a considerable transformation due to new insights regarding its molecular and cellular structure. Technological advancement have allowed to have a proper perspective of what the disease is all about and helped us to critically assess its functional as well as structural effects. However, there is a need to place more emphasis on epileptic symptom which are nonictal in nature. This needs to be done through clinical observations as well as through fundamental research aimed at understanding the true nature of this ailment. There is an existing challenge which makes it difficult to determine the extent to which the causes and treatment of disorders associated with epilepsy are the same or different. There needs to be ore focus on such disorders in research using modern and advanced techniques such as informatics and connectomics which is an emerging field in the management of epilepsy.
Lastly, there is also need to have proper insights on how epilepsy is associated with other psychiatric and neurologic conditions, and to what extent seizures contribute to the development of other diseases. When epilepsy is comprehensively redefined we might find out that it is far much complicated than we had initially thought. New ways of research assessment, diagnosis, and observation need to be adopted if the medical fraternity wish to have a positive impact in the management and ultimate treatment of epilepsy.
References
Beghi, E., Carpio, A., Forsgren, L., Hesdorffer, D. C., Malmgren, K., Sander, J. W., Tomson, T., ... Hauser, W. A. (2010). Recommendation for a definition of acute symptomatic seizure. Epilepsia, 51, 4, 671-675.
Camfield, P., & Camfield, C. (2002). Epileptic Syndromes in Childhood: Clinical Features, Outcomes, and Treatment. Epilepsia, 43, 27-32.
Hagmann, P, Cammoun, L, Gigandet, X, Meuli, R, Honey, C J, & Sporns, O. (2008). Mapping the Structural Core of Human Cerebral Cortex . PLoS Biol 6:e159.
Kleen, J. K., Scott, R. C., Holmes, G. L., & Lenck-Santini, P. P. (2010). Hippocampal interictal spikes disrupt cognition in rats. Annals of Neurology, 67, 2, 250-257.
Lafrance, W. C., Kanner, A. M., & Hermann, B. (2008). Psychiatric Comorbidities in Epilepsy. International Review of Neurobiology, 83, 348-385.
Motluk, A. (2001). Old Testament prophet showed epileptic symptoms . Newscientist. https://www.newscientist.com/article/dn1565-old-testament-prophet-showed-epileptic-symptoms/
Palop, J. J., & Mucke, L. (2009). Epilepsy and cognitive impairments in alzheimer disease. Archives of Neurology, 66, 4, 435-440.
Palop, J. J., Chin, J., Roberson, E. D., Wang, J., Thwin, M. T., Bien-Ly, N., Yoo, J., ... Mucke, L. (2007). Aberrant Excitatory Neuronal Activity and Compensatory Remodeling of Inhibitory Hippocampal Circuits in Mouse Models of Alzheimer's Disease. Neuron, 55, 5, 697.
Rakhade, S. N., & Jensen, F. E. (January 01, 2009). Epileptogenesis in the immature brain: emerging mechanisms. Nature Reviews Neurology, 5, 7, 380-391.
Sporns, Olaf, Tononi, Giulio, & Kötter, Rolf. (2005). The Human Connectome: A Structural Description of the Human Brain . Public Library of Science.
