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The burden of epilepsy The most common types of epileptic seizures Generalised seizures (affecting both cerebral hemispheres) Characteristics ‘Grand Mal’ or Generalised tonic-clonic Unconsciousness, convulsions, muscle rigidity Absence Brief loss of consciousness Myoclonic Sporadic (isolated), jerking movements Clonic Repetitive, jerking movements Tonic Muscle stiffness, rigidity Atonic Loss of muscle tone Focal (partial) seizures (limited to a part of one brain hemisphere) Characteristics Retained awareness No loss of consciousness, short duration Loss of awareness Possible loss of consciousness, no memory of seizure Italian neurologist Ettore Beghi was a presenter at the Global Burden of Disease Brain Summit (GBDBS), held at AUT in November last year.The Neurological Foundation provided funding to bring researchers like Dr Beghi to New Zealand to share their knowledge.We took the opportunity to ask him about his work. While some of Dr Beghi’s professional life is focused on epidemiology for neurological conditions, his special interest is epilepsy. Dr Beghi’s talk at the GBDBS presented neurological disorder data fromWestern, Central and Eastern Europe. His slides showed that the incidence of epilepsy is decreasing in Europe. “Epilepsy is a fairly common disease. Each year there will be about 50 new cases for every 100,000 of population.This is known as ‘incidence’.The prevalence of epilepsy is much higher – about 6 per 1000.The reason for the difference between incidence and prevalence is that few people die of epilepsy. It’s easy to find many patients with ongoing epilepsy”, says Dr Beghi. About epilepsy Epilepsy is characterised by seizures, which are abrupt events.The type of seizure varies depending the on the area of the brain affected. However, having a seizure does not necessarily mean you have epilepsy. “You can have a seizure because you took a toxic drug. Or you may have a seizure in the context of a stroke. These things are to some extent risk factors for epilepsy, but they are not symptoms for epilepsy because they don’t reoccur.” The data presented by Dr Beghi at the summit shows that the incidence of epilepsy is decreasing over time. One of the reasons for this is improved perinatal care. “The most significant cause of epilepsy is hypoxic ischaemic encephalopathy, which can happen when a baby is being delivered. However, having a neonatal seizure doesn’t mean a life of epilepsy. Many neonatal seizures stop at the end of the neonatal period. Others, usually the most severe ones, are connected to greater damage to the brain and ongoing seizures.” Other major causes of epilepsy are stroke and traumatic brain injury. “When you look at the GDB (global disease burden) data, you can assume that a proportion of the decrease is due to better- controlling some of the causes of stroke, as well as giving people access to treatments that were not available before.” Epilepsy in everyday life A major problem for people with epilepsy is driving. Patients who have a loss of consciousness have to be seizure-free for one year to drive. Another big problem is finding an understanding employer or school. 12 / Headlines