Prof. Konrad Rejdak: In patients with epilepsy, we aim for permanent remission

February 14 is Saint Valentine's Day, the holiday of lovers. On this day in Poland we also celebrate the day of epilepsy patients, or so-called Saint Valentine's disease. The World Health Organization estimates that about 50 million people worldwide suffer from epilepsy. What are the Polish statistics?

It is definitely one of the more common serious neurological diseases. Estimates indicate that it affects one percent of the population. And indeed, we are in no way different from other countries in the world here. It is estimated that about 300,000 patients have a diagnosis and receive medical services, which indicates that the disease is active. But let's remember that some people go into long-term remission and may not benefit from active therapy.

We know that epilepsy can manifest itself in different ways. What problems does this raise from the moment of diagnosis to the implementation of treatment?

Epilepsy - remember - is a term that encompasses many different syndromes and diseases. Thus, it represents a symptom in the form of epileptic seizures (the etiology can be very different) and mechanisms of brain damage, which are later associated with spontaneous epileptic seizures. At the level of the individual patient, we must strive to clarify what causes epileptic seizures. Consequently, the course of treatment also changes.

This disease syndrome affects different age groups. It can occur as early as very early childhood. This is the most common period when we diagnose epilepsy. Another peak in incidence occurs in old age. But, of course, these first seizures can occur at any age. Hence, it is a major medical and social problem. Every effort should be made to properly diagnose epilepsy. Let's remember that it can have very different symptomatology. It often remains undetected.

Seizures are most generally divided into focal and generalized seizures. The former, originating in a specific area of the cerebral cortex, can spread throughout the brain, in which case the seizures become generalized. The most classic manifestation is tonic-clonic seizures, during which the patient loses consciousness. There are clonic ruptures in the extremities, but also tonic spasms in the axial muscles and limbs. This is the most spectacular type of seizures. However, there are also, of course, more subtle, unseen seizures, which are much more difficult to recognize. Often patients themselves are unaware that they are epileptic seizures. This can delay the chance of diagnosis and thus pose a certain risk. During uncontrolled episodes, patients' consciousness is switched off, and they are thus often at risk of various injuries.

Today we are increasingly talking about the fact that with epilepsy it is possible to function normally, to realize oneself in the educational, professional or family fields. What conditions must be met so that patients can really integrate back into normal functioning?

Great progress has been made in recent decades. Let me just remind you that in the previous century, residential centers were organized for patients with epilepsy, which indicated that it was a severe and difficult to control disease, that patients required permanent institutional care. Fortunately, those days are gone. Yes, there are severe courses of the disease where very intensive care is required, but thanks to new therapies, we can move patients to a whole new world where they can function and pursue their life plans. This has been made possible by diagnostic capabilities, so we are able to diagnose epilepsy much faster, better. Well, and above all, dozens of different substances have already been introduced into treatment. The challenge is still the phenomenon of drug resistance. It can affect about 20-30 percent of patients who fail to achieve sustained remission. However, we can at least reduce the frequency of seizures and also significantly improve the quality of life of these patients.

Quality of life is increasingly a determinant of the effectiveness of treatment in the field, not the purely medical one, but related to the social functioning of patients. When can we say and what determinants are behind the fact that the quality of life of a patient with epilepsy is improving?

This is a very important aspect. One thing we need to keep in mind here is that the strongest improvement in quality of life correlates with the complete absence of seizures. So this is a very ambitious task. And indeed, thanks to modern drugs, we have a chance to achieve this state in more than 70 percent of patients, that is, to permanently reduce, minimize even to zero epileptic seizures. So this is one fundamental aspect. The other is drug tolerance. In most cases, patients are doomed to many years of taking pills, which can also affect their quality of life. Of course, we are guided here by the balance of benefits. Certain inconveniences associated with the therapy are completely covered up and replaced by the benefit associated with the absence of seizures. This is the goal in every patient - to strive for complete remission. This is why new drugs are needed, to try all the time, even in those in whom such a remission has not been achieved for many years, a reduction in seizures.