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Abstract

Epilepsy, a common neurological disorder, impacts more than 50 million individuals worldwide and presents significant obstacles to both physical and mental health. The condition is defined by recurrent seizures that stem from abnormal electrical activity in the brain, leading to effects that vary from minor attention lapses to severe convulsions. In India, epilepsy is a major public health issue, affecting approximately 12 million people. Despite advancements in treatment options, including antiepileptic drugs (AEDs), surgical procedures, and dietary strategies, a considerable number of patients grapple with challenges due to drug-resistant epilepsy (DRE) and restricted access to healthcare, particularly in rural regions. The quality of life (QoL) for those with epilepsy is influenced by the unpredictable nature of seizures, cognitive difficulties, societal stigma, and financial strains. Management strategies include pharmacological, non-pharmacological, and innovative methods such as personalized medicine, neurogenetics, and artificial intelligence (AI), which show potential for enhanced outcomes. Nonetheless, issues with treatment adherence, psychological support, and public knowledge continue to be significant challenges. A patient-centered strategy that combines medical, psychological, and social support is essential for improving QoL. Prospective directions emphasize precision medicine, early detection, and stigma reduction, aiming to better the lives of individuals with epilepsy across the globe.

Keywords

Epilepsy, Seizures, Quality of Life, Drug-Resistant Epilepsy, Antiepileptic Drugs, Surgical Treatment, Neuromodulation

Introduction

Epilepsy constitutes a chronic, non-communicable disorder that affects cerebral function, with an estimated prevalence of approximately 50 million individuals worldwide. This neurological condition is characterized by recurrent seizures, which manifest as brief episodes of involuntary movements that may either involve specific body regions (partial seizures) or encompass the whole body (generalized seizures), occasionally resulting in a temporary loss of awareness of the surrounding environment or a lack of control over bladder functions. The expressions of seizures can exhibit considerable variability, encompassing slight interruptions in cognitive focus or nuanced muscular contractions to intense and extended convulsive episodes. Additionally, the frequency of these seizure episodes can vary significantly, occurring infrequently (less than once annually) to multiple occurrences on a daily basis. This condition is recognized as one of the oldest documented medical disorders, with historical records tracing back to 4000 BCE. The stigma associated with epilepsy continues to adversely affect numerous populations in contemporary society, potentially impairing the quality of life for individuals afflicted with the disorder and their families. Epilepsy accounts for over 0.5% of the global disease burden, a composite metric that incorporates years lost due to premature mortality along with years lived in suboptimal health. The economic ramifications of epilepsy are substantial, influencing healthcare demands, premature mortality rates, and declines in productivity. Out-of-pocket expenses incurred by individuals, along with productivity losses, can pose significant obstacles for families affected by epilepsy. A research study conducted in India indicated that governmental financial support for both first- and second-line treatments, in addition to other medical expenses, can alleviate the economic pressures associated with epilepsy and is deemed economically feasible.The stigma and prejudice associated with epilepsy on a global scale can frequently present more formidable challenges than the actual seizure occurrences. Individuals with epilepsy and their immediate social circles often encounter discrimination. Prevailing misconceptions that epilepsy is incurable, contagious, or results from immoral behavior can result in social ostracism and dissuade individuals from seeking necessary medical attention.

Epido:

The epidemiological landscape of epilepsy in India highlights a considerable public health issue. It is estimated that more than 12 million individuals in India are affected by epilepsy, representing a significant fraction of global cases. The prevalence of epilepsy in India ranges from 5.59 to 7 per 1,000 individuals. There is a higher prevalence of epilepsy in rural regions, with research showing increased rates of both active and lifetime epilepsy in these areas. Various factors contribute to this substantial burden, such as limited access to healthcare, socioeconomic difficulties, infectious diseases, and the cultural stigma associated with epilepsy. Additionally, prevalence rates differ by region and demographic variables, but epilepsy remains a prominent cause of disability-adjusted life years (DALYs) in India, underscoring the urgent need for enhanced awareness, diagnosis, and treatment options. Despite the progress India has made in improving epilepsy care, there is still a significant treatment gap, with numerous patients not having access to the necessary medications and care. Epilepsy presents a diverse array of signs and symptoms, which can differ based on the type and intensity of the seizure.

Types of Seizures:

a) Generalized Seizures: These affect both hemispheres of the brain and may result in symptoms such as a loss of consciousness, muscle stiffness, rhythmic jerking motions (known as tonic-clonic seizures), or brief lapses in awareness (referred to as absence seizures).

b)Focal Seizures: These are limited to a specific region of the brain and can lead to localized symptoms such as the twitching or jerking of a specific body part, unusual sensations (such as tingling or visual alterations), or changes in mental states

c)Physical Symptoms:

During a seizure, individuals may face convulsions, rigidity of muscles, loss of bladder control, or involuntary movements in the limbs or face.

After a seizure, postictal confusion, where the individual may feel disoriented or sleepy, is also frequently observed.

d)Cognitive Symptoms:

Certain individuals may suffer from memory lapses, trouble focusing, or confusion during or subsequent to a seizure. Cognitive difficulties may also become more evident in those who have chronic epilepsy.

e)Psychological Symptoms:

Individuals diagnosed with epilepsy may experience sensations of apprehension or unease in the temporal vicinity of a seizure, either preceding or succeeding the event.. Depression is also common, particularly among those with inadequately managed epilepsy. The symptoms of epilepsy can range from mild to severe, and the specific indicators often depend on the kind of epilepsy and the brain region involved.

The quality of life (QoL):

For individuals with epilepsy is greatly influenced by both the direct and indirect effects of the disorder. Physical consequences, such as frequent seizures, can result in injuries, disrupt everyday activities, and increase the need for medical visits, ultimately lowering overall quality of life. The unpredictable nature of seizures may restrict a person's autonomy, necessitating reliance on others for help with fundamental tasks. Psychologically, many individuals face cognitive challenges including memory deficits, difficulties with concentration, and slower processing speeds, which can hinder their performance at work or in educational settings. Socially, the stigma linked to epilepsy continues to pose a significant obstacle in numerous cultures, including India, where false beliefs about the condition foster discrimination, isolation, and marginalization. Those with epilepsy may experience feelings of social exclusion, find it difficult to build relationships, and encounter obstacles in obtaining employment or educational opportunities. Furthermore, psychological issues such as depression, anxiety, and heightened stress levels frequently accompany epilepsy, intensifying the effects on mental health and overall quality of life. This can lead to academic difficulties for children, while adults might experience professional challenges, impacting long-term satisfaction with life.There is also a considerable economic impact, as those with epilepsy often face expenses related to ongoing medical treatment, medications, and loss of income due to inconsistent work availability. In India, these issues are exacerbated by limited healthcare accessibility, especially in rural regions, and the high costs associated with antiepileptic medications, which can interfere with medication adherence and worsen the cycle of poor quality of life. Therefore, epilepsy is not merely a medical issue but a complex challenge that affects every facet of an individual's existence.

Management of Epilepsy:

Epilepsy stands as one of the most frequently encountered neurological disorders, impacting approximately 0.5–1% of any population. It constitutes 2–3% of emergency admissions to general medical services. For most individuals who are newly diagnosed with epilepsy, the prognosis is generally favorable. About 65–70% of individuals will achieve long-lasting seizure control with the initial or second antiepileptic medication (AED) prescribed. The quantity of AEDs has significantly risen over the last two decades. In fact, the range has become confusing and intricate for those without specialist knowledge. Treatment is typically advised only after a patient has experienced two or more unprovoked seizures within around 12 months and should only begin if there is a clear diagnosis. There is little benefit to rushing into treatment or attempting a 'trial of treatment,' as taking time allows the patient and their physician to assess the necessity for intervention more clearly. Most individuals will achieve seizure freedom with the first or second medication used alone. The initial drug selection should consider seizure type, the potential for drug interactions, chances of future pregnancy, side effect profiles, and how quickly the drug acts. The decision regarding AED should occur in a suitable specialist environment; phenytoin has no place in the outpatient care of newly diagnosed epilepsy. The newer medications demonstrate comparable effectiveness to older ones but come with fewer issues related to pharmacokinetics and tolerability, making them more appealing for long-term use. The SANAD study indicated that lamotrigine is the most well-tolerated AED for patients with focal epilepsies. For individuals with generalized epilepsies, valproate may provide the best effectiveness, although caution is warranted regarding its use in women of childbearing potential. The SANAD II study is set to commence shortly and will evaluate levetiracetam for both focal and generalized onset epilepsy.

Pharmacological management (First line (AED)

Below table shows type of seizure and there first line( AED)


 

Seizure Type

First-Line AEDs

Second-Line

a)Focal-Onset Seizures

Carbamazepine

Gabapentin

 

Lamotrigine

Topiramate

 

Levetiracetam

Zonisamide

b)Generalized Tonic-Clonic

Valproate

Topiramate

 

Lamotrigine

Perampanel

 

Levetiracetam

 

c)Absence Seizures

Ethosuximide

Clonazepam

 

Valproate

 

 

Lamotrigine

 

d)Myoclonic Seizures

Valproate

Clonazepam

 

Levetiracetam

 

 

Topiramate

 

e)Lennox-Gastaut Syndrome

Valproate

Rufinamide

 

Clobazam

Topiramate

 

Lamotrigine

Cannabidiol

f)Dravet Syndrome

Valproate

Cannabidiol

 

Stiripentol (adjunctive)

Fenfluramine


DRE  drug-resistant epilepsy:

 Individuals with epilepsy who do not adequately respond to anti seizure medication (ASM)

therapies are classified as having drug-resistant epilepsy (DRE). This medical condition is frequently referred to as intractable epilepsy, medically refractory epilepsy, or pharmacoresistant epilepsy.. Approximately 20 to 40 percent of individuals with epilepsy (around 400,000 people in the United States) may experience refractory epilepsy. Those affected by DRE endure the highest levels of epilepsy-related disabilities, which further highlights the significance of this issue.Due to the necessity of personalized treatment approaches, a strict set of guidelines cannot be universally applied to assess medical intractability. However, studies conducted on populations have provided valuable insights regarding the prognosis of DRE that inform treatment choices. Surgical resection for epilepsy can potentially eliminate seizures for numerous patients with localization-related DRE.

Prevalence: Around 20-30% of people with epilepsy worldwide are affected.

Management Options:

Polytherapy: This involves the use of multiple antiepileptic drugs (AEDs) that act through various mechanisms, such as combining levetiracetam with lamotrigine or topiramate. 

Alternative Treatments: These include ketogenic diets, surgical options (such as resective surgery), and neuromodulation methods like vagus nerve stimulation (VNS).

Polytherapy is When monotherapy is ineffective, using a combination of antiepileptic drugs (AEDs) with complementary mechanisms can enhance seizure management. For example:

1)Levetiracetam + Lamotrigine: Engages distinct pathways to lessen seizure activity. 

2) opiramate + Carbamazepine: Merges sodium channel inhibition with GABA receptor enhancement. 

Alternative Treatments:

1)Ketogenic Diet:A high-fat, low-carbohydrate regimen, particularly beneficial for children with drug-resistant epilepsy (DRE). 

2)Surgical Options:Resective procedures may be indicated for focal DRE, especially when seizure activity is localized to brain areas that are not critical for function. 

3)Neuromodulation: Approaches like vagus nerve stimulation (VNS) or responsive neurostimulation (RNS) aid in minimizing seizure occurrence in patients for whom surgery is not appropriate.

Adverse Effects of AEDs: Overview

1)Cognitive Effects:Numerous AEDs, such as topiramate and phenobarbital, may hinder memory, attention, and processing speed, which can influence academic and work performance.

2)Behavioral Effects: Medications like levetiracetam have been linked to alterations in mood, increased irritability, and even depressive symptoms.

3)Physical Effects: Common side effects include dizziness, fatigue, weight gain (for instance, with valproate), weight loss (as seen with topiramate), and potential long-term risks such as decreased bone density or teratogenic impacts during pregnancy.

These adverse effects can significantly diminish the quality of life for patients, highlighting the need for tailored treatment approaches.

Non-Pharmacological Management of Epilepsy 

Surgical Options: 

Types: 

Resective Surgery: Involves the removal of the area responsible for seizures, often successful in cases of temporal lobe epilepsy. 

Laser Ablation: A minimally invasive method that employs thermal energy to target areas of seizure activity. 

Candidacy: Suitable for patients with drug-resistant epilepsy confined to non-critical regions of the brain. 

Success Rates: Resective procedures demonstrate seizure freedom rates ranging from 60-70% among appropriate candidates. 

Neuromodulation Techniques:  

Vagus Nerve Stimulation (VNS): Decreases seizure occurrence by providing electrical impulses to the vagus nerve. 

Responsive Neurostimulation (RNS): Offers targeted stimulation in response to recognized seizure events. 

Deep Brain Stimulation (DBS): Aims at deep brain areas, such as the thalamus, to interfere with seizure pathways. 

Dietary Interventions: 

Ketogenic Diet: A high-fat, low-carbohydrate diet that has proven effective in both pediatric and some adult populations. 

Modified Atkins Diet: An easier-to-follow version that is beneficial for specific types of epilepsy.

Low-Glycemic Index Diet:Emphasizes slow-digesting carbohydrates to maintain stable blood sugar levels and decrease seizure frequency. 

Each method is customized to meet the individual requirements of patients, offering encouraging outcomes when traditional antiepileptic drugs are ineffective.

Behavioral and Lifestyle Interventions in Epilepsy Management 

Stress Management: 

Stress is a recognized trigger for seizures. Techniques such as mindfulness meditation, yoga, and cognitive-behavioral therapy (CBT) can help decrease stress levels, potentially reducing the frequency of seizures. Relaxation techniques also enhance emotional resilience and overall life quality. 

Lifestyle Modifications: 

Sleep Hygiene:The attainment of regular and adequate sleep is of paramount importance, given that insufficient sleep has the potential to precipitate seizures. Developing regular sleep habits and addressing sleep disorders like sleep apnea can be advantageous.

Avoiding Triggers: Recognizing and steering clear of individual seizure triggers, such as alcohol, flashing lights, or excessive screen time, helps lower the risk of seizures. 

Physical Activity: 

Engaging in exercise supports mental health, alleviates anxiety, and boosts physical well-being. Moderate-intensity activities like walking, swimming, or tai chi can elevate mood and may decrease seizure frequency without imposing excessive strain. 

Implementing these strategies complements medical treatments, tackling both the physical and psychological facets of epilepsy.

Innovative Approaches in Epilepsy Treatment:

Custom Medicine and Neurogenetics: 

Progress in genetic analysis and neurogenetics facilitates the detection of gene mutations associated with epilepsy, paving the way for targeted treatments. Custom medicine adjusts therapy based on unique genetic profiles, enhancing outcomes for uncommon and resistant epilepsy types. Methods involve correcting genetic abnormalities and fine-tuning anti-epileptic drug (AED) choices informed by genetic data.

Gene Therapy: 

Investigative treatments seek to alter or mend faulty genes linked to epilepsy. Using viral vectors and CRISPR techniques, researchers are examining ways to administer these therapies, which are showing encouraging results in preclinical studies and early human trials.

Artificial Intelligence (AI):  

AI is transforming the management of seizures by advancing prediction capabilities through algorithms that analyze EEG data, patient histories, and environmental influences. Additionally, AI assists in customizing medication regimens, minimizing the need for trial-and-error strategies.

These innovative approaches have significant potential to enhance treatment effectiveness and the overall quality of life for patients.

Quality of life of epilepsy patient :

Physical Health:  

The frequency and intensity of seizures, along with accompanying issues such as migraines and chronic pain, greatly influence physical health. 

Mental Health: 

Individuals with epilepsy often experience elevated levels of depression, anxiety, and cognitive difficulties, which impacts their overall mental well-being. 

Social Aspects: 

The stigma and discrimination associated with epilepsy obstruct social interactions and integration, resulting in difficulties in relationships and social acceptance. 

Educational Impact: 

Students with epilepsy frequently encounter challenges in the classroom, including learning difficulties, issues with concentration, and social isolation.

CONCLUSION:

Epilepsy represents a widespread neurological condition with significant consequences for both physical and mental well-being, affecting an individual's overall quality of life. In India, where the occurrence rate is particularly elevated, various elements such as restricted access to healthcare, societal stigma, and a lack of awareness exacerbate the difficulties experienced by those living with epilepsy. Despite progress in medical treatments, including the introduction of newer antiepileptic drugs (AEDs) and alternative therapies, a considerable number of patients continue to face disabilities related to seizures due to insufficient medication responses. The management of epilepsy involves a comprehensive approach, which includes pharmacological, surgical, and non-pharmacological strategies. However, the challenges posed by treatment side effects, along with a deficiency in personalized care, continues to be a major issue. This underscores the necessity of implementing patient-centered care models that customize treatments to meet individual preferences and needs, thereby enhancing overall outcomes. Beyond medical treatments, it is essential to tackle the psychosocial dimensions, such as stigma, and to promote social inclusion to elevate the quality of life for those with epilepsy. Public health campaigns aimed at increasing awareness, facilitating early detection, and dispelling myths surrounding epilepsy could be vital in mitigating the societal load and bolstering treatment adherence. Looking forward, the integration of precision medicine, breakthroughs in neurogenetics, and the use of artificial intelligence holds the potential to transform epilepsy care. These advancements may yield more focused therapies, reduce adverse effects, and improve long-term results. Nevertheless, there is still a pressing need for ongoing research, enhanced healthcare accessibility, and robust social support networks to guarantee that individuals with epilepsy can enjoy fulfilling and productive lives, free from stigma and isolation.

REFERENCES

  1. Bazil, C., & Bank, A. (2019). Emergency management of epilepsy and seizures. Seminars in Neurology, 39(01), 073–081. https://doi.org/10.1055/s-0038-1677008
  2. Noe, K. (2019). Counseling and management of the risks of living with epilepsy. CONTINUUM Lifelong Learning in Neurology, 25(2), 477–491. https://doi.org/10.1212/con.0000000000000708
  3. Sirven, J. I. (2016). Management of Epilepsy Comorbidities. CONTINUUM Lifelong Learning in Neurology, 22(1, Epilepsy), 191–203. https://doi.org/10.1212/con.0000000000000268
  4. Ali, A. (2018). Global Health: Epilepsy. Seminars in Neurology, 38(02), 191–199. https://doi.org/10.1055/s-0038-1646947
  5. Leach, J., & Abassi, H. (2013). Modern management of epilepsy. Clinical Medicine, 13(1), 84–86. https://doi.org/10.7861/clinmedicine.13-1-84
  6. World Health Organization: WHO. (2024b, February 7). Epilepsy. https://www.who.int/news-room/fact-sheets/detail/epilepsy#:~:text=Key facts,- and middle-income countries.
  7. Guery, D., & Rheims, S. (2021). Clinical Management of Drug Resistant Epilepsy: A review on current strategies. Neuropsychiatric Disease and Treatment, Volume 17, 2229–2242. https://doi.org/10.2147/ndt.s256699
  8. UpToDate. (n.d.). UpToDate. https://www.uptodate.com/contents/evaluation-and-management-of-drug-resistant-epilepsy#H480281665
  9. Park, S., & Kwon, S. (2008). Cognitive effects of antiepileptic drugs. Journal of Clinical Neurology, 4(3), 99. https://doi.org/10.3988/jcn.2008.4.3.99
  10. Nadkarni, V., & Saxena, V. (2011b). Nonpharmacological treatment of epilepsy. Annals of Indian Academy of Neurology, 14(3), 148. https://doi.org/10.4103/0972-2327.85870
  11. Gururaj, G., Amudhan, S., & Satishchandra, P. (2015). Epilepsy in India I: Epidemiology and public health. Annals of Indian Academy of Neurology, 18(3), 263. https://doi.org/10.4103/0972-2327.160093
  12. Pandey, S., Singhi, P., & Bharti, B. (2013). Prevalence and treatment gap in childhood epilepsy in a North Indian City: A Community-Based Study. Journal of Tropical Pediatrics, 60(2), 118–123. https://doi.org/10.1093/tropej/fmt091]
  13. Chen, Z., Rollo, B., Antonic-Baker, A., Anderson, A., Ma, Y., O’Brien, T. J., Ge, Z., Wang, X., & Kwan, P. (2020). New era of personalised epilepsy management. BMJ, m3658. https://doi.org/10.1136/bmj.m3658
  14. Koh, H. K., Kobau, R., Whittemore, V. H., Mann, M. Y., Johnson, J. G., Hutter, J. D., & Jones, W. K. (2014). Toward an integrated public health approach for epilepsy in the 21st century. Preventing Chronic Disease, 11. https://doi.org/10.5888/pcd11.140270
  15. Hu, C., Zhao, Y., & Xiao, Z. (2024). Effects of stigma on the quality of life in patients with epilepsy. Acta Epileptologica, 6(1). https://doi.org/10.1186/s42494-024-00154-7
  16. Beltrán-Corbellini, Á., Aledo-Serrano, Á., Møller, R. S., Pérez-Palma, E., García-Morales, I., Toledano, R., & Gil-Nagel, A. (2022). Epilepsy Genetics and Precision Medicine in Adults: A New Landscape for Developmental and Epileptic Encephalopathies. Frontiers in Neurology, 13. https://doi.org/10.3389/fneur.2022.777115
  17. Hu, C., Zhao, Y., & Xiao, Z. (2024b). Effects of stigma on the quality of life in patients with epilepsy. Acta Epileptologie, 6(1). https://doi.org/10.1186/s42494-024-00154-7
  18. Meador, K. J. (2013). Behavioral and cognitive effects of antiepileptic drugs. In Oxford University Press eBooks (pp. 269–283). https://doi.org/10.1093/acprof:oso/9780195395549.003.0013
  19. Borowicz-Reutt, K., Krawczyk, M., & Czernia, J. (2024). Ketogenic diet in the treatment of epilepsy. Nutrients, 16(9), 1258. https://doi.org/10.3390/nu16091258
  20. NICE. (2022, April 27). 8 Non-pharmacological treatments | Epilepsies in children, young people and adults | Guidance | NICE. https://www.nice.org.uk/guidance/ng217/chapter/8-Non-pharmacological-treatments  

Reference

  1. Bazil, C., & Bank, A. (2019). Emergency management of epilepsy and seizures. Seminars in Neurology, 39(01), 073–081. https://doi.org/10.1055/s-0038-1677008
  2. Noe, K. (2019). Counseling and management of the risks of living with epilepsy. CONTINUUM Lifelong Learning in Neurology, 25(2), 477–491. https://doi.org/10.1212/con.0000000000000708
  3. Sirven, J. I. (2016). Management of Epilepsy Comorbidities. CONTINUUM Lifelong Learning in Neurology, 22(1, Epilepsy), 191–203. https://doi.org/10.1212/con.0000000000000268
  4. Ali, A. (2018). Global Health: Epilepsy. Seminars in Neurology, 38(02), 191–199. https://doi.org/10.1055/s-0038-1646947
  5. Leach, J., & Abassi, H. (2013). Modern management of epilepsy. Clinical Medicine, 13(1), 84–86. https://doi.org/10.7861/clinmedicine.13-1-84
  6. World Health Organization: WHO. (2024b, February 7). Epilepsy. https://www.who.int/news-room/fact-sheets/detail/epilepsy#:~:text=Key facts,- and middle-income countries.
  7. Guery, D., & Rheims, S. (2021). Clinical Management of Drug Resistant Epilepsy: A review on current strategies. Neuropsychiatric Disease and Treatment, Volume 17, 2229–2242. https://doi.org/10.2147/ndt.s256699
  8. UpToDate. (n.d.). UpToDate. https://www.uptodate.com/contents/evaluation-and-management-of-drug-resistant-epilepsy#H480281665
  9. Park, S., & Kwon, S. (2008). Cognitive effects of antiepileptic drugs. Journal of Clinical Neurology, 4(3), 99. https://doi.org/10.3988/jcn.2008.4.3.99
  10. Nadkarni, V., & Saxena, V. (2011b). Nonpharmacological treatment of epilepsy. Annals of Indian Academy of Neurology, 14(3), 148. https://doi.org/10.4103/0972-2327.85870
  11. Gururaj, G., Amudhan, S., & Satishchandra, P. (2015). Epilepsy in India I: Epidemiology and public health. Annals of Indian Academy of Neurology, 18(3), 263. https://doi.org/10.4103/0972-2327.160093
  12. Pandey, S., Singhi, P., & Bharti, B. (2013). Prevalence and treatment gap in childhood epilepsy in a North Indian City: A Community-Based Study. Journal of Tropical Pediatrics, 60(2), 118–123. https://doi.org/10.1093/tropej/fmt091]
  13. Chen, Z., Rollo, B., Antonic-Baker, A., Anderson, A., Ma, Y., O’Brien, T. J., Ge, Z., Wang, X., & Kwan, P. (2020). New era of personalised epilepsy management. BMJ, m3658. https://doi.org/10.1136/bmj.m3658
  14. Koh, H. K., Kobau, R., Whittemore, V. H., Mann, M. Y., Johnson, J. G., Hutter, J. D., & Jones, W. K. (2014). Toward an integrated public health approach for epilepsy in the 21st century. Preventing Chronic Disease, 11. https://doi.org/10.5888/pcd11.140270
  15. Hu, C., Zhao, Y., & Xiao, Z. (2024). Effects of stigma on the quality of life in patients with epilepsy. Acta Epileptologica, 6(1). https://doi.org/10.1186/s42494-024-00154-7
  16. Beltrán-Corbellini, Á., Aledo-Serrano, Á., Møller, R. S., Pérez-Palma, E., García-Morales, I., Toledano, R., & Gil-Nagel, A. (2022). Epilepsy Genetics and Precision Medicine in Adults: A New Landscape for Developmental and Epileptic Encephalopathies. Frontiers in Neurology, 13. https://doi.org/10.3389/fneur.2022.777115
  17. Hu, C., Zhao, Y., & Xiao, Z. (2024b). Effects of stigma on the quality of life in patients with epilepsy. Acta Epileptologie, 6(1). https://doi.org/10.1186/s42494-024-00154-7
  18. Meador, K. J. (2013). Behavioral and cognitive effects of antiepileptic drugs. In Oxford University Press eBooks (pp. 269–283). https://doi.org/10.1093/acprof:oso/9780195395549.003.0013
  19. Borowicz-Reutt, K., Krawczyk, M., & Czernia, J. (2024). Ketogenic diet in the treatment of epilepsy. Nutrients, 16(9), 1258. https://doi.org/10.3390/nu16091258
  20. NICE. (2022, April 27). 8 Non-pharmacological treatments | Epilepsies in children, young people and adults | Guidance | NICE. https://www.nice.org.uk/guidance/ng217/chapter/8-Non-pharmacological-treatments

Photo
Ruturaj Athawale
Corresponding author

Department of clinical pharmacy, Shivalingeshwar college of pharmacy, almala Tq ausa,dis Latur.

Photo
Atrikumar survase
Co-author

Department of clinical pharmacy, Shivalingeshwar college of pharmacy, almala Tq ausa,dis Latur.

Photo
Achal Hatzade
Co-author

Department of clinical pharmacy, Shivalingeshwar college of pharmacy, almala Tq ausa,dis Latur.

Photo
Yuvraj katu
Co-author

Department of clinical pharmacy, Shivalingeshwar college of pharmacy, almala Tq ausa,dis Latur.

Ruturaj Athawale*, Atrikumar survase, Achal Hatzade, Yuvraj katu, An Analysis on Management of Epilepsy and It Effect on Patients Quality of Life, Int. J. of Pharm. Sci., 2024, Vol 2, Issue 12, 2310-2317. https://doi.org/10.5281/zenodo.14502418

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