National consensus on diagnosis and treatment of epilepsy

2020

Abstract

Definition. The International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE) define epilepsy as “disorder of the brain characterized by enduring predisposition to generate epileptic seizures and by the neurobiological, cognitive, psychological and social consequences of this condition”.
According to the expanded definition of epilepsy of 2014 recommended by ILAE, epilepsy is a disease of the brain defined by any of the following conditions:
1. At least 2 unprovoked (or reflex) seizures occurring greater than 24 hours apart.
2. One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures (a seizure occurring 30 days after brain stroke in case of established brain structural abnormalities and epileptiform EEG)
3. Diagnosis of an epilepsy syndrome (Rolandic epilepsy with low risk of recurring seizures, Landau-Kleffner syndrome, epileptic encephalopathy with continuous spikes and waves during sleep).
Epilepsy is considered to be resolved for:
- Patients who had an age-dependent epilepsy syndrome but are now past the applicable age,
or
- Patients who have remained seizure-free for the last 10 years, with no seizure medicines for
the last 5 years.
Epilepsy is not diagnosed when seizures occur in case of acute injuries of brain structures (strokes, traumas, encephalitis) or metabolism (hypoglycemia, syncope, intoxication) and fever.
2. Epidemiology. Morbidity rate of active epilepsy is similar for the countries with different economic development – 2,3-5,9/1000 for countries with high income economy, 3,7-13,3/1000 for countries with high to moderate income economy, 2,4-22,8/1000 for countries with low to moderate income economy, 3,6-15,4/1000 for countries with low income economy. Morbidity rate is higher for countries with low income and moderate income economy. The average morbidity rate is 45 per 100 000 inhabitants in countries with high income, and 81,7 in the rest of the countries. In Bulgaria individuals suffering epilepsy are about 50 000. In 50 - 60% of the patients, the epilepsy onset occurs earlier than 16 years of age. 2-5% of the children younger than 5 years of age suffer febrile seizures.