Today, however, a renewed focus on quality of life and a growing awareness of digital technologies to support PWE are leading trends that are set to transform epilepsy care. Here, digital therapeutic (DTx) solutions have the potential to catalyze this transformation and optimize patient outcomes.
Epileptic Seizures–A Complex Diagnosis
Epilepsy is a complex condition that can result from almost any insult to the brain, including infection, autoimmune conditions, traumatic injury, and genetic mutations. While the cause of epilepsy is unknown in many patients, diagnosing the seizure type–which varies depending on the affected area of the brain–is key to guiding clinical management.
However, diagnosing epileptic seizures is challenging. Conventional diagnostic approaches–primarily taking a medical history, EEG, and neuroimaging– may not accurately categorize the type of epileptic seizure or may fail to distinguish between epileptic seizures and seizure mimics. Additionally, patients often struggle with accurate recall of their seizure experience, particularly young children, individuals with intellectual disability, or those affected by epileptic amnesia.
Tackling Seizures–A Key Challenge in Epilepsy Care
Epileptic seizures can have serious and enduring consequences for patients, including cognitive dysfunction, mental illness, and social isolation. Freedom from seizures is therefore a primary goal of epilepsy care. Anti-seizure drugs (ASDs) are the backbone of epilepsy care and emerging research is paving the way towards personalized medicine in the diagnosis and treatment. However, at present, only a select group of patients may benefit from these targeted treatments.
ASDs are used to suppress seizure generation, decrease seizure severity, and reduce patient mortality. While ASDs are moderately effective, all have acute dose-related effects and some have long-term adverse effects. Additionally, ASD treatment continues to be largely empirical, with many patients switching medications to achieve seizure control or improve tolerability.
Furthermore, one-third of patients treated with ASDs continue to have uncontrolled seizures, increasing their risk of psychological and social dysfunction, hospitalization, and premature death. Many of these patients have drug resistant epilepsy (DRE) and could benefit from specialist-level therapies, such as surgery and neurostimulation. However, referral to epilepsy specialist care remains suboptimal, in part due to inadequate monitoring of seizure frequency and medication adherence that enables the detection of DRE.
The Bigger Picture: Quality of Life and Mental Health
Seizure freedom is a primary treatment goal for patients with epilepsy. However, for many, having a good quality of life is even more important, yet this is difficult to achieve. Depression and anxiety are common comorbidities of epilepsy, affecting 20% of PWE and up to 50% of those with DRE. In fact, despite a clinical focus on seizure control, depression has a much stronger impact on quality of life than does seizure frequency, and even mild depressive symptoms lower the quality of life in PWE.
Depression and anxiety also directly affect brain chemistry and neuronal activity, acting as drivers of epileptic seizures. Stressful events have been associated with increased EEG-detected epileptiform activity and MRI-detected cerebrovascular reactivity.
Additionally, depression, stress, and anxiety indirectly promote seizures by contributing to sleep deprivation, fatigue, and poor medication adherence, which are well-known seizure precipitants. In PWE, depression, and other psychiatric disorders are associated with a 13-fold increased risk of premature death, primarily from suicide, accidents, and drug overdoses.
Boosting Holistic Approaches to Epilepsy Care
Given the significant burden of psychological, cognitive, social, and physical challenges for PWE, quality of life, and mental health management are increasingly recognized as key components of epilepsy care. Epilepsy experts now advocate for holistic care approaches that address the physiological, psychological, cognitive, and social dimensions of care.
In 2017, the American Academy of Neurology updated recommendations for epilepsy quality measures to include screening for depression and anxiety, as well as quality of life assessments and outcomes. More generally, patient-reported outcomes, including those measuring quality of life, are becoming increasingly integrated into value-based payment models in the United States and elsewhere.