Seizures beget more than seizures: Understanding the cellular, structural, individual and societal impact of seizures in epilepsy

Epilepsy is primarily defined by the repetitive occurrence of seizures, but the full impact of seizures extends beyond these episodic events. Seizures themselves cause changes at the cellular, network, and systemic levels in individual patients with epilepsy and may contribute to the progressive nature of the disease in some patients. Seizures may have an impact on brain structure and function over time. There is also a high societal and economic burden associated with persistent seizures, including major impacts on quality of life, activities of daily living, and productivity. Therefore, seizure freedom with no or minimal side effects should be the key goal in the treatment of epilepsy, with the potential to reduce both disease progression and the societal and economic impacts of the disease. Physicians have a responsibility to address the key obstacles to early seizure freedom, including optimizing initial treatment strategies, minimizing treatment delays, overcoming therapeutic nihilism, and improving medication adherence. PLAIN LANGUAGE SUMMARY: Epilepsy involves repeated seizures which can cause changes in the brain over time and affect memory, thoughts, and everyday activities. Repeated seizures place a heavy burden on individuals, families, and society, affecting their quality of life, independence, and work. The main goal of epilepsy treatment should be the elimination of all seizures with few or no side effects. To achieve this, doctors should act quickly, choose the right treatments early, avoid treatment delays, and support patients in taking their medications.