A COMPREHENSIVE REVIEW ON EPILEPSY AND ITS DIAGNOSIS/ TREATMENT USING EEG SIGNALS

Authors

  • Anvesh Davak
  • Parash Tomar
  • Dr. Navneet Garud

DOI:

https://doi.org/10.53555/eijmhs.v11i1.267

Keywords:

Electroencephalography (EEG), Seizure detection, Wearable EEG

Abstract

Epilepsy is a chronic functional disorder of the brain resulting in recurrent seizures due to hyper-synchronous neuronal activity. About 30% of those who suffer from epilepsy develop an incurable form of the disease that does not respond to medications, also known as drug-resistant epilepsy (DRE), which necessitates a careful evaluation of the diagnostic and therapeutic modalities. The foundation of epilepsy treatment remains electroencephalography (EEG), which continues to provide the best information regarding seizure localization, classification, and treatment follow-up. This review presents a comprehensive study of epilepsy, covering the historical development, epidemiology, and diverse etiology of epilepsy, with an in-depth study of EEG entailing the major contribution to the developments. The EEG techniques applied in this study embrace classical approaches as well as modern techniques, such as time-frequency techniques and machine learning (ML)- based automated seizure detection and deep learning (DL) based signal processing. Emphasis is made on the challenges common in elderly and pediatric age groups, together with specific EEG characteristics and timely treatment interventions. There is a detailed critical analysis of cutting-edge developments, including wearable EEG units, closed-loop neuromodulation systems, and AI-based individualized interventions.

Author Biographies

Anvesh Davak

SOS in Pharmaceutical Sciences, Jiwaji University, Gwalior, 474011

Parash Tomar

SOS in Pharmaceutical Sciences, Jiwaji University, Gwalior, 474011

Dr. Navneet Garud

SOS in Pharmaceutical Sciences, Jiwaji University, Gwalior, 474011

References

Aaberg KM, Surén P, Søraas CL, et al. Seizures, syndromes, and etiologies in childhood epilepsy: The International League Against Epilepsy 1981, 1989, and 2017 classifications used in a population- based cohort. Epilepsia 2017;58(11):1880–1891

Acharya, U. R., Sree, S. V., Swapna, G., Martis, R. J., & Suri, J. S. (2013). Automated EEG analysis of epilepsy: A review. Knowledge-Based Systems, 55, 192–203.

Adeli, H., Zhou, Z., & Dadmehr, N. (2003). Analysis of EEG records in an epileptic patient using wavelet transform. Journal of Neuroscience Methods, 123(1), 69–87.

Anyanwu, C., & Motamedi, G. (2018). Diagnosis and surgical treatment of drug-resistant epilepsy.

Brain Sciences, 8(3), 42.

Bakhtiar, L., & Gruner, O. C. (1999). The canon of medicine. Kazi Publications.

Beghi, E., & Hesdorffer, D. (2014). Prevalence of epilepsy—an unknown quantity. Epilepsia, 55(7), 963-967.

Bellot-Saez A, Kékesi O, Morley JW, Buskila Y. Astrocytic modulation of neuronal excitability through K + spatial buffering. Neuroscience & Biobehavioral Reviews. 2017;77:87-97. doi:https://doi.org/10.1016 /j.neubiorev.2017.03.002

Bendsten, P., et al. (2022). NeuroView subcutaneous EEG system. Epilepsy Research, 183, 106932. https://doi.org/10.1016/j.eplepsyres.2022.106932

Bernasconi, A., et al. (2021). Advances in MRI for epilepsy. NeuroImage: Clinical, 32, 102832. https://doi.org/10.1016/j.nicl.2021.102832

Beyenburg, S. (2010). Epilepsy in children: Current management and emerging treatments. Acta Paediatrica, 99(11), 1638–1641.

Bialer, M., Johannessen, S. I., Kupferberg, H., Levy, R. H., Perucca, E., Tomson, T., White, H. S., & Rogawski, M. A. (2018). Progress report on new antiepileptic drugs: A summary of the ILAE Task Force report. Epilepsia, 59(4), 665–671.

Boon, P., et al. (2023). Real-time seizure detection with wearable EEG devices. Epilepsia, 64(5), 1123– 1135. https://doi.org/10.1111/epi.17567

Bosak M, Słowik A, Kacorzyk R, Turaj W. Implementation of the new ILAE classification of epilepsies into clinical practice - a cohort study. Epilepsy Behav 2019;96:28–32

Bourdillon, P., et al. (2023). Hybrid EEG-ECoG systems for surgical planning. Journal of Neurosurgery, 139(2), 1–10. https://doi.org/10.3171/2023.1.JNS221234

Bourdillon, P., et al. (2023). Hybrid EEG-ECoG systems for surgical planning. Journal of Neurosurgery, 139(2), 1–10. https://doi.org/10.3171/2023.1.JNS221234

Brodie, M. J., & Dichter, M. A. (1996). Antiepileptic drugs. New England Journal of Medicine, 334(3), 168–175.

Brodovskaya, A., & Kapur, J. (2019). Pharmacoresistance in epilepsy: Clinical and experimental evidence. Epilepsia, 47(Suppl 2), 1061–1077.

Cascino, G. D. (2002). Video-EEG monitoring in adults. Epilepsia, 43(Suppl 3), 3–11.

Christensen, J., et al. (2021). Gender differences in epilepsy: A population-based study. JAMA Neurology, 78(4), 456–463. https://doi.org/10.1001/jamaneurol.2020.5412

Cloyd J, Hauser W, Towne A, et al. Epidemiological and medical aspects of epilepsy in the elderly.Epilepsy Res 2006;68(Suppl 1): S39–S48

Cullen, W. (1791). First lines of the practice of physic (4th ed.). Bell & Bradfute and William Creech.

Delasiauve, L. J. F. (1854). Traité de l'épilepsie: Histoire, traitement, médecine légale. Victor Masson.

Devinsky, O., et al. (2023). Sudden unexpected death in epilepsy: Mechanisms and risk factors.Epilepsia, 64(1), 12–25. https://doi.org/10.1111/epi.17562

Duncan, J. S., et al. (2023). SPECT in epilepsy: Current applications and future directions. Epilepsia, 64(3), 1–12. https://doi.org/10.1111/epi.17588

Edelstein, L. (1967). Ancient medicine: Selected papers of Ludwig Edelstein (O. Temkin & C. Temkin, Eds.). The Johns Hopkins University Press.

Engel, J. (2020). Approach to the patient with focal epilepsy. Epileptic Disorders, 22(1), 1–14. https://doi.org/10.1684/epd.2020.1134

Engel, J., & Pedley, T. A. (2008). Epilepsy: A Comprehensive Textbook (2nd ed.). Lippincott Williams & Wilkins.

Epi25 Collaborative. (2023). Whole-exome sequencing in 25,000 epilepsy patients. Nature Genetics, 55(3), 401–410. https://doi.org/10.1038/s41588-023-01338-6

Faigle R, Sutter R, Kaplan PW. Electroencephalography of Encephalopathy in Patients With Endocrine and Metabolic Disorders. Journal of Clinical Neurophysiology. 2013;30(5):505-516. doi:https://doi.org/10.1097/wnp.0b 013e3182a 73db9

Faust, O., et al. (2013). Wavelet-based EEG processing for epilepsy detection. Computer Methods and Programs in Biomedicine, 111(1), 231–241. https://doi.org/10.1016/j.cmpb.2013.03.006

Fiest, K. M., et al. (2022). Global incidence of epilepsy: A systematic review and meta-analysis. The Lancet Neurology, 21(10), 893–905. https://doi.org/10.1016/S1474-4422(22)00259-4

Fiest, K. M., Sauro, K. M., Wiebe, S., Patten, S. B., Kwon, C. S., Dykeman, J., ... & Jetté, N. (2017). Prevalence and incidence of epilepsy: a systematic review and meta-analysis of international studies. Neurology, 88(3), 296-303.

Fisher, R. S., et al. (2005). Epileptic seizures and epilepsy: Definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia, 46(4), 470–472.

Fisher, R. S., et al. (2014). ILAE official report: A practical clinical definition of epilepsy. Epilepsia, 55(4), 475–482.

Fisher, R. S., et al. (2023). Tele-EEG clinics and socioeconomic impact in adult epilepsy. Neurology, 101(8), e789–e801. https://doi.org/10.1212/WNL.0000000000201678

French, J. A., Kanner, A. M., Bautista, J., Abou-Khalil, B., Browne, T., Harden, C. L., ... & King, D. (2004). Overview of the first 20 years of the ILAE classification of epileptic seizures and the epilepsies. Epileptic Disorders, 6(6), 313–316.

Giovannini, M. G. (2008). Cholinergic modulation of cognitive processing: Insights from behavioral studies. Behavioral Brain Research, 187(2), 115–128.

Glass, H. C., et al. (2021). Neonatal seizure detection using continuous EEG monitoring. Pediatric Neurology, 118(1), 12–20. https://doi.org/10.1016/j.pediatrneurol.2021.03.005

Goodman, R. R., & Emerson, R. G. (1995). Does brain stimulation prevent seizures? Epilepsia, 36(3), 255–262..

Gorji, A., & Khaleghi Ghadiri, M. (2001). History of epilepsy in medieval Iranian medicine.

Neuroscience & Biobehavioral Reviews, 25(5), 455–461.

Gowers, W. R. (1901). Epilepsy and other chronic convulsive diseases: Their causes, symptoms, and treatment (2nd ed.). Churchill.

Gowers, W. R. (1903). The border-land of epilepsy: Faints, vagal attacks, vertigo, migraine, sleep symptoms, and their treatment. P. Blakiston's Son & Company.

Halford, J. J.,etal. (2022).Ambulatory EEG innovations. Epilepsia, 63(4), 789–801. https://doi.org/10.1111 /epi.17189

Hauser, W. A., & Beghi, E. (2008). First seizure definitions and worldwide incidence and mortality.Epilepsia, 49, 8-12.

Herpin, T. (1867). Des accès incomplets d'épilepsie. J. B. Baillière.

Hesdorffer, D. C., et al. (2021). Psychiatric comorbidities in adult epilepsy. Epilepsy & Behavior, 124(1), 108307. https://doi.org/10.1016/j.yebeh.2021.108307

Heyne, H. O., et al. (2023). Genetic insights into pediatric epilepsy. Nature Medicine, 29(5), 1123– 1135. https://doi.org/10.1038/s41591-023-02313-6

Hippocrates. (1950). The sacred disease. In J. Chadwick & W. N. Mann (Eds.), Hippocratic writings (pp. 175–188). Blackwell. Hippocrates. (1985). The sacred disease. Gryphon Editions.

Hojjat Adeli, Z., Zhou, Z., & Dadmehr, N. (2003). Analysis of EEG records in an epileptic patient using wavelet transform. Journal of Neuroscience Methods, 123(1), 69–87.

Holmes, G. L. (2015). Cognitive impairment in epilepsy: The role of network abnormalities. Epilepsy & Behavior, 49, 129–133.

Holmes, M. D., et al. (2022). Quantitative EEG markers of cognitive decline in temporal lobe epilepsy. Clinical Neurophysiology, 141(1), 45–58. https://doi.org/10.1016/j.clinph.2022.05.012

Jacobs, J., et al. (2023). High-frequency oscillations predict surgical outcomes in epilepsy. Annals of Neurology, 93(4), 789–801. https://doi.org/10.1002/ana.26589

Jain, S., & Tandon, P. N. (2004). Ayurvedic medicine and Indian literature on epilepsy. Neurology Asia, 9, 57–58.

Kaiboriboon, K., Bakaki, P. M., Lhatoo, S. D., & Koroukian, S. (2013). Incidence and prevalence of treated epilepsy among poor health and low-income Americans. Neurology, 80(21), 1942-1949.

Kannathal, N., Choo, M. L., Acharya, U. R., & Suri, J. S. (2005). Entropies for detection of epilepsy in EEG. omputer Methods and Programs in Biomedicine, 80(3), 187–194.

Kanner, A. M. (2016). The treatment of refractory epilepsy. Current Treatment Options in Neurology, 18(9), 41.

Kanner, A. M., et al. (2023). Autoimmune epilepsy in adults. Neurology, 100(3), e230– e242. https://doi.org/10.1212/WNL.0000000000201456

Kanner, A. M., et al. (2023). Depression in epilepsy: A review. Neurology, 100(1), e1–e12. https://doi.org/10.1212/WNL.0000000000201234

Kaur, H., Kumar, B., & Medhi, B. (2016). Antiepileptic drugs in development pipeline: a recent update. Eneurologicalsci, 4, 42-51.

Kelvin, E. A., Hesdorffer, D. C., Bagiella, E., Andrews, H., Pedley, T. A., Shih, T. T., ... & Hauser, W.

A. (2007). Prevalence of self-reported epilepsy in a multiracial and multiethnic community in New York City. Epilepsy research, 77(2-3), 141-150.

Kim, J. H., et al. (2023). Ketogenic diet efficacy in pediatric drug-resistant epilepsy. Epilepsy Research, 189(1), 106745. https://doi.org/10.1016/j.eplepsyres.2022.106745

Krauss, G. L., et al. (2023). Cenobamate for focal epilepsy: A phase III trial. New England Journal of Medicine, 388(15), 1401–1412. https://doi.org/10.1056/NEJMoa2212064

Kwan, P., & Brodie, M. J. (2000). Early identification of refractory epilepsy. New England Journal of Medicine, 342(5), 314–319.

Labat, R. (1951). Traité akkadien de diagnostics et pronostics médicaux. Brill.

Lai, C. W., & Lai, Y. H. (1991). History of epilepsy in Chinese traditional medicine. Epilepsia, 32(3), 299–302.

Lee, S., et al. (2023). Dry electrode EEG systems for long-term monitoring. IEEE Transactions on Biomedical Engineering, 70(8), 2456–2464. https://doi.org/10.1109/TBME.2023.3266789

Lehnertz, K., & Litt, B. (2005). Epilepsy and seizure dynamics. Journal of Clinical Neurophysiology, 22(4), 238–254.

Lipourllis, D. (1968). The suffix in presocratic philosophy and in the Hippocratic corpus (in Greek).Aristotle University.

Liu S, Yu W, Lü Y. The causes of new-onset epilepsy and seizures in the elderly. Neuropsychiatr Dis Treat 2016;12:1425–1434

Lukasiuk, K. (2014). Epileptogenesis. In Encyclopedia of the Neurological Sciences (2nd ed.).Academic Press.

Magiorkinis, E., Diamantis, A., Sidiropoulou, K., & Panteliadis, C. (2014). Highights in the history of epilepsy: the last 200 years. Epilepsy research and treatment, 2014(1), 582039.

Mayo Clinic. (2023).Epilepsy– Diagnosis and treatment. Retrieved from https://www.mayoclinic.org/diseases-conditions /epilepsy/diagnosis-treatment/drc-20350098

Meyer, A. C., et al. (2023). The burden of epilepsy in sub-Saharan Africa: A population-based study.

The Lancet Global Health, 11(4), e456–e467. https://doi.org/10.1016/S2214-109X(23)00029-3 Mormann, F., Andrzejak, R. G., Elger, C. E., & Lehnertz, K. (2007). Seizure prediction: The long and

winding road. Brain, 130(2), 314–333.

Nair, D. R., et al. (2023). Closed-loop neuromodulation with the RNS System. JAMA Neurology, 80(4), 345–354. https://doi.org/10.1001/jamaneurol.2022.5023

Ngugi, A. K., et al. (2022). Childhood epilepsy in low-resource settings: Incidence and risk factors. Epilepsia, 63(Suppl 1), S15–S25. https://doi.org/10.1111/epi.17301

Niedermeyer, E., & Lopes da Silva, F. (Eds.). (2004). Electroencephalography: Basic Principles, Clinical Applications, and Related Fields (5th ed.). Lippincott Williams & Wilkins.

Noachtar, S., & Rémi, J. (2008). The role of EEG in epilepsy diagnosis. In J. Engel & T. A. Pedley (Eds.), Epilepsy: A comprehensive textbook (2nd ed., pp. 809–825). Lippincott Williams & Wilkins.

Noachtar, S., & Rémi, J. (2009). The role of EEG in epilepsy: A critical review. Epilepsy & Behavior, 15(1), 22–33.

Nygaard, A., & Gonen, O. (2010). Advances in surgical treatment for epilepsy. Current Opinion in Neurology, 23(2), 186–192.

Orosco, L. L., Garces Correa, M. A., & Laciar Leber, E. (2013). A survey of performance and techniques for automatic epilepsy detection.

Panayiotopoulos, C. P. (2008). Typical absence seizures: A review. Epilepsia, 49(Suppl 8), 56–62. Patterson, A. L., et al. (2023). Wearable EEG devices for pediatric home monitoring. Epilepsy &Behavior, 142(1), 108891. https://doi.org/10.1016/j.yebeh.2023.108891

Penfield, W., & Jasper, H. (1954). Epilepsy and the Functional Anatomy of the Human Brain. Little, Brown & Company.

Perucca, E. (2006). Pharmacoresistance in epilepsy: Clinical and experimental evidence. Epilepsia, 47(Suppl 2), 1061–1077.

Perucca, E., & Tomson, T. (2011). The pharmacological treatment of epilepsy in adults. The Lancet Neurology, 10(5), 446–456.

Perucca, P., et al. (2020). Risk factors for epilepsy. Epileptic Disorders, 22(1), 1–10. https://doi.org/10.1684/epd.2020.1131

Pittau, F., et al. (2021). EEG-fMRI in epilepsy: Mapping interictal networks. Human Brain Mapping, 42(10), 3158–3172. https://doi.org/10.1002/hbm.25425

Rajakulendran S, Hanna MG. The Role of Calcium Channels in Epilepsy. Cold Spring Harbor Perspectives in Medicine. 2016;6(1):a022723. doi:https://doi.org/10.1101/cshperspect.a022723

Rowland, K., & Lambert, C. E. (2022). Evaluation after a first seizure in adults. American Family Physician, 105(5), 631–638.

Salamon, N., et al. (2022). PET-MRI fusion in epilepsy surgery planning. Epilepsy Research, 180, 106861. https://doi.org/10.1016/j.eplepsyres.2022.106861

Scheffer, I. E., Berkovic, S., Capovilla, G., Connolly, M. B., French, J., Guilhoto, L., Hirsch, E., Jain, S., Mathern, G., Moshé, S. L., Perucca, E., Scheffer, R. J., & Zuberi, S. M. (2017). ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia, 58(4), 512–521.

Schirrmeister, R. T., Gemein, L., Eggensperger, K., Hutter, F., & Ball, T. (2017). Deep learning with convolutional neural networks for EEG decoding and visualization. In 2017 IEEE Signal Processing in Medicine and Biology Symposium (SPMB) (pp. 1–5). IEEE.

Schomer, D. L., & Lopes da Silva, F. H. (2011). Niedermeyer’s Electroencephalography: Basic Principles, Clinical Applications, and Related Fields (6th ed.). Lippincott Williams & Wilkins.

Shellhaas, R. A., et al. (2020). Neonatal seizure classification. Pediatric Neurology, 112(1), 28–

35. https://doi.org/10.1016/j.pediatrneurol.2020.07.011

Shoeb, A. (2009). Application of machine learning to epileptic seizure detection. Epilepsy & Behavior, 15(3), 278–287. https://doi.org/10.1016/j.yebeh.2009.03.029

Siani, S., & Chambers, J. A. (2007). EEG Signal Processing. John Wiley & Sons.

Sinha, N., & Calderon, L. (2021). Advances in neurostimulation for drug-resistant epilepsy: A systematic review. Epilepsy Research, 171, 106515.

Specchio, N., et al. (2022). Fenfluramine in Dravet syndrome. Epilepsia, 63(7), 1621– 1632. https://doi.org/10.1111/epi.17278

Stafstrom CE, Carmant L. Seizures and Epilepsy: An Overview for Neuroscientists. Cold Spring Harbor Perspectives in Medicine. 2015;5(6):a022426-a022426. doi:https://doi.org/10.1101/cshperspect.a022426

Subasi, A., & Gursoy, M. I. (2010). EEG signal classification using PCA, ICA, LDA and support vector machine. Neural Computing and Applications, 19(7), 937–942.

Suruchi Sharma and Vaishali Dixit, “Epilepsy-A Comprehensive Review”, International Journal of Pharma Research & Review, Dec 2013.

Takahashi, Y., et al. (2023). High-density EEG in pediatric cortical dysplasia. Clinical Neurophysiology, 149(1), 1–12. https://doi.org/10.1016/j.clinph.2023.02.175

Tanaka A, Akamatsu N, Shouzaki T, et al. Clinical characteristics and treatment responses in new- onset epilepsy in the elderly. Seizure 2013;22(09):772–775

Thijs, R. D., et al. (2023). Epilepsy in the elderly. The Lancet Neurology, 22(5), 455–

467. https://doi.org/10.1016/S1474-4422(23)00029-7

Thodoroff, P., et al. (2022). Deep learning for seizure detection. IEEE Transactions on Biomedical Engineering, 69(7), 2301–2312. https://doi.org/10.1109/TBME.2021.3134567

Tissot, D. M. (1770). Traité de l'épilepsie: Faisant le tome troisième du traité des nerfs et de leurs maladies (P. F. Didot, Ed.). Didot le jeune.

Trinka, E., & Kälviäinen, R. (2022). Frontal lobe seizures: EEG patterns and management. Epileptic Disorders, 24(2), 1–15. https://doi.org/10.1684/epd.2022.1432

Truong, N. D., et al. (2023). Transformers in EEG analysis. Journal of Neural Engineering, 20(2), 021001. https://doi.org/10.1088/1741-2552/acb234

Tzallas, A. T., Tsipouras, M. G., & Fotiadis, D. I. (2009). Epileptic seizure detection in EEGs using time–frequency analysis. IEEE Transactions on Information Technology in Biomedicine, 13(5), 703–710.

van Diessen, E., et al. (2023). Network analysis of epileptic brain connectivity. Brain, 146(5), 1–15. https://doi.org/10.1093/brain/awad001

Wilmshurst, J. M., et al. (2023). ACTH and vigabatrin for infantile spasms. Neurology, 100(10), e1023–e1032. https://doi.org/10.1212/WNL.0000000000201679

Wilson, J. A. (1962). Medicine in ancient Egypt. Bulletin of the History of Medicine, 36(2), 114– 128.

Wilson, J. V., & Reynolds, E. H. (1990). Translation and analysis of a cuneiform text forming part of a Babylonian treatise on epilepsy. Medical History, 34(2), 185–198.

Wilson, S. B., et al. (2023). Real-time qEEG platforms for clinical use. Clinical Neurophysiology, 149, 1–10. https://doi.org/10.1016/j.clinph.2023.02.174

Winston, G. P., et al. (2020). DTI in temporal lobe epilepsy. Epilepsia, 61(1), 22–34. https://doi.org/10.1111/epi.16403

Wirrell, E. C., et al. (2022). Pediatric epilepsy syndromes. Epilepsia, 63(Suppl 3), S15– S30. https://doi.org/10.1111/epi.17301

World Health Organization. (2022). Epilepsy fact sheet. Retrieved from https://www.who.int/news- room/fact-sheets/detail/epilepsy

World Health Organization. (2023). Epilepsy: Key facts. https://www.who.int/news-room/fact- sheets/detail/epilepsy

Wyllie, E., & Kwok, C. (2005). Pharmacological management of epilepsy in adults. British Journal of Hospital Medicine, 66(7), 390–394.

Zuberi, S. M., et al. (2022). Genetic testing in epilepsy. Epileptic Disorders, 24(1), 1–15. https://doi.org/10.1684/epd.2021.1371

Downloads

Published

2025-05-16