Epilepsia é causa de invalidez/incapacitação para o trabalho? #epilepsia

The brain can be represented as a set of electrical circuits, forming intricate and complex networks. Our functions—such as movement, speech, and thought—result from the precise firing of one unit to another. Here, a minimal error can have major consequences. If the brain is a circuit, then an epileptic seizure can be imagined as a "transient short circuit." In fact, we can all suffer a seizure if our brain is placed in abnormal situations, such as an extreme drop in glucose, alteration of body salts, infection, fever, sleep deprivation, drugs, etc. Epilepsy, on the other hand, designates a brain with the intrinsic tendency to spontaneously undergo abnormal and simultaneous depolarization of millions of neurons (the "short circuit"), leading to involuntary manifestations, such as loss of consciousness, muscle spasms, behavioral changes, purposeless movements, and unusual perceptions (seeing everything larger, everything smaller, having the sensation that the present scene has already happened, etc.). Epilepsy is a broad phenomenon with quite diverse causes and clinical evolutions, and can be the consequence of brain injury from stroke, trauma, tumor, infection, but also from malformations and congenital diseases. Most of the time, however, epilepsy has an unknown cause and is believed to originate from the combination of several genes that result in a brain with an imbalance between excitability and inhibition. Genetic cause does not necessarily mean hereditary, as it can result from de novo mutations, that is, mutations that were previously unknown in the ancestors of the affected person. The treatment of epilepsy begins with an accurate diagnosis. From this, the underlying cause is defined, which will determine the course of action, for example, the removal of a tumor, the treatment of an infection, etc. In most cases, however, the cause remains unknown (cryptogenic epilepsy) and treatment consists of the use of anticonvulsants. About 2/3 of patients have their seizures controlled when using one or two medications. However, 1/3 show refractoriness, and these are the situations in which surgical intervention may be indicated. Epilepsy is more common in low-income countries, affecting about 2% of the population in our country. If we had better assistance for women during pregnancy and childbirth (reducing the number of children with brain injury), fewer car accidents (preventing head trauma), and better hygiene conditions (reducing cases of neurocysticercosis), this number would be much lower. Because it encompasses such diverse situations, epilepsy also has varied treatments and clinical outcomes. Despite this, in general, it can be said that most people treated with anticonvulsant medication become seizure-free. However, about 1/3 of them do not improve and would require more complex interventions, such as neurosurgery or brain stimulation, performed only in a few centers in Brazil. The most common cause of refractory seizures in adults is mesial temporal lobe epilepsy, which is most often due to an anatomical lesion (with neuronal death and gliosis) called hippocampal sclerosis. Removal of the affected area (epileptogenic area) has excellent results in terms of seizure control or remission, but it can result in memory or language impairment and therefore requires careful pre-surgical evaluation. In addition, precisely because the brain is composed of circuits, the epileptogenic area can change the firing patterns of other regions, which also become seizure foci. The biggest problem with epilepsy is ignorance, which, fueling prejudice and stigma, delays or even prevents the search for professional help. The second problem is the scarcity of specialized medical professionals and services. It is now known that it is not enough to simply make the patient seizure-free. It is necessary to consider other disorders that frequently accompany them, such as depression, anxiety, cognitive problems (impairment of memory, language, concentration), insomnia, sleep apnea, daytime sleepiness, side effects of medications, vitamin D deficiency, etc. People with epilepsy suffer for several reasons. Living under the constant risk of a seizure that would cause embarrassment, in addition to potential accidents, being under the side effects of medications and having professional and social limitations (not being able to work at heights, with machines, driving vehicles, etc.) is quite difficult, but being seen as crazy, or possessed, is even worse.