Article by Marco Mula

Epilepsy is one of the most frequent neurological disorders affecting around 50 million people worldwide. Over the last 30 years, the diagnosis and treatment of epilepsy has tremendously improved with new diagnostic tests, a large number of drug treatments, the development of epilepsy surgery and neurostimulation techniques. However, the incredible technical advances have also shifted the focus of clinicians and healthcare professionals out of the complex needs of people with epilepsy.

Comorbidity is defined by any distinct additional clinical condition that co-occurs with a primary disorder. Epidemiological studies are now showing that up to 50% of people with epilepsy have at least one additional medical condition, and up to 30% more than one. During the last 10 years, a number of studies have focused on the issue of comorbidities of epilepsy, showing that some disorders are indeed more frequently encountered in epilepsy as compared to the general population. Theories of comorbidity are complex and include causative mechanisms, shared risk factors, bidirectional effects and resultant mechanisms due to the long term effects of treatments. Regardless of the specific mechanisms, managing seizures and comorbidities can be challenging and the burden of comorbidities in people with epilepsy is high. Comorbidities affect the quality of life of patients and their families and even in patients completely seizure free, if comorbidities are not addressed or seizure freedom is achieved at the expense of unacceptable long-term complications, adherence to treatment and quality of life remain poor.

The new definition of epilepsy and the new classification of epilepsy syndromes issued by the International League Against Epilepsy have tried to emphasise the importance of a holistic approach to people with epilepsy explicitly recognizing the presence and impact of comorbidities. However, comorbidities and still poorly understood by clinicians and healthcare professionals and they often remain unaddressed.

The Comorbidities of Epilepsy is not meant to be a complete textbook of all possible comorbidities in epilepsy, but rather, a practical as well as a comprehensive collection of clinically relevant topics from international experts who will share some of the latest discoveries and their approaches. The book covers somatic, neurological and psychiatric conditions occurring in people with epilepsy, each which is discussed in a specific chapter, like for example Epilepsy and Bone health, Epilepsy and Sexual Dysfunction, Epilepsy and Diabetes, Epilepsy and Heart diseases, Epilepsy and Obesity, Epilepsy and Headache, Epilepsy and Sleep Disorders, Epilepsy and other neurological disorders, Epilepsy and Autistic Spectrum Disorder, Epilepsy and Depression.

The common denominator of all these chapters is that neurologists and health care professionals looking after people with epilepsy should increasingly recognise the need for specialists from different disciplines to work together in order to improve the life of patients.

With this book, I do hope to have successfully communicated to you the importance of a holistic approach to epilepsy care. Epilepsy is a chronic condition and a large majority of our patients can live an absolutely normal and healthy life if we take all these factors into account.

Marco Mula, MD, Ph.D. is Consultant in Neurology and Epileptology at the Atkinson Morley Regional Neuroscience Centre, St. George’s University Hospitals NHS Foundation Trust in London and Reader in Neurology at St. George’s University of London. He is a Fellow of the Royal College of Physicians and the European Academy of Neurology. He is Associate Editor of Epilepsy & Behavior and a member of the Editorial Board of Epilepsia Open, British Journal of Psychiatry, Journal of Epileptology and Frontiers in Neurology. He has been Chair of the Commission on Neuropsychiatry of the International League Against Epilepsy (ILAE), member of the Scientific Committee and Executive Committee of the International Neuropsychiatric Association and he is now Chair of the ILAE Task Force on Identification Treatment and Prevention of the Commission on Psychiatry and member of the ILAE Task Force on Paediatric Psychiatric Issues. He has authored almost 200 publications in the field of epilepsy treatment and the management of comorbidities of epilepsy with special reference to behavioural problems.