Sex steroid hormone axis abnormalities occur more commonly in people with epilepsy. The relationships between the hypothalamic mass and the different types of seizures remain unknown. As the SNR plays a major role in the modulation of seizures, the seizures may be treated with high-frequency stimulation of SNR. Seizures may lead to progressive microanatomical changes in putamen of both hemispheres. Interestingly, epilepsy has been reported to have inverse relationship with Parkinson's disease as incidence of seizures is less in patients with Parkinson's disease. Sufficiently, sustained seizures cause damage of substantia nigra pars reticulate (SNR) and globus pallidus. Dopamine is reported to involve in the control of seizures related to the type of epilepsy. Although no specific epileptic electroencephalography changes were observed in basal ganglia, involvement of basal ganglia in distribution of epileptic activity was reported. Earlier studies hypothesized that basal ganglia functions as a part of a modulatory control system over seizures rather than a propagation pathway. The role of basal ganglia in cognitive functions is well established. Atrophied hippocampus is reported to be responsible for seizures, and surgical removal of hippocampus is reported to improve the condition. Apart from neuronal loss and gliosis, granule cell dispersion in dentate gyrus is also observed in epilepsy.
In other types of epilepsy, neuronal loss can be observed in all hippocampal areas. Histological changes include selective and extensive hippocampal neuronal loss in CA1 and CA3 regions and around the end folium where the cells of CA2 region are spared. Structural (histological) and functional changes occur in hippocampus in epilepsy. It was reported that recurrent seizures might cause hippocampus damage throughout the lifetime of the patient. Hippocampus and associated areas were reported to be affected critically in epilepsy, especially temporal lobe epilepsy, which is more common in adults. Hippocampus plays a crucial role in cognition and it is involved in minute-to-minute cognitive processing. Hence, we aimed to review the microanatomical changes in the brain structures related to cognition in epilepsy. Understanding the microanatomical changes in brain structures may lead to innovative therapeutic approaches to prevent/delay the cognitive impairment in epilepsy. Further, the extent of brain damage also depends on number, duration, and severity of seizures. However, seizures in children have reported to cause long-term adverse effects. Underlying cause of cognition impairment may be lesion in particular brain area consequence to seizures or epileptic dysfunction, with age-associated increase in the vulnerability. Learning disabilities, poor academic outcome, behavioral problems, and language stagnation or deterioration are additional features observed in children. Impairment of cognition is a common condition in epilepsy, and the features include mental slowness and memory and attention deficits in adults. In India, over 10 million patients suffer from epilepsy, which equates to a prevalence rate of 1%. The causes and treatment protocols vary widely. Global prevalence of epilepsy is approximately 0.5% affecting predominantly early childhood and late adulthood resulting in psychological and social consequences. Epilepsy can be classified into three major types: grand mal epilepsy, petit mal epilepsy, and focal epilepsy. Although epilepsy is not a specific disease, it is considered as a group of syndromes as a result of chronic neurological disorders. Epilepsy (also called “Seizures”) is characterized by uncontrolled excessive activity of either part or all of the central nervous system.
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