Abstract
Epilepsy is a chronic neurological disease with recurrent seizures. Its incidence, the social and psychological aspects of epilepsy-associated stigmatization in society, the medical risk of severe seizures, and the challenges in treatment confirm its medical and social significance. The pathogenesis of the diseases is associated with abnormal activity of a population of neurons due to various mechanisms, the most frequent being oxidative stress, glutamate excitotoxicity, and mitochondrial dysfunction. In the last 3-4 decades, the possible connection between epilepsy and melatonin - a neurohormone secreted by the pineal gland - has been sought and studied. Various physiological functions of melatonin in humans have been proven - regulation of circadian rhythms (diurnal, seasonal), sleep and wakefulness, participation in the processes of thermoregulation, tumour growth and aging, sexual activity and reproductive functions. It also has immunomodulatory, cytoprotective and antioxidant activity. The results from the studies with experimental models with animals conducted so far in search of a correlation between melatonin and epileptogenesis are mainly in support of the hypothesis of its anticonvulsant effect. The studies with humans are diverse in design, with a smaller number of participants, and the results are not always in explicit support of this hypothesis. The correlation between melatonin concentration and the course of the disease in patients with epilepsy has been discussed. The possibility of adding melatonin to anti-epileptic therapy has also been studied recently.
Highlights
Epilepsy – definition, epidemiology, pathogenesisMelatonin is a neurohormone synthesized and secreted by the pineal gland
It has an important role in the regulation of circadian rhythms, as well as proven neuroprotective, antioxidant, and anticytotoxic effects on the central nervous system (CNS)
In 2014, the ILAE recommended an expanded definition, according to which epilepsy is a brain disease that occurs under any of the following conditions: 1) at least 2 unprovoked seizures observed over a period of more than 24 hours; 2) one unprovoked seizure and the presence of factors that determine a higher probability of subsequent seizures, similar to that after 2 unprovoked seizures; 3) diagnosis of an epileptic syndrome (Roland’s epilepsy with low risk of recurrent seizures, Landau-Kleffner syndrome, epileptic encephalopathy with prolonged spike-slow wave complexes during sleep)
Summary
Melatonin is a neurohormone synthesized and secreted by the pineal gland It has an important role in the regulation of circadian rhythms, as well as proven neuroprotective, antioxidant, and anticytotoxic effects on the central nervous system (CNS). In Bulgaria, epileptic patients are about 50 000.1-3 According to the 2006 definition of the International League against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE), epilepsy is a brain disease characterized by a persistent predisposition to generate epileptic seizures and the neurobiologic, cognitive, psychological, and social consequences of seizure recurrences. The formation of free radicals in combination with low antioxidant enzyme activity in the CNS has been shown to cause some types of epilepsy and to increase the risk of recurrence of epileptic seizures. Glutamate excitotoxicity, and mitochondrial dysfunction have been shown to be the main mechanisms associated with abnormal neural activity.[3,4,5,6]
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